FY 18 Trump Budget Impact on Seniors

PRESS RELEASE: May 24, 2018

Contact Al Norman: 978-502-3794

FY 18 TRUMP BUDGET: “No Path To Follow”

MEDICAID WHACKED, FOOD STAMPS SLASHED, FUEL AID GONE, HEALTH INSURANCE COUNSELING GONE.

Mass Home Care, the statewide elder rights group, said this morning that the FY 18 budget released yesterday by President Trump is “no path for Congress to follow,” and said it will oppose the elimination of several key programs that are key to the economic security of seniors.

The President’s budget outright eliminates several key programs:

  • Low-Income Home Energy Assistance Program (LIHEAP). The President eliminates funding for a fuel assistance, a reduction of $3.9 billion that helps low-income households and families, including many older adults, with heating and energy bills throughout the year. Especially critical in New England.
  • State Health Insurance Assistance Program (SHIP). The President’s budget zeroes-out the $52.1 million for State Health Insurance Assistance Program, known in Massachusetts as SHINE (Serving the Health Insurance Needs of Everyone), which provided 76,000 Massachusetts seniors last year with free health insurance counseling for Medicare and Medicaid needs. SHINE is a cost-effective, volunteer-driven counseling services that is the only source of counseling that is not tied to insurance providers.
  • Senior Corps: The President eliminates the Older Americans Act Senior Community Service Employment Program (SCSEP), administered by the Department of Labor (DOL), and the Senior Corps programs (RSVP, Foster Grandparents and Senior Companion) under the Corporation for National community Service (CNCS). The President’s budget cuts $400 million in FY 2018. SCSEP is the only workforce development program that specifically targets older adults in or near poverty. Many of these jobs supplement workforce needs at Area Agencies on Aging and other community-based organizations serving seniors.
  • Community Services Block Grant (-$715 million)
  • Social Services Block Grant (-$1.7 billion)
  • Community Development Block Grant (-$615 million).
    These programs fund state and local community and economic development efforts that provide key services to older adults.

           Unhealthy Medicaid and Food Stamp Cuts

The President’s makes deep cuts to domestic and safety-net programs, increases in defense spending and tax cuts for higher-income earners and corporations. The $4.1 trillion budget request includes proposals to cut federal spending by $3.6 trillion over ten years through massive cuts to Medicaid, nutrition and income assistance programs for low-income Americans. The budget spares Medicare, Social Security and most Older Americans Act (OAA) programs from cuts, but the request would propose eliminating many other key programs that supplement and support the capacity of the Aging Network to serve older adults and caregivers. Key safety-net programs including Medicaid, the Supplemental Nutrition Assistance Program (SNAP) and the Temporary Assistance for Needy Families (TANF) would see major reforms.

These changes and cuts would reduce assistance for low-income Americans by nearly $1 trillion over 10 years, over half of which would come from Medicaid. Under the budget proposal, states would have a choice to either block grant or per-capita cap their Medicaid programs. The Administration would further cut Medicaid by allowing states to block grant the Medicaid program for all eligibility categories, including for the older adults and people with disabilities who make up the bulk of Medicaid spending. The Administration estimates these reforms would result in a $610 billion reduction in Medicaid spending over 10 years on top of the $840 billion cut assumed in the American Health Care Act.

The Trump budget makes deep cuts to SNAP (Food Stamps). SNAP benefits support 4.8 million adults age 60 and over every year, but still only reach three out of five seniors who qualify for this support. The budget proposal would cut SNAP by 25%, or $193 billion over 10 years. SNAP cuts could put pressure on other nutrition assistance programs, like Meals on Wheels, which currently aren’t meeting existing need due to stagnant funding.

Additionally, the budget would cut spending on domestic programs by a total of $57 billion to $479 billion in FY 2018, which is $37 billion below “sequester-level” caps established in the Budget Control Act (BCA) for this coming fiscal year. (Unless Congress passes another bipartisan agreement this year to ease the budget caps established under the BCA, they will again kick in at the start of FY 18.)
 
Older Americans Act Spared Deep Cuts

. The Trump  budget  preserves all the Older Americans Act programs administered by the Administration on Aging/Administration for Communithy Living. Funding for OAA Title III B Home and Community-Based Supportive Services ($347 million), III C Nutrition Services ($447 for Congregate and $226 for Home-Delivered Nutrition Services), and III E Family Caregiver Support ($150 million) was flat. Unfortunately, the budget request does not reflect the ultimate increases for III B and III C services that were included in the final FY 2017 funding bill, as mentioned above, but that should not be read as a cut.

Elder Justice and Adult Protective Services

The budget request also level funds OAA Title VII Long-Term Care Ombudsman ($15.8 million) and Prevention of Elder Abuse and Neglect ($4.8 million) programs. Additionally, Elder Rights Support Activities, including the Elder Justice Initiative—an ACL priority under the Obama Administration—are level funded at $11.9 million. Again, President Trump’s budget request does not factor in the $2 million increase to the Elder Justice Initiative in FY 2017 to continue developing a national Adult Protective Services (APS) data system and to continue APS research. This is the first budget request in several years that does not include a significant increase in funding for Elder Justice and APS activities.
 
Senior Housing

The Trump budget increases funding for Section 202 Housing for the Elderly to $510 million—a massive $77 million increase (18 percent) increase over FY 2017. This request includes $90 million to renew service coordinator/congregate housing services grants. Section 202 Housing provides funding to create and support multifamily housing for very low-income elderly people. However, this increase also includes policy changes that would give the Department of Housing and Urban Development (HUD) authority to not increase rental payments; to transfer money between housing programs serving both seniors and people with disabilities; and to increase cost-sharing requirements for beneficiaries. Nearly 400,000 units for low-income senior households have been produced to date, and Section 202 is currently the only federal program that expressly addresses this need for affordable senior housing.

