November 18, 2008

Governor David Paterson
Executive Chamber
State Capitol
Albany, NY 12224

Dear Governor Paterson:

We are writing to express our deep concerns about your Executive budget proposal to delay the implementation of Bridges to Health, a small but crucial program operated by the Office of Children and Family Services (OCFS), which was specifically designed to lower the State's long-term health costs by providing alternatives to institutionalization for the most severely disabled children in foster care.

The proposed 50% ($5 million) cut to this year's funding of Bridges to Health along with the overall delay of its three-year implementation plan has the potential to be very costly for New York State in the long-term. According to the press release OCFS issued earlier this year hailing the new program, medical institutionalization of disabled children costs $185,000 to $300,000 per child annually. Bridges to Health, in contrast, has a significantly lower annual cost of approximately $50,000 per child.

Furthermore, Bridges to Health is approved by the federal Department of Health and Human Services and receives a 50% federal Medicaid funding match to provide services not otherwise available through Medicaid. One quarter of the remaining operating costs are provided by the State and the other 25% of costs are locally matched. Thus every dollar the State invests in enhancing services to foster children with special circumstances and keeping them out of costly institutional settings is matched by three dollars in federal and local funding.

Bridges to Health was planned for a three year phase in, eventually reaching $73 million in annual funding and ultimately serving 3,300 children across New York State. The current budget includes Phase 1 level funding of $10 million, which has enabled the provision of expanded and enhanced services to hundreds of children in foster care, including children in OCFS custody, who are severely emotionally disturbed, medically fragile, or have developmental disabilities. The program serves the children directly as well as their families; including birth parents, foster parents, pre-adoptive parents, and their siblings. These services include health care coordination, family and caregiver support, crisis management, intensive home care support, immediate crisis response services, accessibility modifications, and advocacy for the children's participation in school and other community activities.

Our understanding is that there are currently slightly over 200 children in the Bridges to Health system and that hundreds more have applications pending. However, the proposed cuts would prevent all but a few dozen additional children from being admitted. Letters OCFS sent to the affected Health Care Integration Agencies (HCIA) last week suggested that applications "in the pipeline" would still be processed, but this seems impossible given these proposed cuts. One of the HCIA's we have spoken to, the Jewish Children's Aid Society in New York City, is currently processing more applications than the number slots these cuts would seem to allow for the entire state.

In short, by cutting $5 million from this year's Bridges to Health budget and $24 million in 2009-2010, New York will not only be forgoing twice that much in evermore scare Medicaid funding from the federal government, it will also condemn hundreds of our most challenged children to a life of institutionalization. It seems counterintuitive to cut funding for a program that is specifically designed to save the state health dollars in the long-term. We are also hard-pressed to imagine any population less able to withstand the impact of service cuts than severely disabled children in foster care – particularly when the savings to the state are so small.

Bridges to Health is a shining example of New York's commitment to our most vulnerable children. We respectfully ask for your reconsideration on this matter.

Very truly yours,

Thomas K. Duane
New York State Senate

Micah Z. Kellner
New York State Assembly Member

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