LeadingAge NY Seeking to Address Career Pathways Training Program Concern

(Sept. 23, 2025) LeadingAge NY recently became aware of an issue with the Career Pathways Training (CPT) program that would likely prevent many nursing homes from serving as service commitment sites. We have had several discussions with the Department of Health (DOH) on the issue and are hopeful for a positive resolution.

The CPT program is an education and training program authorized under NY's 1115 Demonstration Waiver and operates as part of the NY Health Equity Reform (NYHER) waiver amendment. The program is designed to create a reliable workforce pipeline to address workforce shortages by funding education and training for health, behavioral health, and social care workers throughout NYS. The goal of the initiative is to recruit new workers into the field to increase access to care for Medicaid members, with training provided through three regional Workforce Investment Organizations (WIOs). Participants of the CPT program must make a three-year commitment to work at a service commitment site such as a health, behavioral health, or social care provider that serves Medicaid-eligible individuals. Background information on the program is available here, and the program website is here.

In order to qualify as a service commitment site for graduates of the CPT program, a provider’s patient or resident census must exceed 30% Medicaid members and/or uninsured individuals. The CPT attestation to qualify as a service commitment site asks the provider to certify that they had a “patient population that was at least 30% Medicaid and/or uninsured members during one of the last three (3) years,” calculated by dividing the number of Medicaid and uninsured individuals served by the total individuals served. If unaddressed, this could pose a barrier for nursing home participation.

Even though Medicaid pays for more than 70% of nursing home days in NYS, if a facility’s Medicaid services are calculated based on the number of people served over the course of a year, rather than on any given day, most nursing homes would not qualify. Medicare residents come and go after a short stay, while Medicaid residents typically stay for a year or more. As a result, nursing homes typically serve more individuals as Medicare residents over the course of a year than Medicaid residents. As a result, the current attestation calculation would disqualify most nursing homes from serving as service commitment sites, even though most of their resident days are covered by Medicaid and most of their residents on any given day are covered by Medicaid.

We have reached out to all of the WIOs that manage the program and to the DOH program leads suggesting that the 30% threshold be based on resident days by payer. Such a calculation would correspond most closely to how many hours over the course of a year staff spends with residents whose care is paid by Medicaid and would best align with the program's goals. Alternatively, the end-of-year census by payer reported in the Residential Health Care Facility (RHCF) Medicaid cost report could also be used.

The Department has indicated that they will try to address the problem, and we will continue to raise the issue. We encourage members that have already referred staff to the program with the expectation that they will return with advanced training to speak with their WIO. We also encourage members to speak with their WIOs if they are interested in serving as service commitment sites or if they are considering sending staff to the program. We will keep you informed of developments.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841