Transportation


The President’s FY 18 budget request for the Department of Transportation (DOT) includes a $2.4 billion cut (13 percent) over FY 2017 funding. Funding for the Federal Transit Administration (FTA), would fall $500 million below last year, including a $49 million (15 percent) cut to FTA Section 5310, transportation programs focusing on serving seniors and people with disabilities. The request also includes $5 million in funding for the n4a and Easterseals–led National Aging and Disability Transportation Center (NADTC), as part of the Federal Transit Administration’s technical assistance program to assist local communities and states in the expansion and provision of transportation services for older adults and people with disabilities.
Prevention and PublicHealth Funding 

The Administration eliminates the Prevention and Public Health Fund (PPHF), which was created in 2010 via the Affordable Care Act (ACA). PPHF provides a source of mandatory funding for activities devoted to boosting public health and using proven prevention strategies to reduce Americans’ rates of illness and disability. Because the budget request would, like the House health care reform bill recently passed, eliminate the PPHF, several disease prevention and health promotion initiatives targeting older adults would shift from being mandatorily funded to the discretionary side of the federal leger. The Trump Administration proposes discretionary funding for the Chronic Disease Self-Management Program (CDSMP) at $3 million below FY 2017 levels, which amounts to a 38 percent cut for these activities. Elder Falls Prevention would be level-funded at $5 million under the budget request, but because this funding would come out of the ACL/AoA discretionary budget, it puts pressure on other discretionary programs. Funding for Alzheimer’s Disease Program, which provides funding for Alzheimer’s outreach and awareness campaign activities and long-term services and caregiver support programs, would also move to the discretionary side of the ledger (and receive a boost in funding).

“The people who are disproportionately impacted by all these budget cuts are poor people,” said  Mass Home Care Executive Director, Al Norman. “The people at the bottom of the economic ladder will feel the weight of the loss of Medicaid health care, food stamps, and fuel assistance. The Trump budget make the daily lives of the Americans more difficult. And this is where our advocacy must begin.”

Budget analysis assistance provided by tne National Association of Area Agencies on ‘Aging (n4a)

Senate Ways & Means Releases FY 18 Budget

Press Release: May 16, 2017

SENATE WAYS & MEANS RELEASES FY 18 BUDGET

Contact: Al Norman 978-502-3794

 

The Senate Ways and Means Committee, chaired by Senator Karen Spilka (D-Ashland) , released its FY 18  budget on May 16th.  The Senate budget  invests a total of $305.3M in the Executive Office of Elder Affairs “to enhance the health and wellness of our seniors and allow them to continue to contribute to their communities as they age.”

Here were the items highlighted in the Committee’s Executive Summary:

  • $227.8M for the Elder Home Care program, providing critical support services to help seniors remain in their homes, regardless of their health needs. This is $12.5 million above last year’s level.
  • $29.2M for the Protective Services Program to prevent elder abuse and neglect.
  • $14M for local Councils on Aging to strengthen programs and services in senior centers in communities across the state.
  • $7.3M for nutrition programs for seniors, including the Meals on Wheels program to address the challenges of hunger and isolation that seniors face.
  • $1.2M to expand access to home care services for seniors above the income cutoff and a study of the home care program’s cost effectiveness.
  • $642K for Naturally Occurring Retirement Communities, offering services to communities with a high proportion of seniors aging in place.

According to Mass Home Care, the SWMs budget clings very close to the House budget for FY 18, with a few ups and downs. The major needs that remain unresolved include: workforce retention, elder abuse investigations, and meals on wheels.

Mass Home Care noted the following issues:

  • Over Income home care: The Senate added a welcomed $1.2 M increase for new elder applicants to the basic home care/enhanced home care consolidated program for applicants who are over-income. This over income program began in January of 2017. This new Senate funding will allow the equivalent of 321 elders to be provided with 12 months of home care services in FY 18.
  • Direct Care Workforce: The Senate budget provides no funding to address the worsening home care workforce availability shortfall. Advocates are seeking a $14 million amendment to use 100% federal funds to recruit and retain home care aides, home health aides, and care managers for the elderly home care system.
  • Elder Protective services in the Senate drops $250,000 below the House budget. Given a projected spend of $31.1 Million in FY 17, the Senate version for protective services will be roughly $3 million short what is needed to investigate and resolve elder abuse cases in FY 18.
  • Elder Meals: The Senate budget is level with the House, and level with FY 17 funding. The Senate recommendations for meals is $1.168 million below the projected meals needed in FY 18, which would be a 3% increase in meals provided, or 936,253 additional meals.
  • Adult Foster Care Needs Rate Protection: the Senate language in 4000-0601 needs to be amended to replicate the House language that prevents a $10 million to AFC rates in FY 18.

In anticipation of Senate floor action, four amendments were endorsed by Mass Home Care: 1) Senator Barbara L’Italien’s (D-Andover) amendment to add $14 million for frontline home care workers; 2) Senator Julian Cyr’s (D-Cape) amendment to add $3.1 million to the elder abuse/protective services account; 3) Senator Walter Timilty’s (D-Milton) amendment to add $1.17 million for meals; Senator Jennifer Flanagan’s (D-Leominster) amendment to protect Adult Foster Care programs from a $10 million rate hike.

New Health Care Bill Worse Than Earlier Version

Mass Home Care Press Release: For Immediate Use
contact: Al Norman 978-502-3794

AMERICAN HEALTH CARE ACT 2.0 WORSE THAN 1.0

“From bad to worse.”

