Michael Sirotkin: 2/3/11
POLITICAL NEWS - Gini and I met with AHS Secretary Doug Racine several weeks back and while the budget report he gave us was sobering (see below) he did emphasize that it was a work in progress; and that if we could present alternatives that they would be entertained. I also had several meeting with Susan Weary where we made progress on the Choices for Care waiver. So far the session seems to be mostly about the budget and health care reform with little else moving. Rumor has it, however, that rapid progress on health care may not occur this session and detailed review of the Hsiao proposal may get effectively pushed back until after the session.
FUEL ASSISTANCE – December’s report on fuel assistance was quite bleak with the major source of federal funds facing a potential 40% cut. Surprisingly, just before Christmas, Congress acted and restored full funding, raising the block grant to VT to over $25 million. Applications are up, as we knew they would be, and fuel prices are higher than anticipated. So folks will see some decrease from last year (far more households will be eligible) but nowhere near the amount that had been anticipated just last December.
We have just received word of the average bonus benefit amounts households will see credited to their fuel bills. On average households will see an additional credit of $375 this week above the $660 they received earlier in the winter for a total average benefit of $1035. Last year’s average benefit was $1136. This relative small reduction was expected as we have expanded greatly the number of household’s eligible (e.g., no asset test anymore to qualify)
TRANSPORTATION - “Smart Streets” is a legislative proposal to ensure all future road projects take into consideration the transportation needs of mobility impaired Vermonters and the promotion of alternative means of transportation. If passed, it will promote walking, biking, public transportation, etc. in the future design of new roads, as well as in the existing road improvements and expansions. AARP has been working this issue hard over the summer and the issue has good momentum this session.
The Agency of Transportation has testified that they will be placing greater priority on public transit as compared to the previous administration. Our preliminary understanding of the Governor’s budget, however, is that it will effectively level fund public transportation operating line items in FY’12
HEALTH CARE – As mentioned above, health care reform seems to be consuming the statehouse. However, there are so many questions surrounding the Hsiao report that recent rumors (which make sense) is that not much substantive change will be enacted this year. Instead, a blue ribbon board will work out the details over the summer and a full package of proposals will be introduced next year. Marge Power put together excellent comments regarding senior citizen concerns with the Hsiao report, which COVE supports. We will highlight two major omissions – long-term care as a covered benefit and non-inclusion of Medicare in the single payer model – as well as the proposal to subject working seniors to a payroll tax for which they will get nothing in return.
PROTECTIVE SERVICES (APS) - Vermont’s APS program has deteriorated over the last few years with less people and resources protecting elders and other vulnerable adults from abuse, neglect and exploitation. We find our state inexplicably ranked near the bottom of the states in the numbers of investigations and substantiated cases, as well as seeing too many cases being unreasonably delayed in their resolution. We need to treat these cases every bit as seriously as cases of child abuse, and need to do a full review of why the program is not functioning as well as other states’ programs.
We met yet again with DAIL last week to explore the extent of the problem and possible solutions. We confirmed again that DAIL is admittedly triaging complaints, so credible reports of abuse; neglect and exploitation are being delayed weeks or months beyond the required 48-hour required timeline. If the situation gets markedly worse and it is reported, only then does it move up the queue. The number of reports of abuse, neglect or exploitation waiting to be investigated has now jumped to 350!
We have asked VT Legal Aid to explore the possibility of litigation to bring the state into compliance. They are seriously researching this along with Disability Rights Vermont, and may be sending a demand letter to the state shortly.
In the interim, it is clear that DAIL knows they have a problem and are making attempts to transfer more resources to the program- but they have so far to go to come anywhere near what is called for in law. The Governor, Secretary and Commissioner have all made this a top priority and apparently up to 10 retired police officers may be hired on a temporary basis to address the backlog of investigations.
The Policy Committee and the Board also asked the Vermont Senior Law project to explore using the state rule making process to highlight and get to the bottom of the problem. We have talked extensively with VSCLP and are nearing the point of requesting program protocols (or lack thereof) be reduced to formal rules. If we proceed in this fashion, there will likely be public hearings where we will need stories and witnesses.
