Health Care

Community-based care that helps low-income New Yorkers can’t disappear

Like many New Yorkers, “Emma” immigrated to the United States to seek a better life. As someone living with HIV, one of the first things she needed was health care, but she didn’t know where to start. Thankfully she founded Alliance for Positive Change, a nonprofit that offers community-based care management as part of New York State’s “Health Home” program.

The Health Home model of care management helps New Yorkers with low incomes and complex health conditions develop an individualized and comprehensive plan of care, navigate health systems, and address social determinants of health. With her Health Home care manager as her advocate and partner, Emma was able to secure quality medical care, attain food benefits, navigate the immigration system, complete job training, pursue a nursing degree, and secure a job at a major hospital.

Emma’s incredible journey to health and self-sufficiency was possible because of her determination and the support she received from Alliance’s Health Home care management program. Unfortunately, funding for this impactful model— which provides support for over 180,000 New Yorkers like Emma — is at the risk of being slashed in half if a misleading proposal in the Governor’s executive budget moves forward.

Gov. Kathy Hochul’s executive budget contains a harmful administrative proposal to “Recalibrate the Health Home Program to Improve Care Management for Vulnerable Populations.” In reality, this proposal will do the opposite of what its name implies, resulting in a Health Home program cut of $30 million in 2023 and $70 million in 2024, and disenrollment of 70,000 New Yorkers with significant chronic health conditions including HIV, mental health concerns , and active substance use disorders. This change would create disruption in their continuity of care and cause an increase in emergency department utilization and in-patient stays.

The proposal disregards the social determinant care needs of these New Yorkers by arbitrarily “stepping down” or disenrolling participants after just nine months in the program. As director of care management at Alliance, I know that nine months is simply not enough time to achieve significant, lasting progress. It took Emma six years to get to where she is today, and that is not unique. Care managers need time to develop trust with participants and to address complex and interconnected social determinants of health, such as housing and food insecurity.

Outcomes for Health Home participants speak for themselves: participants had a 54% increase in outpatient services, including primary care visits; 61% of participants experiencing depression reported feeling significantly less depressed; and 43% of members experiencing homelessness secured housing. The program also improves outcomes and saves costs across the entire healthcare system — in 2021, Health Home members have a 38% reduction in in-patient hospitalizations, resulting in a cost savings of $8.8 million.

This valuable Health Home care management infrastructure is being blown up to make room for more fragmented interventions that will further silo the healthcare system and waste valuable healthcare and taxpayer dollars. Investment of future funding should be made to enhance the Health Home model that is currently in place, instead of trying to replace it with fragmented models without proven outcomes.

Moving forward with the proposal will cause chaos for patients who already have the fewest resources and who are dealing with complex health challenges. We hope the governor will stand by his commitment to fortify New York’s health care system and improve the continuum of care by investing in the Health Home model, not destroying it. Thousands of lives are at stake.

Arnaldo Jara is director of outposting care management at Alliance for Positive Change, based in New York.

This article originally appeared on Rockland/Westchester Journal News: My home health care cannot disappear