A Massachusetts elder advocacy group says the health care reform legislation now in the operating room  in Congress will not make seniors healthy or happy. According to Al Norman, Executive Director of Mass Home Care, the American Health Care Act 2.0  jeopardizes health care coverage and affordability for vulnerable older adults, and  gives states the option to waive Essential Health Benefits and community rating rules, if states agree to establish a “high risk pool” that would collect patients with pre-existing conditions.

Such high risk pools are very expensive, and inadequate funding from the feds could pricing many consumers out of the market. “This could drive up  health care costs because when people can’t get the care they need—they get sicker and more expensive to treat,” Norman said.

The AHCA 2.0 has the same dangerous Medicaid per-capita cap structure, and still will cut $840 billion from Medicaid and force as many as  24 million Americans to lose their health insurance coverage over a 10-year period.

Older Adults Should Not Be Penalized for their Age

AHCA rolls back ACA’s 3:1 age rating provision, which limited how much more an insurance company could charge an older consumer vs. a younger one. AHCA would allow at minimum, a 5:1 rating, and would even let states exceed that rating. Despite the attempt in AHCA to provide older consumers with larger tax credits to offset higher premiums, the bill will still mean higher costs for individuals age 55-64, most especially lower-income Americans.

Do No Harm to Medicare

Although AHCA dramatically changes Medicaid, it does not make major changes to Medicare. However, by eliminating a specific ACA tax and thus a source of revenue for Medicare, the bill would hasten insolvency of Medicare by four years (to 2024 instead of 2028, which was extended a full 11 years by the ACA).

Prevention Works for Older Adults

The AHCA would reduce funding for the Prevention and Public Health Fund (PPHF) by $100 million (10 percent) in 2018 and completely eliminate the fund in 2019. Currently, PPHF supports Administration for Community Living grants for falls prevention activities, chronic disease self-management programs and Alzheimer’s disease prevention and education efforts.

Bottom line diagnosis: AHCA 2.0 is worse for the patient than AHCA 1.0.

“This bill should be taken off life support,” Norman said.

Federal Budget Cuts SHINE, Levels Fuel Aid

PRESS RELEASE: FOR IMMEDIATE USE
CONTACT: AL NORMAN 413-772-6289
FINAL FY 17 BUDGET FROM CONGRESS HITS ELDERLY JOBS PROGRAM, CUTS SHINE HEALTH COUNSELING, BUT SPARES FUEL ASSISTANCE.
Late Sunday night, April 30th, in their rush to pay for the final 5 months of federal fiscal year 2017 appropriations (May to September) to prevent a government shutdown, Congress agreed to some budget cuts that lop off a significant amount of funding for elderly services—including nearly a 10% cut in funding for the very popular SHINE program (Serving the Health Information Needs of Everyone), and deep cuts to an elder jobs program. But fuel assistance was level-funded, and small increases provided to meals on wheels and elder abuse programs.

“We expect 2018 to be much worse than this,” said Al Norman, the Executive Director of Mass Home Care, “but cuts to health counseling and jobs programs for seniors make no sense in any budget year.” Norman said the “fuel aid crisis will come next winter if Congress freezes out the program.”
Leadership in the House and Senate announced that they had reached a  deal to fund the government through the remainder of FY 2017,  and they  rejected many cuts to FY 2017 funding that the Trump Administration requested last month.

Congress must still pass, and the President must sign, the proposal funding federal programs for the remaining five months of the current fiscal year,

How Aging Programs Fared: Most Older Americans Act (OAA) and other aging programs were level funded in the final bill. There are some modest increases included for Older Americans Act Title III Supportive Services ($2.5 million), Title III Home Delivered Meals ($1 million) and Congregate Meals ($2 million), and caregiver support ($25,000). The Elder Justice Initiative also received a $2 million increase, to identify, prevent and prosecute elder abuse and exploitation.

The OAA Title V Senior Community Services Employment Program (SCSEP), administered under the Department of Labor, was cut by $34 million—or nearly 8%. The Trump Administration has proposaed to eliminate SCSEP in FY 2017 and 2018.

The final bill also includes a $5 million—or 9.6 percent—cut to the State Health Insurance Assistance Program (SHIPs), which we call SHINE in Massachusetts.  This means the $1 million SHINE grant in Massachusetts, will lose roughly $96,000 over the last 5 months of the federal fiscal year, or close to 10% of its annual funding–a larger cut since it must be made up over 5 months. The Senate appropriators has targeted SHIP funding in the previous two budget cycles, and the Trump Administration requested nearly eliminating current-year SHIP funding. The bill just passed avoids the Senate’s more drastic proposed cuts. 76,000 seniors received free health insurance counseling in 2016 under the Massachusetts SHINE program.

Other Key Programs: The final funding package also rejects the new Administration’s requests to significantly curtail funding for other critical aging programs. Lawmakers included level funding for Senior Corps programs (RSVP, Foster Grandparents and Senior Companion) and the Low Income Home Energy Assistance Program (LIHEAP). Additionally, the Social Services Block Grant (SSBG), Community Services Block Grant (CSBG), and Community Development Block Grant (CDBG) were spared any cuts to current-year funding.

Most other OAA and aging programs were also level funded, including Title III E Family Caregiver Support program, Title VII Long-Term Care Ombudsman program, and the Chronic Disease Self-Management and Falls Prevention programs funded through the Prevention and Public Health Fund.

Information in this release includes analysis from the National Association of Area Agencies on Aging.

Mass Home Care Testifies Against Adult Foster Care Rate Cuts

NO ONE TESTIFIES IN FAVOR OF EOHHS CUTS TO ADULT FOSTER CARE RATE CUT

The state’s Executive Office of Health & Human Services held a hearing on March 17th regarding a proposed rate cut to the Adult Foster Care program that would take effect April 20th and cut $2 milion from to the program by June 30, 2017, and another $10 million in FY 18.