FY’12 BUDGET- I am attaching the list of budget cuts handed out the day of the Governor’s budget address. Far and away the biggest cuts to low-income elders are those to the home and community based side of the choices for care program (see below). Also attached is a press release, which was picked by radio, weeklies, and the internet. The major cuts impacting seniors are in the DAIL and DVHA budgets and includes choices for care (see below) and cuts to the
AAAs
CHOICES FOR CARE - This program was designed to provide greater choices in long term care (e.g. home and community based services) for those Vermonters eligible for Medicaid. It was also designed to save the state money by reducing the utilization of expensive nursing home care. Unfortunately, the program has been periodically shut down – as it is currently – to new applicants. This is coming at a time when the evidence shows significant reductions in nursing home days and millions of dollars in savings. These savings were supposed to be reinvested in improved and expanded home and community based services, and with the freeze on new applicants, the intent of the program is unfortunately not being honored.
Again, we have been working closely with VSCLP to dig deeper into this issue. I have also spoken at length with the DAIL commissioner and testified before 3 committees. The commissioner understood our concerns and has recently testified that the waiting list was being eliminated.
That is the good news. The bad news is that the new proposed budget hits home and community based services under the waiver hard. The caps to instrumental activities of daily living (IADLs) and respite/companion care are being cut by 50% or more, which will clearly jeopardize many seniors ability to continue to live in their own homes.
We needed to get out a press release early so that our concern with these major cuts would be on policy makers radar screen. Since then, we have consulted with VSCLP to refine the numbers a bit. Here is what we know at this point:
1) There are 1464 folks (Dec #) getting home based care that are getting cut; 332 on ERC who may be getting cut in IADLs but probably not C/R. The 2500 number must include moderate needs.
2) The IADL cut is 10.75 hours per month, or roughly $120 per month or $1450 per year. Most CFC Benes get the full IADL amount and would be subject to this cap and cut;
3) The Respite/Companion cut is much larger, 30 hours per month, roughly $280 per month or $3400 per year. A much smaller percent of CFC participants must get respite/companion, so this is a very large cut for those folks, most of whom get the full cap amount now and take the full cut (that is my assumption at least from the cases I have seen).
4) My guess is that the companion/respite cut impacts around 700 people on CFC, who likely also get cut on IADLs, so they lose roughly $400 per month or $5000 per year in CFC benefits total. This will be in the range of 10% to 20% of their CFC benefit.
5) “companion” care is only for those who can’t care for themselves and are socially isolated—the neediest of needy on CFC;
6) “respite care” is only to support unpaid caregivers like family, providing free care on top of what CFC\pays for.
7) Meal prep is not an IADL under the cap, so technically that is not getting cut. The capped and cut
IADLs are phone, money, household maintenance, housekeeping, laundry, shopping, transportation,
and adaptive equipment. We have had several fights over the years about “laundry” in cases for
incontinent clients; 2 hours a week for IADLs is totally inadequate for laundry alone for those folks.
We have already been gearing up to find seniors and family members willing to testify on 2/14 at the interactive TV public hearing before the Appropriations committees or to otherwise let their stories be told. Gini and I have already met with 2 key members of the Appropriations committee. While they were clearly sympathetic, they are also saying everyone is making similar claims and rainy day funds and new taxes are clearly off the table.
MODERNIZATION- We’ve all read the horror stories of hundreds; if not thousands of public assistance beneficiaries are being delayed in their receipt of food stamps, Medicaid, fuel assistance, etc. since the summer. Over the last few months, Legal Aid has been negotiating a resolution with DCF. And in December they announced an agreement. Here’s the synopsis VSCLP gave the policy committee:
We negotiated a settlement with the Dept over the processing delays for Food stamps and Medicaid and Reach up. The Dept has agreed to make major changes in how it processing applications and recertification, including working toward same day approval of applications They agreed to eliminate the current backlog of 2239 applications in a massive review this month. We are going to meet with them regularly regarding implementation and compliance. This includes auditing folks denied since July 1, and if we determine that a measurable percentage remain off the programs, the Dept agreed to restore benefits and/or provide notice to all terminated.
Legal Aid has made it clear that this agreement need careful monitoring to see if it is complied with. As promised, the House Human services committee is holding weekly hearings on this problem to oversee the progress.
