(Photo: SEIU 1199)

Long-term care providers took their campaign against $1 billion in proposed Medicaid cuts to new heights Friday, teaming with sympathetic community groups, lawmakers and even unions to protest at seven New York locations.

Thousands of workers took part, many transported to afternoon rally sites right after their shifts ended.

“What’s unprecedented about it is we’re in alignment with the employers, like nursing homes, the community organizations and other healthcare unions,” Todd Hobler, executive vice president for 1199/SEIU Western/Upstate New York, told McKnight’s. “That is something we haven’t seen at this level in a long time.”

Rallies and media events were held in New York City and most of the state’s major population centers. 

The multi-site action comes after providers and others held walkouts and kettle-banging demonstrations in April 2023, resulting in slight pay increases. But this time the stakes are higher since Gov. Kathy Hochul’s (D) proposal would drain a fund that currently pays only about 70% of care costs, opponents noted. 

“All sides appreciate that nursing homes in New York state are generally under-resourced,” Hobler said. “That creates problems in terms of being able to have a competitive wage and benefits. It hurts staffing and filling vacancies so we have a common interest in addressing those problems.”

Providers and their union counterparts last fall “uniquely” created a singular funding proposal so that lawmakers couldn’t be confused by competing efforts, Hobler explained. 

“Most of our nursing homes and hospitals are losing money [on daily Medicaid pay rates] and that’s got to stop,” he said.

Everyone vs. the state

State lawmakers actually have answered the call, he pointed out. Legislation has been introduced to reverse the Medicaid cuts and increase Medicaid rates, and also initiate a system that rebases rates starting in 2026.

But those lawmakers are also butting heads with an executive branch that likes to play hardball, said Chris Koenig, the top executive of three nonprofit long-term care organizations in western New York.

“They’ve done a few things that if you were a provider doing this, or say you were in general business doing this, you’d probably be in trouble legally,” he said of state overseers.

“It’s that dire of a situation, really,” added Koenig, the president of Lineage Care Group, and CEO of both Schofield Care and of Niagara Lutheran Health System. Together, his communities employ more than 1,000 workers and service more than 10,000 residents and patients per year. “If we don’t get these financials figured out, and get the state to pay where we need to be to maintain our viability, the unions are going to be non-existent anyway. It’s really that bad.”

He pointed out that the uniqueness of the situation extends beyond employer-union cooperation. Competing for-profit and nonprofit operators who vye for the same census are spending “15 to 20 hours a week together” while trying to come up with a fix to counter any Medicaid cuts the governor threatenes, he said

“New York is pretty unique,” Koenig said. “I talk to providers in other states in various collaborations we’re a part of, or advocacy groups. LeadingAge, AHCA, take your pick. Ever since COVID, we’ll share war stories and what happened in the industry and what the state’s done. I’ve heard other states have increased Medicaid rates to make sure staff is paid for, to pay for PPE, that kind of thing. And then when we say New York, there’s none of that. And then, hey, by the way, they cut our rates “

Governor playing hardball

The budget is supposed to be approved by April 1, which is just a week away. But last year, talks stretched closer to June, which is what Koenig expects again for political reasons. Lawmakers do not get paid if they don’t meet the April 1 deadline, he pointed out, which leaves them susceptible to coercion.

“I’m assuming it’s not going to get settled and then they’re going to use the Assembly and the Senate’s pay as a bargaining tool, which is really unfortunate,” he predicted. “They (the governor and lawmakers) are not on the same page. She’ll use it against them.”

Koenig said he has talked to politicians who have said, “When it gets to June and I have to pay my mortgage, I’m in it for the long game, but … It does change it when [the governor] literally holds their purse strings, too. Then there’s no way to be impartial.”

While Koenig thinks a modified deal will get done, he is assuming providers will not get all that they’re asking for, or that the system needs to appropriately deliver quality care.

“[Hochul is posturing [about the threatened Medicaid cuts]. She knows she’s in for a fight, so she’s starting at the lowest point she can. She knows she’s going to have to come up, but she’s going to make it really hard for us and the other politicians to get where we need to go. I don’t have faith we’ll get where we need to this year, which is why we need a multi-year approach.”