Rep. Denise Garlick (D-Needham), the chair of the Mental Health committee, testified against the rate cuts, as did the Mass Council for Adult Foster Care programs.

Excerpts of the testimony from Mass Home Care are shown below:

Mass Home Care Testimony Regarding Adult Foster Care Rates

101 CMR 351.00

March 17, 2017

  1. Statutory Requirements for Rates

The Executive Office of Health & Human Services derives its rate setting authority pursuant to section 13C of chapter 118E of the General Law, where it states:

“The secretary of the executive office shall have the responsibility for establishing rates of payment for social service programs which are reasonable and adequate to meet the costs which are incurred by efficiently and economically operated social service program providers in providing social service programs in conformity with federal and state law, regulations and quality and safety standards…When establishing rates of payment for social service programs, the secretary of the executive office shall adjust rates to take into account factors, including, but not limited to: (i) the reasonable cost to social service program providers of any existing or new governmental mandate that has been enacted, promulgated or imposed by any governmental unit or federal governmental authority; (ii) a cost adjustment factor to reflect changes in reasonable costs of goods and services of social service programs including those attributed to inflation; and (iii) geographic differences in wages, benefits, housing and real estate costs in each metropolitan statistical area of the commonwealth and in any city or town therein where such costs are substantially higher than the average cost within that area as a whole.”  (emphasis added)

In reviewing  any social services rates, we should ask if the methodology to derive those rates produce  a rate which is “reasonable and adequate to meet the costs which are incurred by efficiently and economically operated social service program providers.”

 

  1. Are these rates Reasonable and Adequate?

Each  time a rate is determined for AFC, the methodology is changed and inconsistent with past rate-settings. For example, in 2003 the state used a method that calculated a daily rate based on the “average hours per day” of staff needed x an hourly rate.

In November of 2006, MassHealth transmitted a new Level II AFC rate set at $82.02 per day, with no methodology cited in the transmittal letter. Ibn 2017, that rate is being proposed cents higher: $82.06–and a cut from the current Level 2 rate of $85.18.

In the 2017 Notice of Public Hearing for these Adult Foster Care rates, EOHHS stated yet another  methodology for determining the AFC rates:

“AFC provider cost report data was reviewed and the proposed rates apply an efficiency standard for indirect costs at the 75th percentile among AFC providers. After these adjustments, the 60th percentile  of unit costs was taken to determine the proposed per diem rates. The proposed amendments to 101 CMR 351.00 also include the additional of code modifiers to determine utilization of medical leave of absence days, and nonmedical leave of absence days as well as changes to align the reporting requirements with other existing EOHHS rate regulations.”

 

EOHHS does not publish its working papers that the analysts use to reach the rates found in 101 CMR 351. Such working papers can be requested through a public records act request, but the calculations are not included in any document made public as part of the rate hearing process.            There is no consistent pattern or predictability to the methodology the state used to “build” rates for AFC that meet the statutory requirements of section 13C of Chapter 118E.

The following points can be made about this somewhat opaque methodology:

  1. These rates do not meet the standard of being “reasonable and adequate to meet the costs which are incurred by efficiently and economically operated social service program providers.” Instead, EOHHS has usedAFC provider cost report data,” which by definition refers to historical cost statements from prior fiscal years. It can be demonstrated by AFC provider cost reports from prior fiscal years that previous rate increases were neither reasonable nor adequate. In fact, the rate increases for the AFC program in the past, which produced costs reports, had been wholly inadequate and unresponsive to meet the costs incurred by efficiently and economically operated programs.

 

  1. The AFC program rates promulgated in December of 2006 were in effect until April of 2008, and in May of 2008 were slightly increased, but AFC programs went without another increase for 5.5 years. The rates established in December of 2013 were not changed for 3.33 years. The rate being suggested today is 4 cents higher than it was in FY 2006!

Massachusetts AFC Rates

  1. The AFC rate increases historically over the past decade have been untimely and inadequate. For example, after increasing by only 1.3% in May of 2008, the level 2 rate remained unchanged for 5.5 years without a rate hike, and in December of 2013, the level 2 rate rose by only 2.5%, and saw no change for the next 3.3 years. MassHealth is now proposed to cut the level 2 rate set in December of 2013 by -3.66%, reducing the level 2 rate to roughly the same rate it was granted in December of 2006—9.33 years ago! No human services program can operate a 2017 program based on 2006 rates. This erratic funding pattern, has seriously constrained AFC agency program delivery, because the program spending has to meet imposed budget limitations.

            A methodology that uses an “efficiency standard for indirect costs at the 75th percentile” appears to be entirely arbitrary and capricious when compared to the language found in Chapter 118E, section 13C. EOHHS estimates that these proposed rates will result in a loss to the AFC programs of $10,600,000 in FY 18. Because these rates are based on historically-restrained cost reports, the resulting rates bear no relationship to rates which are “reasonable and adequate to meet the costs which are incurred by efficiently and economically operated social service program providers.”

 

III. Do these rates take into account  existing or new governmental mandate that has been enacted, promulgated or imposed?

            EOHHS is taking testimony today on 28 pages of updated regulations to the Adult Foster Care program. These proposed regulations contain numerous new governmental mandates that will add to the complexity of managing the AFC program.

