1. Low Income Home Energy Assistance Program (LIHEAP): The federal LIHEAPprovides 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 Legislature funded the state portion of LIHEAP for FY ’15 at $6 million, which in addition to federal funds and reserves set aside, should be sufficient to keep recipients at the level they were last year. In addition, the legislature authorized DCF to provide crisis fuel in an expedited way to those households that applied for expedited seasonal fuel but were not going to receive the fuel in time to prevent them from running out of fuel. This is reflective of the circumstances of this winter in which, given the cold temperatures, there was a backlog of crisis fuel requests and an inability to meet the demand quickly enough. Finally, the legislature was very concerned about the interplay between low-income weatherization and LIHEAP. Language was inserted into the budget to require the fuel assistance office to evaluate the home heating needs of homes before and after weatherization. After the analysis is conducted the legislature requested recommendations about adjustments to appropriations to LIHEAP either up or down to account for the interplay between LIHEAP and weatherization. The important point that we will continue to make is that, as fuel prices have risen and benefit levels have declined, recipients’ purchasing power has been reduced, even if they have more efficient homes as a result of weatherization. In other words, there continues to be a great need for the LIHEAP program, and further cuts would make it even more difficult for low income Vermonters to heat their homes.
2. 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 promised, or to offset other pressures and priorities in the state budget.
The administration’s proposed funding level for FY ’15 was approved by the legislature. In addition to the FY ’15 appropriations, almost $3 million in savings was allocated through the budget adjustment process, to be used over two years to support the moderate needs program. COVE and its allies were also able to get the legislature to agree to spend another $1 million in additional savings on investments into home and community based services. In the last day of the session language was inserted to say that a portion of the savings should be used to help pay for wages for independent home care workers, in addition to the other priorities that the legislature set forward (such as assistive devices and home access needs). We urged Legislators, and had language included in the budget, not to use $1.9 million in CFC savings (from lower utilization of nursing homes) to pay for a statutory annual increase in nursing homes’ funding. While they inserted such language, they continued to fund the statutory increase out of the base CFC program, arguing that it was not technically coming out of savings. This will be an issue that we will continue to push next session.
There will be discussions over the summer and fall about how best to appropriate the CFC savings in FY ’15 budget adjustment. The legislature did insist upon reserving 1% of CFC funds to make sure that there is some cushion to prevent wait lists from developing. By October 1st, 2014 the Department of Disabilities, Aging and Independent Living (DAIL) is required to present a report outlining the needs in CFC. One consistent theme is the need for non-medical transportation, which was mentioned in last year’s report but did not receive the needed support this session. That could be an area of emphasis in the discussion about reinvestment in 2015.
3. Transportation: We are happy to report that the additional funds proposed by the Administration for public, “Elderly & Disabled” (E&D) and VT Kidney Association transportation remained in the final-passed transportation budget.
4. Paid Sick Leave (H.208): The Paid Sick Leave Coalition, of which COVE is a member, was very active this session, but was unable to get H.208 out of House Appropriations for a floor vote, despite continued pressure on House leadership. The Coalition is already reconvening to strategize on how to move this legislation next year.
5. Telephone Lifeline (H.576):H.576 (now Act 105 of 2014:http://www.leg.state.vt.us/docs/2014/Acts/ACT105.pdf changes the recipient of applications for the Telephone Lifeline program from the Tax Department to the Department of Children and Families (DCF). During the process, DCF agreed to develop an interagency MOU which would continue to promote the program through tax outlets such as in the tax booklet; on the tax department’s website; and through outreach to tax preparers. In addition, Senators Sirotkin and Ayer sent a letter to the Public Service Department requesting that the Department look at ways to expand this program to cell service and internet companies offering phone service. COVE will be working with DCF over the summer to develop the MOU and to make sure there is follow up on the promise to promote the program as a tax benefit.
6. 3Squares VT (H.620): H.620 addresses a problem that results from an excessive overpayment error rate in the Department of Children and Families’ (DCF) Supplemental Nutrition Assistance Program (3 Squares VT). Cove and AARP issued a joint letter to the committee to support the efforts to relieve the burden on claimants for having to pay back anything received as a result of the DCF’s error. This bill did not make it out of the Appropriations Committee. However, because of the pressures from advocates such as Hunger Free Vermont, Vermont Low Income Advocacy Council, Legal Aid, COVE and others, the Administration took regulatory action which required that any household that has an overpayment resulting from agency error is to receive an automatic compromise of 50% of the debt, a big win for recipients of 3Squares. In addition, the regulation will raise the threshold for collecting over payments from the current $400 to $600, which should also help many recipients.
7. Adult Protective Services (APS) (S.23): The proposal in S.23 would have established guidance by which a health care provider or financial institution would be allowed/required to provide medical or financial records of a vulnerable adult to a law enforcement officer or an adult protective services worker investigating whether the vulnerable adult was the victim of abuse, neglect, or exploitation. This bill passed the Senate but was not taken up by the House.
8. Accountable Care Organizations (ACO’s): An ACO is a network of providers that agrees to be held accountable for the cost and quality of care for a defined patient population. To date, the defined patient populations for which ACOs have been approved in Vermont are Medicaid beneficiaries, Medicare beneficiaries and some limited private insurance populations. If the cost of care for the patient population covered by an ACO ends up being less than would have otherwise been expected, and quality targets are met, providers keep a share of the cost savings. The payer (the government, as the insurer in the Medicare/Medicaid context) keeps the rest.
