New York’s Promise to Its Seniors
New York has made a solemn commitment to its older adults. The state pledged that seniors can age with dignity — in their homes, in their communities, surrounded by the people and places they love. Today, however, that promise stands at risk. As lawmakers finalize this year’s State budget, the very program meant to uphold that promise is failing the people who need it most.
The stakes are high. Tens of thousands of older New Yorkers depend on home-based care services to live safely and stay connected to their communities. They are not asking for luxury. They are asking for basic support — the kind that keeps them out of hospitals and nursing facilities and allows them to remain where they belong.
What Is Managed Long-Term Care?
Understanding the MLTC Program
Managed Long-Term Care, or MLTC, is the Medicaid program that allows low-income seniors and people living with disabilities to receive care at home. It targets those managing multiple chronic conditions, recovering from serious illness, or navigating life with a disability. Moreover, it provides a critical alternative to institutional care.
MLTC gives older adults the support they need where they want it most — at home. Without it, many would face unnecessary hospitalization or placement in nursing facilities. Consequently, the program is not just a healthcare benefit. It is the foundation of New York’s aging-in-place strategy.
A Broken Funding System
Rewarding the Wrong Plans
Despite the program’s vital purpose, its current funding model is deeply flawed. Right now, MLTC funding rewards plans that serve the healthiest populations while penalizing those that serve the most complex cases. This creates a perverse incentive: insurers benefit most when they avoid the sickest, most vulnerable seniors.
Plans that take on high-need patients — those with multiple diagnoses or advanced disabilities — receive inadequate reimbursement. As a result, these plans face financial strain even as they do the hardest, most essential work. Furthermore, the current structure discourages plans from investing in robust care for the people who need it most.
Why This Approach Must Change
This funding imbalance directly undermines New York’s stated commitment to aging in place. A system that punishes complexity cannot deliver equity. In fact, it actively creates harm. When plans are financially discouraged from serving high-need patients, those patients fall through the cracks. They end up in more costly, less dignified settings — precisely the outcome the MLTC program was designed to prevent.
Who Bears the Cost?
Older New Yorkers Pay the Price
When the system gets it wrong, our neighbors pay the price. Seniors who need complex care face reduced access to services. Their families shoulder greater burdens. In addition, the broader healthcare system absorbs avoidable costs through emergency visits and nursing home placements that proper home care would have prevented.
As Chair of the New York State Senate Aging Committee, Senator Cordell Cleare witnesses these consequences firsthand. She sees how quickly a failed funding model translates into real suffering for real people — older adults who counted on the state to protect them.
The Role of Nonprofits in Home Care
VNS Health and the Front Lines of Care
Community-based nonprofit organizations stand on the front lines of this crisis. Groups like VNS Health deliver home care services to some of New York’s most vulnerable older adults. They absorb the complexity that the current MLTC funding model penalizes. Yet they continue to show up — because the mission demands it.
These organizations make aging in place possible. They coordinate care, support caregivers, and bridge gaps that the formal healthcare system leaves behind. Therefore, protecting nonprofits from the financial consequences of a broken funding formula is not just fair — it is essential.
What the Master Plan for Aging Demands
A Plan Requires a System That Works
Through the State’s Master Plan for Aging, New York committed to meaningful goals: helping New Yorkers age in place, strengthening the caregiving workforce, improving care coordination, and ensuring access to home-based services. These are the right commitments. However, a plan is only as strong as the system supporting it.
Right now, that system is not working. Fixing the MLTC funding formula is not optional. It is the single most consequential step New York can take to align its budget with its stated values. Furthermore, action must happen before the budget is finalized — delay only deepens the harm to seniors already being underserved.
Keeping the Promise We Made
New York cannot say it supports aging in place while allowing the care that makes it possible to erode. The state cannot ask families to carry this burden alone, nor can it overlook the older adults who depend on it most. These are not abstract policy questions. They are urgent moral obligations.
Reforming MLTC funding to equitably reflect the cost of caring for high-need populations is both fiscally responsible and ethically necessary. Additionally, it keeps faith with the thousands of older New Yorkers who trusted this state to keep its word. Now is the time to honor that commitment — not in principle, but in practice, in this budget, and in this moment.