Below are highlights of unfunded regulatory mandates:

  • The regs add a Community Health Worker to the Multidisciplinary Professional Team. Although the reason for adding this staff position to the MPT is to give providers the opportunity to substitute a lower cost staff person for an RN or care manager visit, the fact is the new staff will come at a cost: there will be advertising, supervision, training and payroll/fringe costs to the agency.
  • The new regulations require AFC providers to become accredited. Although AFC providers support accreditation, this could be a time-consuming and expensive process, occurring as EOHHS cuts the program funds by $10.6 million annually.
  • AFC providers will be dealing with a new Third Party Administrator for prior authorization, which will increase costs for staff training, and staff time spent preparing and processing prior authorization requests. The EOHHS are falling, but administrative burden is rising.
  • New requirement for annual AFC authorizations for consumers to continue in program
  • The regulations add a new requirement for a new assessment to be performed when a member Transfer from one AFC provider to another.
  • Calculating medical and non-medical Leaves of Absence will become more administratively burdensome because they must be calculated on a consecutive 12 month period basis rather than a simple calendar year basis.
  • Expanded Policy Manuals: the regulations substantially increase the written list of policies and procedures that must now be developed as part of an AFC provider’s policy manual.
  • Expanded Plan of Care Requirements for level 2 members: New plan of care review requirements substantially increase the reporting and documentation requirements mandated for plan of care review for all level 2 members, with a new list of policies and procedures that must be in the plan, including an emergency file with list of required contents.
  • New preadmission procedures and activities that may or may not lead to prior approval. Instead of waiting for prior approval, the regulations require AFC providers to do a full workup on the applicant, right up to a move-in date—without any guarantee of approval by the Third Party Administrator.
  • New Staffing Qualification checks, in addition to already required licenses and certification verification, TB screenings and PS reporting, AFC agencies will now be responsible for pre-hire screening of Sex Offender Registry, OIG checks, checks, These new vetting and training requirements will drive up administrative and personnel costs and prolong the hiring process.
  • Expanded scope of first month staff orientation: such as basic first aid, CPR, emergency procedures, Heimlich maneuver, universal precautions, elder abuse and neglect, critical incident reports, techniques of providing safe personal care assistance, good body mechanics, human rights and non-discrimination, developmental needs of the member, reporting changes in conditions, relevant provisions of the affordable care act, etc.
  • AFC Backup Staff Coverage: As a new requirement, AFC providers must budget for professional and direct care backup staff to cover for illnesses, vacations or other reasons.  This would be an additional line item on AFC Cost Reporting.

The proposed rates do not meet the statutory requirements of providing for the reasonable costs of new government mandates. Given all the programmatic and  administrative changes, it is inconceivable that rates would be reverting to 2006 levels.

  1. Do these rates apply a cost adjustment factor to reflect changes in reasonable costs of goods and services of social service programs including those attributed to inflation?

 

The explanation of these new rates in the Hearing Notice makes reference to “indirect costs,” “code modifiers,” and “changes to align reporting requirements.” But there is no evidence that these programs, pursuant  to the section 13C requirements, have had any inflation cost adjustments. This has been the pattern for the past decade: long periods with no rate increase, followed my small adjustments, following by rate reductions.

 

  1. Conclusion

The evidence available suggests that EOHHS has backed into these rates based on a target spending figure for FY 17 and FY 18, by manipulating findings of cost reports that do not reflect the true scope of the current day AFC Program.   This random methodology fails to  address any of the statutory requirements in Chapter 118E for setting rates “which are reasonable and adequate to meet the costs which are incurred by efficiently and economically operated social service program providers,” or which “take into account factors, including, but not limited to: (i) the reasonable cost to social service program providers of any existing or new governmental mandate that has been enacted, promulgated or imposed,” or which take into account “a cost adjustment factor to reflect changes in reasonable costs of goods and services of social service programs including those attributed to inflation,” or which take into account “geographic differences in wages, benefits, housing and real estate costs in each metropolitan statistical area of the commonwealth and in any city or town therein where such costs are substantially higher than the average cost within that area as a whole.”

These rates are not in compliance with state law, and should be withdrawn and recalculated to account for the factors that are required for AFC programs that are “reasonable and adequate to meet the costs which are incurred by efficiently and economically operated social service program providers.”

We also request that all AFC providers be sent a copy of the analyst’s worksheets and methodology that were used to calculate the proposed rate.

Mass Home care thanks EOHHS for the opportunity to testify on these AFC budgetary cuts and proposed rates.

 

 

 

 

Mass Home Care’s Analysis of President Trump’s FY 18 Budget “Blueprint 3 16 17

Mass Home Care released an analysis of President Trump’s FY 18 “Budget Blueprint.” Here is the release:

Impact of President Trump’s FY 18 Budget Blueprint on Elders in Massachusetts

Mass Home Care 3/16/17

President Trump’s FY 2018 Budget Blueprint sent to Congress March 16th will result in:

  • major cuts in Medicaid enrollment (a drop of 306,000 Medicaid enrollees by 2026—many non-elders–  due to the impact of the American Health Care Act),
  • the loss of $140 million in fuel aid in FFY 18
  • $1.2 million in Older Americans Act funds for social services and meals in FFY 18
  • A loss of 81,317 in elder meals funding  ($609,884) in FFY 18
  • nearly $2 million in senior aide jobs in FFY 18
  • $16.5 million in Community Services Block Grants
  • the end of legal services corporation, and many other federal program noted below.

                                        [all figures based on 3.34% cut in DHHS funds, across the board, below  FFY 17 funds]

DISCLAIMER: The President’s ”Blueprint” budget is more of a press release than a detailed budget. The fact is, Congress is not even finished with the FY 17 budget, and Appropriations Committees will produce a final federal budget that may or not look much like the President’s plan. As in Massachusetts, the Governor submits a House 1 budget document usually in late January, and then after 5 months of deliberations by the General Cour, the final budget is produced—often very different than House 1.

