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New York’s Seniors and Disadvantaged Adults Need Urgent Help

Social Adult Day Cares are serving disadvantaged and older adults around-the-clock during today’s global health crisis. Why aren’t insurance companies paying up?

Since the coronavirus pandemic swept the country and the world earlier this year, social adult day cares have been providing telecare—including daily programs, socialization, meals and community—for thousands of seniors and disadvantaged adults every day, a lifeline for New York’s most vulnerable.

Social adult day cares in New York City have worked overtime to ensure participants have essentials like food and medicine, but also the mental health and daily wellness telecare check-ins that are so important for senior well-being.

But Managed Long-Term Care Plans—insurance providers also known as MLTCPs—are refusing to properly reimburse the centers taking care of our seniors.

Members of the Coalition of New York City Social Adult Day Cares—representing 56 centers servicing over 10,700 members—have reported an average of 25 to 50 percent reimbursement at their centers, the lowest being 20 percent.  In round numbers, this equals approximately $20-$50 per day, instead of the contractually agreed-upon $100 per day, per participant. One major insurance company is paying just $10 per hour, for a maximum of three hours per week.  Centers cannot survive on these reduced amounts, or provide the service, meals and staff needed to sustain adequate care.

Insurance companies are putting an unnecessary burden on social adult day care centers with additional paperwork as well. One member of the Coalition, who asked her name be withheld, works with nineteen MLTCPs. With one MLTCP, she had to send a report back seven times before it was accepted due to changes in the reimbursement process. From another insurance company, she requested authorization forms—which are needed to sign up a new participant—and waited over four weeks for one authorization. But the wrong form was sent: an “in-center” form rather than a telecare authorization, delaying the process further. Additionally, MLTCPs expect the same four to six hours of service per participant per day, in order to gain reimbursement, even though they are reimbursing a small fraction of the agreed-upon rate.  Now this Coalition member, and other centers like her, are running out of time and funds to sustain their programs, all the while continuing to serve the needy adults and seniors that comprise our city’s most endangered population.

Most social adult day care center owners got into this business because we want to help the community and create safe, life-enriching spaces for seniors to thrive and make the most of what is often a challenging situation. Without proper reimbursements from MLTCPs, these centers are not sustainable.  The Coalition wants to reopen social adult day cares in New York City when it’s safe. But until then, center owners need to be paid the contractually agreed-upon amounts for providing telecare. Without telecare, participants are at grave risk of illness, isolation and even death.

The Coalition of New York City Social Adult Day Cares looks forward to reopening centers. The Rockland County Office for the Aging reopened social adult day care centers, and has ensured that MLTCPs are paying their centers properly. The state of Maryland has led the way, with insurance companies paying social adult day care centers the same amount both before and during the ongoing coronavirus crisis. New Jersey is paying the full rate as well for telecare—doing what New York’s centers are doing, including meal delivery and daily wellness check-ins. Ohio has reopened their adult day care centers. A lot of states are leading the way and protecting the centers that protect the seniors. Participants’ health is our number-one priority, and centers should reopen when it’s safe. Until then, reimbursement needs to be fair for providing these essential services—so we can give New York’s neediest the care they deserve.

Bureaucracy has long been a convenient way to cover up illegal business practices and greed. Whether insurance companies are refusing to reimburse social adult day care in order to maximize profits, or if it’s simply incompetence, this behavior is not acceptable and it’s directly hurting disadvantaged adults and seniors. New York State needs to ensure that centers get the funds needed to continue care, and that the greed of insurance companies don’t pocket the money Medicaid has set aside for these participants’ care. Let’s not let New York’s most unprotected population suffer with more uncertainty, and ensure they get the continued care they deserve.