Updated January 29, 2013
COVE’s mission is to promote and protect a higher quality of life for Vermont’s elders, through education and advocacy. The needs, concerns, safety and well-being of elders who are economically disadvantaged, physically or mentally challenged, or geographically or socially isolated, are a central focus of our public policy work.
1. The State Budget: With possible shortfalls in federal funding for theStateHospital and other Irene recovery work, plus the projected state deficit, COVE is watching very carefully for any cuts that might negatively affect services to frail elders and people with disabilities.
2. Choices for Care (CFC): COVE continues to lead the fight to get savings realized in this program (several million dollars annually) reinvested inCFC and other authorized long-term care (LTC) programs to meet unmet need and increase services to those who qualify. Vermont statute requires such reinvestment, yet millions of dollars sit in reserve or are used to plug holes in other, unrelated programs. (Please see page 3 for additional information onCFC.)
3. Improved Wages, Working Conditions and Training for Home Care Workers. CFC home care workers have seen wages stagnate over the last decade. As a result, high turnover has been troubling. These workers should be allowed to organize to meaningfully improve wages and other working conditions, as called for in the 2008 legislative report on this topic.
4. Dual Eligible Waiver Proposal: COVE and Vermont Legal Aid worked with the administration during the 2012 legislative session to put basic protections into this important waiver proposal, to insure that new “duals” will not receive any less procedurally and substantively than they would under either Medicare or Medicaid alone. Vermont then received a major grant to reform its payment methodology for all of health care to a capitation model. Everything has now been delayed into next year, with many questions still unanswered as to how duals will be affected. (Please see page 3 for additional information on “duals.”)
5. LIHEAP Fuel Assistance: The Governor’s proposed budget for 2014 includes a tax on break-open tickets, part of which would provide annual funding for LIHEAP in the amount of $6 million. That would leave the program $3 million short of the 2013 funding level, provided that no more federal cuts are made. COVE will work with our partners and the legislature to ensure that LIHEAP is fully funded in the budget. (Please see page 4 for additional information on LIHEAP.)
6. Adult Protective Services (APS): For several years now COVE has questioned the adequacy and statutory compliance ofVermont’s APS program in protecting vulnerable adults against abuse, neglect and exploitation. After informal discussions about how to get the program back on track broke down, COVE and Disability Rights Vermont (DRVT) sued the state to force compliance with the law. Last spring, two Area Agencies on Aging (Senior Solutions and Southwestern Vermont Council on Aging) joined in the suit, which continues.
COVE will continue to work closely with the Legislature on this issue as well, until we are satisfied that the APS system is complying with statute and fully protecting vulnerable adults.
COVE supports S.24 and H.105, which would require the Department of Disabilities, Aging, and Independent Living (DAIL) to provide monthly reports to the General Assembly regarding its APS Program. The bill also calls for an independent evaluation of the APS services provided by DAIL. (Please see page 4 for additional information on APS.)
7. VPharm Pharmaceutical Assistance Program: We discovered last March that the premiums paid by recipients in this program ($15-$50/mo.) are almost as much as the overall benefits they get from the program. If, as some evidence indicated last year, the state is making a profit from this program, we would expect DVHA to at the very least call for a reduction in the $15, $20, and $50 monthly premiums in VPharm I, II, and III respectively. A study report by DVHA on the relative value of VPharm was due in early January, but has been delayed. (Please see page 5 for additional information on VPharm.)
8. Kinship Caregivers: COVE will support measures to help grandparents and other family members caring for their young relatives (when the parents are not able to do so) to get the supports and assistance the children need – and to which they are entitled – so that these dedicated caregivers can afford to provide secure loving homes for the children, without putting themselves into financial distress.
9. H.10 Insurance Coverage for Hearing Aids: COVE supports this bill, which requires health insurers to provide coverage for hearing aids and directs the Green Mountain Care Board to consider including coverage for hearing aids as part of Green Mountain Care.
10. S.35 Licensed Dental Practitioners: COVE supports this legislation to establish and regulate licensed dental practitioners inVermont, in order to increase access to affordable oral health care for Vermonters of all ages.
11. Additional and Appropriate Consumer Protection for Elders: COVE participated in a task force that looked at this area, and expects to support the recommendations that were provided by the task force to the legislature in early January, once the bill is introduced.
12. Paid Sick Leave: COVE participates in the “Paid Sick Days Campaign,” a broad coalition supporting legislation which would allow employees to accumulate up to 7 days of paid sick leave during the course of a year, and to use the time to take care of a family member, including a child or parent.
(Topic numbers correspond with same numbers on pages 1 & 2.)
2. Choices for Care: CFC is Vermont’s long-term care program for low- to moderate-income seniors and adults with disabilities. It provides for both nursing home and home- and community-based care. The program has been very successful in giving Vermonters a choice about where to receive services and in saving the state money. The biggest problem CFC has repeatedly encountered is deciding how to use those savings – whether to reinvest the savings in an improved program, as promised when the program was created, or to offset other pressures and priorities in the state budget.
The administration continues to propose reductions in funding and/or services inCFCeach year, despite the fact that several million dollars in savings are realized annually because more and more people choose to receive long-term care services in their homes. The savings are either held in unnecessary reserve or used instead to pay for other programs, including ones unrelated to long-term care, despite the requirement in statute to reinvest the savings in home-and-community-based care. COVE continues to fight, with the support of our partners who are providing services to seniors and people with disabilities, to get theCFCsavings used to meet unmet need and increase services to those who qualify.