The President’s “skinny” budget is a message to the Congress about the Trump Administration’s funding priorities. The budget contains very few individual program line-items, and many programs that impact the elderly—including funds for Older Americans Act and other aging programs within the Administration for Community Living (ACL) and Administration on Aging (AoA) are not specifically mentioned.

The President’s  FY 18 budget reflect deep cuts below current budget caps and sequestration levels as mandated by the Budget Control Act of 2011. The President does not outline any proposals for mandatory spending, such as Medicare and Social Security, or for federal revenue and tax proposals.

Older Americans Act (OAA) and Other Aging Programs

President Trump proposed funding the Department of Health and Human Services (DHHS), which houses the Administration for Community Living (ACL)  and its Administration on Aging, at $65.1 billion. This is a $12.6 billion cut (-16.2 percent) below current funding. But roughly $10 billion of the overall cut to HHS comes from rolling back recent funding increases for the National Institutes of Health and from eliminating other block-grant programs. That would leave a cut of around 3.34% to make in other DHHS programs. If those cuts were made equally across Older Americans Act programs, the state would lose around $1.21 million Older Americans Act-related federal funds. But the Blueprint contains no data on actual line item cuts.

President Trump wants to eliminate the Older Americans Act Title V Senior Community Services Employment Program (SCSEP), which is housed within the Department of Labor. Last year, Senate appropriators targeted SCSEP for a $34 million cut to its $434 million funding level, but the House lawmakers rejected that cut. The Trump budget would zero out the program entirely. This would result in a loss of $1.88 M to the Community Service Employment program in Massachusetts.

Within the federal Department of Housing and Urban Development (HUD), the President proposed cuts to rental assistance programs, which could include Section 202 Supportive Housing for the Elderly. HUD is slated for an 11.6 percent cut. The Section 202 program helps expand the supply of affordable housing with supportive services for the elderly. It provides very low-income elderly with options that allow them to live independently but in an environment that provides support activities such as cleaning, cooking, transportation, etc.

Other Key Programs Slated for Elimination

In addition to Senior Aides jobs, other programs on the chopping block that could affect services and support for older adults include the Corporation for National and Community Service (CNCS), which includes the Senior Corps programs such as Foster Grandparents and RSVP; the Low Income Home Energy Assistance Program (LIHEAP), which would cost Massachusetts $140.4 million in financial assistance for fuel costs; the Community Services Block Grant, which provides around $16.5 million in wrap-around services for older adults in many communities; and the Legal Services Corporation, which administers some elder justice programs.

Additionally, the budget would eliminate funding within HUD for the Community Development Block Grant (CDBG). This $3 billion cut would eliminate CDBG funding to states to use for a variety of programs including a small amount that a few states and communities direct toward shoring up senior nutrition programs such as home-delivered meals. However, this cut does not mean that the federal home-delivered meals program under the Older Americans Act was slated for elimination. Those details are not available in the current budget blueprint, but news reports of the CDBG cut have led to confusion among advocates and the public.  

As is shown below, Massachusetts gets $10.1 million for social services under the Older Americans Act. A 3.34% cut in these OAA funds would result in a loss of $337,340. The state receives $18.26 million for the elderly meals program—both at congregate meal sites and home-delivered meals. A 3.34% cut in meals funding would result in a loss of $609,884 in nutrition funding, or a loss of roughly 81,317 meals in FFY 2018.

 

The federal grant funds that came to the Executive Office of Elder Affairs in FY 17 total $36,412,065

 

Adult Foster Care Faces Cuts March 1st.

 

Cuts to Adult Foster Care Begin March 1st

The countdown to cuts is on.

On March 1, the Baker Administration will begin cutting as much as $5.6 million from the Adult Foster Care program. The cuts will continue through the last four months of the fiscal year.

“We are running out of time to protect the elderly and people with disabilities,” said Linda Andrade of the Mass Council on Adult Foster Care. “Adult Foster Care is one of the premier ‘community first’ programs in the Commonwealth. The population in need is growing, and our budget should be growing to meet that need.”

Next year, the program could lose as much as $22.6 million.

Adult Foster Care is a program that allows elderly and disabled people to move in with a host family that provides 24/7 support. The average cost per client is less than $21,000 a year. Comparable round-the-clock support at a nursing facility can cost up to four or five times more.

“Community programs like this one make programmatic sense and financial sense,” noted Al Norman of Mass Home Care. “It just makes no sense to cut back community programs that help keep people out of costlier institutions.”

“Individuals with disabilities want to live in a home, in the community,” added Gary Blumenthal, CEO of the Association of Developmental Disabilities Providers. “Adult Foster Care is one of the few round-the-clock care programs that takes place in a home setting. That is why consumers are attracted to it.”

Governor Baker used his executive powers to make $5.6 million in 9C cuts to this MassHealth service for low-income individuals. These cuts amount to a 9-percent rate cut for providers. The cuts will undermine the program and can harm those who receive Adult Foster Care services and support, including caregivers who receive visits and oversight.

Andrade, Norman and Blumenthal agreed that the Adult Foster Care program is on the verge of a crisis. Adult Foster Care providers have indicated that sizeable funding reductions to their individual programs may make this innovative cost-saving program impossible to operate.

“It is imperative that the governor rescind this 9C reduction or that the Legislature overturn this reduction in a FY 17 Supplemental Budget appropriation,” concluded Al Norman.

FACT SHEET FY17 9C Action –

MassHealth Adult Foster Care Program

(4000-0600, 4000-0700)

 

Cut Will Leave 12,000 Caregivers Without Support and Oversight

 

MassHealth will cut rates for Adult Foster Care (AFC) services by 10% effective March 1, 2017, reducing payments to AFC Providers by $5 Million in FY2017 and more than $20 Million in FY2018.

