NYC’s adult day cares say irregular reimbursements complicate services

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The Coalition of New York State Social Adult Day Cares is fighting for the help that members need in order to continue providing services to the attendees relying on them. Photos courtesy of Coalition of New York City Social Adult Day Cares

The Coalition of New York State Social Adult Day Cares is fighting for the help that members need in order to continue providing services to the attendees relying on them. Photos courtesy of Coalition of New York City Social Adult Day Cares

By Rachel Vick

For professional caregivers at Heritage Social Adult Day Care in Rockaway Beach, the COVID pandemic has only heightened a sense of responsibility.

Throughout the crisis, they continued checking in on their clients with disabilities who are at a high risk for infection and isolation through teleservices, virtual programming and meal deliveries, said Heritage owner Oleg Yavorovskiy.

“We’ve lost members who have passed away because they've gotten so socially isolated, so sick and are just having a lot of anxiety and depression during this time,” Yavorovskiy said. “They've been cooped up in their homes and most of them are afraid to come out, because they’re afraid that they’ll get sick and die.”

Despite the work, Heritage has often gone months without being reimbursed by insurance companies, Yavorovskiy said. He and dozens of other adult day care organizations in New York City are dealing with the same issue, complicating their ability to pay rent and retain staff.

More than 50 organizations have joined the newly-formed Coalition of New York State Social Adult Day Cares to demand reimbursements from Medicaid and other insurance providers. 

Since Heritage and others shifted to primarily remote services, most insurance companies have either cut the rates for day care or have completely failed to reimburse the providers, Yavorovskiy said. The insurers are withholding pay in spite of regulations from the state Department of Health, he said.

“If we don’t get reimbursed for them, we can’t sustain our business,” Yavorovskiy said. “Most [centers] haven’t been paying rent since March because we can’t afford it. Everything is falling on deaf ears and the ones that are suffering are our members.”

Centers like Heritage offer comprehensive services for individuals 21 and older with special needs ranging from traumatic brain injuries to mental illness and physical limitations. 

Heritage has spent the past eight years enabling their clients to maintain their independence by providing support with daily tasks like paying bills. 

The remote services should still be covered by Medicaid and private insurers under state rules related to the pandemic, the coalition says.  

Department of Health spokesperson Jonah Bruno said that’s accurate.

New York COVID restrictions allow adult day care facilities the “flexibility to provide services through telehealth or by telephone and requires Medicaid managed care plans to reimburse for the services rendered through these new modalities,” Bruno said

“While DOH does not dictate reimbursement rates between health plans and providers, it will continue to work to ensure that consumers who benefit from these services are able to access them,” Bruno said.

But irregular and partial payments make it harder for Heritage and roughly 300 other social adult day cares in New York City to continue providing the services. Yavorovskiy said.

Coalition members acknowledge that reimbursement is a complex issue, but they feel abandoned by agencies like the Department of Health, which administers Medicaid and can pressure private insurers, Yavorovskiy said.

“We reached out and they said, ‘We don’t get involved,’” Yavorovskiy said of the state. “But those [insurance plans] are governed by the Department of Health and they continue to get a fixed rate, so the money they’re not paying us stays with the plans right now because they’re getting the same dollar.”