4. Dual Eligible Waiver Proposal: “Dual eligibles” are people who receive both Medicare and Medicaid. The state has requested a waiver from the federal government to combine services for “duals” into one program, run and paid by the state as a managed care entity. “Duals” may choose not to participate in the program.
COVE and Vermont Legal Aid (VLA) worked with the administration during the 2012 legislative session to put basic baseline protections into the important dual eligible waiver proposal. When first introduced, it had no protections and would have given the administration a blank check to write the application any way it saw fit. Most of the new statutory protections insure that new “duals” will not receive any less procedurally and substantively than they would under either Medicare or Medicaid alone. One important last minute improvement required that at least half of any budget savings in any given year be reinvested to enhance the waiver. If done properly, the waiver can provide an important option for low-income seniors in how their care is delivered and coordinated.
A significant new development is that VT has received a major grant to reform its payment methodology for all of health care to a capitation model. That would include services provided under the dual eligible waiver and would be an important precursor to the Green Mountain Care single payer proposal in 2017. One initial question we raised at the Medicaid Exchange Advisory Board was whether that could change the voluntary nature of the waiver or any other choice issue in Medicare. While it appears not, it is a question that COVE will continue to ask as these complex proposals develop. A recent update on this grant revealed that everything has now been delayed into next year, with many questions still unanswered.
5. LIHEAP Fuel Assistance: The federal LIHEAP provides assistance paying for home heating for people of all ages whose household income does not exceed 150 percent of the federal poverty level.
Thanks to the state supplementing $20 million in federal funds with $8.8 million in state funds, the average benefit per household for 2013 is once again $900, which is a good achievement given that the caseload is up several thousand households. On the other hand, if the winter remains cold and fuel prices rise, the gallons able to be bought, and the overall percentage of an average heating bill assisted through this program, will likely be going down.
We need to break the cycle of having to go to the executive branch each fall to ask how much they can afford to supplement the federal LIHEAP funding. We need to secure a dependable appropriation or find a funding/revenue source. The Governor’s proposed 2014 budget addresses that need to a significant degree, but we need to identify additional revenue in order to fully fund the program and keep all low-income Vermonters (many of whom are elders) warm during our cold winters.
An expansion of the gross receipts tax on all fuels to help low income fuel assistance has been suggested by some as a logical source of new revenue. However, we know that many other people have their eyes on that same tax for such things as weatherization and renewable energy. They are calling it a thermal tax and they have the benefit of a lengthy summer study report backing the need.
6. Adult Protective Services: APS investigates reports of abuse, neglect or exploitation of vulnerable adults, and if the reports are substantiated, can take steps to protect the victim and put the perpetrator on the adult abuse registry to ensure that person cannot get another job working with vulnerable adults. There are statutory requirements as to how much time is allowed for opening an investigation and notifying the reporter and victim of progress, etc.
For several years now COVE has questioned the adequacy and statutory compliance ofVermont’s APS program in protecting vulnerable adults against abuse, neglect and exploitation. After informal discussions about how to get the program back on track broke down, COVE and Disability Rights Vermont (DRVT) sued the state to force compliance with the law. Last spring, two Area Agencies on Aging (Senior Solutions and Southwestern Vermont Council on Aging) joined in the suit.
The legislature has also been very concerned about this issue, and the Health Care Oversight Committee (HCOC), which received monthly reports from the Department of Disabilities, Aging and Independent Living (DAIL) on APS over the summer and fall, has reported back to the standing committees with its recommendations. Unfortunately, DAIL’s new Harmony computer system, which is now up and running, is not producing all of the information that DAIL promised during the 2012 session.
COVE appreciates the efforts of House Human Services, Senate Health & Welfare, the Health Care Oversight Committee (HCOC), and other legislators to address our concerns and to obtain the information they need to understand how things are progressing in APS. We will continue to work with the legislative committees until we are satisfied that the APS system is complying with statute and fully protecting vulnerable adults. The commissioner has testified that the program is fully staffed and working wonderfully, but that is very different from what people on the ground in COVE’s network are telling us.
The lawsuit has had the effect of shining a public spotlight on APS and we should note that it has resulted in significant improvements and greater attention at DAIL, although many serious problems still plague the program, and the lawsuit remains active for that reason. While some may say that such actions might have happened without a lawsuit, it is obvious that attempts at collaboration for years brought little change.
7. VPharm pharmaceutical assistance program: VPharm is the state program for seniors under 225% of poverty which helps 12,000 seniors with their Medicare part D premiums and all other out-of-pocket drug expenses not otherwise covered by Medicare – deductibles, co–pays and coinsurance.
We discovered last March that the premiums paid by recipients in this program ($15-$50/mo.) are almost as much as the overall benefits they get from the program. There is not a great deal of state assistance anymore as the federal government has covered more and more of the cost of Medicare Part D. Furthermore, in addition to collecting premiums from recipients, the state also receives and keeps rebates from the manufacturers.
After all is said and done, the state may actually be making a profit on this program, which would be outrageous. If that is the case, we would expect the Department of Vermont Health Access (DVHA) to at the very least call for a reduction in the $15, $20, and $50 monthly premiums in VPharm I, II, and III respectively. A study report by DVHA on the relative value of VPharm was due in early January, but has been delayed.
COVE will revise this list periodically as these issues evolve, other issues arise, and bills continue to be introduced through the 2013 legislative session.