 

AFC makes it possible for 12,000 elders and younger adults with disabilities to live at home with full-time caregivers.

  • A critical Community First innovation, AFC has contributed substantially to reducing utilization of nursing facilities and state-run institutions.
  • AFC is one of the few community options available to MassHealth members who need assistance with personal care and around-the-clock support and supervision.
  • AFC Provider Agencies provide education and coaching to lay caregivers – most often friends and family members without health care experience or training – so they have the support they need to provide care to elders and people with disabilities who have complex physical and behavioral health conditions.

 

The cut will:

  • Reduce the number of home visits by 50%, decreasing support for AFC caregivers, increasing the incidence of caregiver stress, and jeopardizing the health and safety of elders and people with disabilities. One of the most impactful features of the program, home visits ensure MassHealth members and their caregivers have regular and predictable access to a trusted care team (nurse and case manager) who understand the member’s health and social circumstances. AFC care teams help caregivers manage challenging behaviors and medical conditions, and can assess situations and act quickly when a member’s conditions change, preventing unnecessary health care costs. Consumers who are enrolled in AFC  are adults with intellectual disabilities/developmental disabilities, dementia, autism, behavioral health needs and/or are medically complex and many have co-mobidities.  AFC support provides the opportunity to manage individual situations, keep people stable at home and maintain program integrity through frequent visits.  The program serves people who would otherwise not be living in an independent apartment or who would be in a nursing facility or group home.
  • Undermine the ability of quality agencies to continue to operate across the Commonwealth. A 10% rate cut is decimating and unprecedented. AFC providers will not be able to absorb such losses.
  • Limit the Commonwealth’s capacity to provide care at home where people want to be, and jeopardize the savings that MassHealth realizes by supporting members in AFC. (Clinically comparable members are $85 p/day in AFC and ~$160 p/day in nursing facilities.) Without ongoing support from their care teams, some families will be unable to continue their around-the-clock commitment to caregiving at home and may elect more expensive out-of-home alternatives. This model works because of dedicated caregivers and because of the comprehensive support system and professional help that AFC Provider Agencies provide to those caregivers. AFC serves a complex and vulnerable consumer base.  Host families are trained and supported.  In a time of direct care worker shortages, this model of care offers a residential option for consumers and quality caregiving through host or natural family members who receive a modest monthly stipend.

 

Please Act Now to Reverse the 9C Cut to the AFC Program

and Keep Care at Home for 12,000 MassHealth Members

Here is the legislative language we are seeking to place in a supplemental appropriations bill before the March 1st cuts begin:

 

SECTION __. Chapter 133 of the acts of two thousand and sixteen is hereby further amended in Item 4000-0600 by adding after the words “in providing kosher foods” the following new language: —

“provided further, that the eligibility, staffing and rate requirements for the adult foster care program shall not be more restrictive than those in effect in fiscal year 2016; provided further, that not less than $5,600,000 shall be added to this item to maintain said eligibility, staffing and rate requirements;”

and by striking out the sum “$3,509,766,093” and replacing it with the following:–

“$3,515,366,093”

HOME CARE WAIT LISTS START SEPT. 1ST

               Press Release: For Immediate Use

                 Contact: Al Norman, 978-502-3794

          Elder Home Care Wait Lists To Begin In 26 Days

STATEWIDE—The Baker Administration has officially announced that starting September 1st, waiting lists for some elders will begin in the home care program. Massachusetts calls itself a “community first” state—but the doors to nursing facilities are wide open, while the entrance to home care will soon be limited. Mass Home Care predicts that the monthly caseload for elders will have to drop by 650 to 800 elders per month.

“Due to projected demand exceeding FY17 budgetary limitations,” the Administration said in a memo to Aging Services Access Points (ASAPs), “Elder Affairs will be implementing a managed intake process. This process will be effective as of September 1, 2016.”

The final Conference Committee budget for FY 17 home care items is roughly $3.5 million below FY 16 appropriations:

Line Item FY16 Budget FY 17 FINAL
9110-1500 ECOP $ 70,255,327 $70,548,399
9110-1630 HCPOS $104,595,483 $102,570,589
9110-1633 HC  CM $35,546,961 $33,795,743
TOTALS $210,397,771 $206,914,731

The maintenance budget for the enhanced home care program is around $74 million—so the total shortfall is closer to $7.5 million.

“This was an entirely predictable—and avoidable—outcome,” said Mass Home Care Executive Director Al Norman. “The General Court didn’t give home care enough funding to run a maintenance budget, and the Governor filed a supplemental budget that added more federal dollars—but  reduced the state share, setting up a wait list situation.”

According to the Executive Office of Elders Affairs, elders who have “a critical unmet need for meal preparation” will be put on a waiting list—regardless of where they live in the state. Every elder who applies for home care is assigned a “priority level” based on their need for service.

The state is also cutting off funding for the Intensive Care Management program, which helps seniors with behavior health reasons for resisting care. A pilot program approved by the General Court to provide up to $1 million to help seniors with income slightly over the home care eligibility limit has also been scrapped.

Mass Home Care has written an amendment to the Governor’s supplemental budget  to add $3 million in available federal  dollars for home care from the “Community First” Trust Fund.

“This is a manufactured crisis,” Norman concluded. “The state has federal dollars in its hands that could end this wait list before it happens.”

“We hope they act quickly—on September 1st we start turning some elders away.”

#                             #                                  #                                  #

ELDER HOME CARE WAITING LISTS PREDICTED DUE TO BUDGET CUTS

“Rightsized” Budget for FY 17 Will Mean Elders On Home Care Wait Lists

Contact: Al Norman 978-502-3794

STATEWIDE: An elder rights group says that seniors  will be put on a wait list for home care as a result of cuts made in the final days of the FY 17 budget process.

