By David Mickenberg
- Choices for Care (CFC): CFC is Vermont’s long-term care (LTC) program for low-to moderate-income elders and adults with disabilities. It provides for both nursing home and home-and community-based care for those with financial and clinical needs for the same. The program has been very successful in giving Vermonters a choice as to where to receive services and in saving the state significant dollars. The biggest problem CFC has repeatedly encountered is how to use those savings - whether to reinvest the savings in an improved home and community based services program, as required by the Federal waiver, or to offset other pressures and priorities in the state budget.
The Choices for Care (CFC) program has become a topic of discussion in the appropriations process, beginning with budget adjustment, in which the administration proposed both an increase in the budget to cover their contingency funds as a way to mitigate against high and highest needs waitlists, as well as a cut of $900,000 from moderate needs which was attributed to underutilization. COVE lobbied the Appropriations Committee members and through that discussion we were better able to understand the “underutilization” argument. We were able to get commitments from the Administration to allow programs such as Adult Days and Area Agencies on Aging (AAAs) to spend the money they have obligated for FY ‘15 for moderate needs, but perhaps have not spent. This was a win, as it means that, despite the $900,000 cut there will be money dedicated to continuing the program that providers implemented this year. However, the Administration has said that unlike in the past, they will not allow agencies to reallocate unused funds from one agency to the next, which is disappointing.
The House Appropriations committee is beginning to look at the FY ‘16 Department of Disabilities, Aging and Independent Living (DAIL) budget. Included in that budget are a few modest CFC increases, including a 6 month, 2.5% Medicaid “Provider Bump” (increase in reimbursement rates). There is a statutory increase for the nursing home industry that equates to a $3.2 million increase, despite nursing home utilization going down. There are also several cuts to Home and Community Based Service (HCBS) providers, including a $115,710 cut to Adult Days and a $433,622 cut to case management at Enhanced Residential Care facilities, generally administered by the AAAs. COVE will continue to advocate for all aspects of the LTC continuum and discuss with legislators the efficacy of the Administration’s proposals. It should be noted that the broader Medicare bump would not cover LTC providers. COVE and its partners will also be pushing for language that provides for a statutorily mandated increase for HCBS similar to that provided to nursing homes. This will be an important discussion.
- Low Income Home Energy Assistance Program (LIHEAP): The federal LIHEAP provides assistance paying for home heating for people of all ages, including many elders whose household income does not exceed 150 percent of the federal poverty level.
The Governor’s FY ’16 budget cut LIHEAP by $6 million from last year’s appropriation for FY ‘15. In his budget presentation he committed to reexamining this cut in the FY 16 budget adjustment process next year, as has been done in the past. The rationale for this cut was that, because fuel prices have dropped and enrollment in the program has gone down, this cut would not have a meaningful impact on benefits for current participants. However, subsequent to the cut the Administration realized that the federal eligibility level applied to those Vermonters at 150% of poverty, whereas because of the state dollars budgeted previously, we could cover folks at 185% of poverty. This fact has the potential to knock approximately 4,000 Vermonters off the LIHEAP program next year. The Administration has proposed a solution which may mitigate the issues, but if the $6 million cut were to continue, it would result in an approximately 11% reduction in purchasing power for beneficiaries. COVE will continue to advocate strongly with the appropriators about this issue to ensure that Vermonters have the fuel assistance they need to stay warm during the heating months.
- Adult Protective Services: APS investigates reports of abuse, neglect and exploitation of vulnerable adults. When reports are substantiated, APS can take steps to protect the victim and can put the perpetrator on the adult abuse registry to ensure that person cannot get another job working with vulnerable adults.
H.131 and H.112 APS: There are two bills that address concerns related to Adult Protective Services. H.112 makes it easier to investigate allegations of financial abuse of vulnerable adults, a concept that COVE has supported in the past. H.131 provides greater protections for abusers of vulnerable adults, including greater transparency about the nature of the charge, an attorney for the alleged abuser, and other protections. COVE believes that these protections go too far, and therefore, we oppose this bill and will monitor it closely.
