I'm Back

In more ways than one. First, my departure from the world of disability is proceeding apace, although there were some bumps in that road. Second, I have been able to do some travel, in particular a visit to Washington, D.C., to attend a conference sponsored by the Centers for Disease Control. But now I've decided to start writing again, and the first thing that needs addressing is the needs of the disabled population, older or otherwise.

Yes, we all know that New York State is in a budget crisis. Yes, it is expensive to provide the safety net that is mandated in the New York State constitution:


The aid, care and support of the needy are public concerns and shall be provided by the state and by such of its subdivisions, and in such manner and by such means, as the legislature may from time to time determine.


There are a number of programs that seek to address that mandate. Medicaid, the joint Federal/State program, is one way to secure support for the needy. Medicaid, however, cannot be the only means. First, to this observer, it seems to be a reimbursement-driven program, not a needs-driven program. Second, it requires virtual impoverishment, not necessarily a good criteria of need. Finally, there are less expensive options. But Medicaid is a de-facto mandate that does not require a lot of thought to fund: it is there by fiat, so the tough decisions are removed.

Could it be that the legislature, as cited in the constitution, does not take the other options seriously, or that it lacks the political will to vote more expenditures (headline: "Legislature increase spending in some-such program"). Is it just easier to "cut" spending on non-mandated programs but in the end spend more on the mandated ones?

What about EISEP, the Expanded In-Home Services for the Elderly Program? EISEP has a long history of leveraging a wide range of supports, both formal (i.e., funded services) and informal (i.e., non-funded support from friends, relatives, or neighbors). The result is less "formal" costs for the same services, and those formal costs are the ones paid from the State's budget. I would argue that upping the budget for EISEP would -- in the end -- reduce State spending, but that would require somebody to stick their neck out and ask for increases when, in today's political climate, that may not be the politically correct thing to do. So soak the taxpayer again, but let them think it's a good deal!