“We need to reduce our caseload by 628 elders per month for the entire year,” explained Mass Home Care President Greg Giuliano. “The General Court left us roughly $4 million short of what we need to maintain our current home care programs.” Giuliano said the Conference Committee budget sent to the Governor produced an appropriation lower than  either the House or Senate versions of the budget. “Usually lawmakers compromise on a number between the high and low mark—but this year they went below the low mark—and guaranteed waiting lists.”

The core home care line items in the final FY 17 budget are lower than FY 16 appropriations

Line Item FY16 GAA FY 17 Gov FY 17 House FY 17 Senate FY 17 FINAL
9110-1500 ECOP $ 70,255,327               0 $  74,345,122              0 $70,548,399
9110-1630 HCPOS $104,595,483 $158,143,535 $101,485,589 $158,143,536 $102,570,589
9110-1633 HC  CM $35,546,961 $  51,482,919 $   33,795,743 $  52,557,919 $33,795,743
TOTALS $210,397,771 $209,626,454 $209,626,454 $210,701,455 $206,914,731

Elder Home Care begins FY 17 facing a shortfall that translates into 349 elders per month in the enhanced home care program, and 279 elders per month in basic home care, for a total of 628 elders per month in FY 17 who will not receive needed services.

The Governor vetoed language that would require MassHealth to apply for two state plan amendments that would bring in more than $20 million in new federal revenue that could be used for home care services. Giuliano said this veto “leaves federal dollars on the table at a time we are cutting elders off home care.”

Although lawmakers agreed to a $1.075 million home care expansion for the “near poor” who are slightly over the program’s income cap, Giuliano said he is concerned that advocates will have to fight to make the program happen.

Waiting lists for home care have been a chronic problem for the elderly, Giuliano said. In FY 2013, for example, as many as 2,000 elders were on a wait list for home care for much of the program year.

“We say Massachusetts is a ‘community first’ state, Giuliano said, “but in most parts of the state there is no wait to get into a nursing facility. These home care cuts send exactly the wrong message to families.” Nursing home use has dropped more than one-third since the year 2000 Giuliano said,  largely due to home care services, but access to home care too often is sporadic.

“We can keep 5 or 6 elders in home care for the cost of one person in an institution,” Giuliano said, “so closing off home care is financially a bad deal for taxpayers.”

Mass Home Care said it will urge lawmakers to restore the cuts in home care funding through a supplemental budget, restore the state plan amendment language cut by the Governor, and push for implementation of the $1 million ‘near poor’ home care pilot project.

                             #                 #                 #                 #

SENATE APPROVES EXPANSION OF HOME CARE TO ‘NEAR POOR’

              PRESS RELEASE: MAY 26, 2016
contact: Al Norman 978-502-3794
SENATE PASSES ELDER HOME CARE          AMENDMENT TO ADD NEAR POOR
​STATE HOUSE–​In one of its final budget votes of Thursday night around 9 pm, the State Senate approved on a voice vote an amendment that increases funding for the state’s elder home care program by just over $1 million, to create a program for elders whose income is just over the limits allowable ​under current eligibility guidelines.
The amendment allows the Executive Office of Elder Affairs to admit elders whose annual income is between $27,015 and $31,066. This includes seniors who “​(i) are unable to afford sufficient unsubsidized home care for their needs; (ii) pose a risk of higher-cost state-provided care in a nursing facility should they be ineligible for home care; or (iii) lose home care eligibility as a result of a spouse’s death;”

Al Norman, the Executive Director of Mass Home Care, said the Senate action “will provide some much needed relief to ‘near poor’ seniors who cannot pay the full cost of home care services on their limited income.” Norman said elders who qualify for this program will pay for some of the cost of their care on a sliding fee basis.

“When we keep an elder living independently at home, we are also saving the taxpayers the cost of keeping them in an institution,” Norman said.

Norman credited Senate President Stan Rosenberg for guiding the amendment to its final passage. “The President has taken a personal interest in looking after the well-being of our seniors.” Norman said.

The measure now goes to a Joint Conference Committee to work out the final provisions of the budget.

Here is the text of the amendment adopted this evening by the Senate:

Further EHS 469.2

Home Care Rates

Ms. Jehlen, Ms. L’Italien, Ms. Lovely and Ms. Chang-Diaz moved that the amendment be amended by striking out the text in its entirety and inserting in place thereof the following:-

the proposed new text be amended, in section 2, in item 9110-1633, by inserting after the word “provided”, in line 5, the following words:- “, that the secretary of elder affairs shall develop a pilot program to provide home care services to certain persons whose annual income exceeds, by 15 per cent or less, the current income eligibility limit based on regulations promulgated by the secretary; provided further, that such persons may include those who:

​​

(i) are unable to afford sufficient unsubsidized home care for their needs; (ii) pose a risk of higher-cost state-provided care in a nursing facility should they be ineligible for home care; or (iii) lose home care eligibility as a result of a spouse’s death; provided further, that an amount not to exceed $1,075,000 shall be used for the pilot program which shall be allocated between items 9110-1630 and 9110-1633; provided further, the secretary shall report to the house and senate committee on ways and means not later than February 1, 2018 on: (a) caseload and expenditures made from the pilot program; (b) projected cost effectiveness from the piloted population including, but not limited to, estimated savings from reduced medical costs, avoided nursing facility admissions and cost sharing by recipients; and (c) the estimated fiscal impact and cost benefits of expanding home care to all eligible persons whose annual income exceeds the current income eligibility by 15 per cent or less; provided further”; and

in said section 2, in said item 9110-1633, by striking out the figure “$51,482,919” and inserting in place thereof the following figure:- “$52,557,919”.