- Transportation: According to testimony on February 6 (in the Senate Transportation Committee) by Barbara Donovan, Public Transit Administrator at the Agency of Transportation (AOT), there will be no change in the administration of Medicaid transportation in 2016, and funding for the Elderly & Disabled Transportation Program remains level. She also noted the consolidation of the Connecticut River and Deerfield Valley transportation agencies, and that Addison County was providing management services for Stagecoach.
Committee members discussed the need for bus routes to serve hospitals and health centers, and Senator Kitchell highlighted the need for transportation to adult day centers. Senator Mazza suggested that C.I.D.E.R. (Champlain Islanders Developing Essential Services) was a good model for other areas to follow.
- S.20 and H.1 Licensed Dental Practitioners: The “Licensed Dental Practitioner” bill has been reintroduced this year in both the House and the Senate, and the Vermont Oral Health for All Coalition (of which COVE is an active member) is working hard to get it through the Senate before “crossover.” The bill would establish and regulate mid-level dental practitioners, who would work under a collaborative agreement with a dentist. Adding these practitioners would help to increase access to oral health care for Vermonters of all ages. The current shortage of dentists in Vermont is projected to increase as more dentists retire in the next decade or two and the supply of new dentists remains inadequate nationally to fill states’ needs.
- H.25 Natural Burial Grounds: COVE testified in favor of H.25, which would expand the availability of natural burial grounds. This is an issue that COVE has supported historically. We said that natural burial grounds should be an option available to Vermonters, given that it is a cost effective, environmentally conscious and natural burial process. The House General committee seemed very interested in the subject.
- 7. 38 Long Term Care Task Force: COVE is strongly supporting this bill, which would establish a long term care task force to assess and catalogue LTC services provided by or funded by the state. This task force is a fantastic opportunity to establish a body that can raise the level of discussion of LTC issues in Vermont.
- S.15 Earned Time Off: The earned sick days bill has been introduced in the Senate with a companion bill in the house. It would provide for a set number of days employees could take as time off. Any businesses that already give at least the amount of time off required in the bill would not be affected by it. The Senate Economic Development committee has held two days of testimony on the topic. It is unclear at this time whether the bill will advance, as there is vocal opposition from the business community.
- H.160 Older Drivers: A bill has been introduced in the House again this year to require additional testing for older drivers. It would require a vision test starting at age 75 and a driving test at 80 or older for renewal of drivers’ licenses. This bill is blatant age discrimination and is not supported by the facts related to safe driving. COVE does not support this bill in its current form and would encourage a more thoughtful discussion of safe driving generally.
- H.94 and S.5 Observation Status: Two bills have been introduced involving “observation status” in hospital admissions. This is an important issue, as seniors are often put on such status instead of being admitted as inpatients, resulting in the hospital stay being covered differently and an inability to access important Medicare funds to be used for care following their release from the hospital. COVE supports these bills. In conversations with the Hospital Association it seems that they understand the motive behind the bills, but would prefer a voluntary approach to a legislative mandate.
- H.110 Jury duty for elders: This bill would allow elders 70 and over to opt out of jury duty. It appears to send a message that elders are somehow less capable than younger Vermonters, and therefore we cannot support it.
- S.40 and H.46 Adult Fatality Review Team: These bills would establish a review team that examines the deaths of vulnerable adults and tracks this information for review by the legislature. COVE supports this idea.
PUBLIC HEARINGS
Tuesday, February 24, 2015 - 2:30 p.m.-3:30 p.m. and Wednesday, February 25, 2015 -9:30 a.m.-10:30 a.m. - Room 11 - House committee on Appropriations - Public hearings for the Governor’s proposed FY 2016 budget. Sign up with Theresa Utton-Jerman at (802)828-5767 or [email protected] or in Room 40.
Governor’s Proposed Budget: http://finance.vermont.gov/state_budget/rec
Individual department proposed budgets: http://www.leg.state.vt.us/jfo/dept_budgets_fy_2016.aspx
