Michael Sirotkin: 10/3/11
Political News- Irene continues to be a game changer in all respects. As you will readily see below, it is already impacting the state budget and several of our issues.
1. Budget – The joint fiscal committee met again last Monday and now total Irene costs to Vermont and Vermonters is expected to exceed $1 billion dollars! Clearly the state’s general fund expenditures will be impacted greatly. Perhaps most important in calculating the amount of new state funds needed to address the needs caused by Irene will be the federal matching rates Vermont qualifies for. Some work will be 100% federally funded; other projects may have matching rates as low as 75%. Some projects will probably be all state funds.
Of equal importance may be the loss of revenues caused by Irene. The national news, repeatedly showing VT as a major disaster area, appears to be dissuading many tourists from coming this Fall.
Higher expenses and reduced revenues can only make for a challenging legislative session for our programs and priorities. I’m attaching the so-called “ budget gap” materials given to the joint fiscal committee last week. As you can see, there appears to be more than enough money to bridge the gap at this point, but that assumes the state will need only $20 million in new monies to address Irene. It is hard to imagine that will suffice.
2. Fuel Assistance – At this month’s HEAT task force we were advised that federal funding still remained unclear, with the projected amounts ranging from$ 11.5 m to $25.6m (last year’s LIHEAP block grant to VT was $25.6 million). At the end of last week the US Senate voted to effectively give Vermont about $20million. While this is better than it could have been, the amount is far from final and still would represent an average 15% cuts in benefits.
Here is the latest out of Washington for the 3 active LIHEAP funding proposals
Obama Budget
Total Funding $2.6 billion
Block Grant Funds $2 billion
Contingency Funds $600 million
Total for Vermont $11.598 million
VT Average full-season fuel-liability benefit projected $400
House Budget
Total Funding $3.4 billion
Block Grant Funds $3.4 billion (same as the senate)
Contingency Funds $-0-
Total for Vermont $18.713 million
Uses the new formulas that disadvantages the cold weather states
VT Average full-season fuel-liability benefit projected $711
Senate Budget
Total Funding $3.6 billion
Block Grant Funds $3.4 billion (same as the House)
Contingency Funds $200 million
Total for Vermont $20.047 million
VT Average full-season fuel-liability benefit projected $765
We may now have a new basement level of funding with the House budget.
Also of significance is that fuel prices are expected to be $4/gallon by winter and this represents another 15% decrease in purchasing power. Overall we may need many millions in state dollars to supplement the federal funds in order to avoid cuts to this essential program.
I guess the good news is that key legislators and the executive branch continue to acknowledge the problem as something the state will have to address. This means that they are planning on finding additional state dollars to assure Vermonters stay warm this winter.
COVE has begun looking for stories to use with legislators to make sure they keep their commitment to these most vulnerable Vermonters.
One final piece of good news on fuel assistance is that the decision of the Public Service Board to establish a low-income electrical affordability program – which could remove arrearages and provide a 25% subsidy on the electric bill of GMP and CVPS customers at 150% of poverty-, has become final. If the program can get up and running by March, it can save the fuel program over $1m in crisis benefits as crisis benefits to prevent shut offs would be greatly reduced.
3. Adult Protective Services (APS) – Vermont’s APS program has deteriorated over the last few years with less staff 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.
As we reported in previous updates, we have been meeting with AHS and DAIL since last fall to address the multiple challenges/violations in this program. About 6 months ago we asked VT Legal Aid to explore the possibility of litigation to bring the state into compliance. On the eve of filing a complaint, DAIL agreed to work collaboratively with advocates establishing written protocols and benchmarks to address the shortcomings and delays in APS and a remediation plan was agreed to.
Two weeks ago several of us met with the Commissioner and the APS Director. Unfortunately, it was confirmed that several key components agreed to under the remediation plan (such as new staffing levels and reducing the backlog of pending investigation) continue to be in non-compliance. As such, litigation is again being seriously contemplated. One piece of good news is that the most serious cases of abuse appear to be being dealt with in a more timely fashion. However, “less serious” cases of neglect and financial exploitation are still waiting months to be investigated.
While the challenges of Irene have no doubt made the state’s work more difficult and challenging, virtually all of the shortcomings of this program existed well before Irene. Moreover, it is a well-known fact that disasters such as Irene, only serve to exacerbate the numbers and degree of elder abuse, neglect and exploitation that is likely to take place in our communities.
4. Healthcare Reform – It is still unclear how the exchanges going into effect in 2014 will impact retirees’ health plans. While Medicare will probably not be impacted by the exchanges, Medicare supplements and collectively bargained and other retiree supplemental plans may be. I will be meeting every 3 weeks this Fall, along with other groups, such as the state employees and the VtNea, with the state director of health care reform and the commissioner of BISHCA to better understand these issues and how to protect retirees’ and seniors’ interests.
5. Dual Eligible Project – AHS is proceeding aggressively on developing a plan to submit for funding to CMS next Spring. I attended the most recent stakeholder meeting and it was for the most part a summary of the four working groups. One issue that was touched upon briefly is the voluntary nature of enrollment for these 21,000 Vermonters on both Medicare and Medicaid. The state is likely to push very hard for the so called “opt –out” provision, where all seniors are presumed to be part of the new managed care entity but can choose, by notifying the state in writing, to opt out. The other choice, which would probably result in far less participation, would be the “opt-in”, where to participate one would have to take affirmative action of writing the state and asking to be part of the plan.
AHS recently decided to combine all the working groups and eliminate all the remaining stakeholder meetings, as there appeared to be great overlap in attendance. It is unclear how much legislative involvement is envisioned by AHS in making this waiver a reality. Applications for the implementation phase of the waiver are due next spring. Legal Aid is monitoring the working groups carefully and there are also national groups who are having periodic conference calls to make sure state’s waivers are protective of consumer interests. It is already clear that AHS and BISHCA view the dual eligible population as a group where many dollars in health care delivery can be saved. This is no doubt true, but we need to be sure quality and reasonable choice is also preserved.