Recap: Cost savings are an incentive for providers to cooperate and reduce health care spending. For example, providers may be incented to avoid unnecessary tests and procedures and prevent duplication of care.
What are the risks of ACOs? One risk is that the reduction in cost could come by limiting or rationing care. For example: a provider might not order an expensive test that is medically necessary; a provider might “cherry pick” patients, e.g., choosing healthier patients and/or refusing to accept patients with expensive health conditions. Another risk is that the increased consolidation of hospitals and practices will result in fewer independent doctors and hospitals, reduce competition, and drive up costs.
Why are ACOs of concern to COVE? 1) ACOs are an experimental model with limited data available to support the outcomes. 2) There is limited and unclear oversight of quality of care. 3) We don’t know yet how the ACOs’ care systems will integrate with the current community based long term care systems that are so important to COVE and our members. 4) We fear that there will be limited consumer input and oversight of these systems, including legislative oversight. There has been limited consumer or legislative input during the planning process. 5) Similarly, COVE is concerned about the transparency and inclusiveness of the ACO governance.
Update: The House Health Care and Senate Health and Welfare committees listened to andlearned about concerns regarding ACOs. There was no formal action taken this session by the legislature, and the legislative oversight of ACOS is unclear at this point.
9. Licensed Dental Practitioners/LDPs (S.35): Despite Senate Government Operations voting this bill out on a 4-1 vote and Senate Health & Welfare reviewing it informally and supporting it, the bill went to Senate Finance where it was not advanced. The co-sponsors of the bill have pledged that they will reintroduce the bill next winter and we anticipate that it will be taken up very early in the session, if the same committee chairs are reappointed in January. COVE will continue to work on this important bill.
10. Minor Guardianship (H.581): This bill, intended to enhance families’ ability to keep children in the home with non-parental guardians when parents are temporarily unable to take care of the child, affects all generations in kinship families, including grandparents raising grandchildren. It will change some of the processes for individuals getting guardianship of minors, and the individuals will be better informed of the rights and responsibilities of all the parties. The bill passed both houses: http://www.leg.state.vt.us/docs/2014/bills/Passed/H-581C.pdf
11. Pension Lending (S.223): This AARP priority bill is now Act 109 of 2014: http://www.leg.state.vt.us/docs/2014/Acts/ACT109.pdf. It effectively bans the practice of targeting financially insecure pensioners by offering lump sums for part or all of their pension benefits in exchange for an obligation to redirect the pension payments to the company. Exorbitant fees often reaching 40-60% are hidden these transactions. Vermont is the first state to ban this practice – before it gets a real foothold here.
12. Department of Public Service (S.25): Another AARP priority bill, S.25 is now Act91 of 2014: http://www.leg.state.vt.us/docs/2014/Acts/ACT091.pdf. It mandated that the Department of Public Service give “heightened consideration” to under-represented groups such as low-income, small business and residential rate payers, particularly as it pertains to utility proceedings. The Department is set to report back in July about the impact of this law and the extent to which they have worked to provide additional focus on traditionally under-represented groups.
13. APS and Housing (H.750): This session COVE and the Public Housing Authorities, the Barre Housing Authority in particular, worked together to address a concern about having the appropriate tools to protect vulnerable adults who receive Section 8 rental assistance. COVE testified in the House Human Services and House General, Housing & Military Affairs committees on the issue and got the committees to send a letter to DAIL and stakeholders asking them to examine the issue and come back next session with recommendations. All of the interested parties seemed motivated to address this issue.
14. Reach Up (H.790): Many kinship families, including grandparents raising grandchildren, benefit from the Reach Up program. H.790, as passed by the Legislature (http://www.leg.state.vt.us/docs/2014/bills/Passed/H-790C.pdf) provides a full year of additional child care subsidies, without any grant reductions. The new formula calls for the first $250 plus 25% of the earnings to be disregarded, which translates to about a 4%increase in income for families.
15. Health Care for Retired Teachers: For retired teachers, health insurance payments come from their pension funds, a financially unsustainable arrangement. After many years of effort, an agreement was finally reached among all parties involved that will make the pension system more financially stable and will spread the cost of the insurance moving forward among active teachers, the state, and local school boards.
16. Training needs for direct care workers (H.301): This bill would have set up a task force to assess the training needs of direct care workers who provide home and community based services through Medicaid. With lack of support from the administration for financing the task force, the Quality Care No Matter Where Coalition, of which COVE is a member, accepted an offer to participate in a newly-formed sub-committee of the VT Health Care Innovation Project’s Health Care Workforce Committee (whew!) to address the issues that were in H.301.
MAY IS OLDER AMERICANS MONTH
In recognition of the 2014 theme, “Safe Today. Healthy Tomorrow,” COVE would like to share the links below to scheduling information for the Vermont RSVPs’ Bone Builders Programs. For COVE members who do not have internet access, you may find out about classes by calling the phone numbers listed with each link.
The RSVP Bone Builders Osteoporosis Prevention and Reversal Program is an effective combination of weight bearing, balance and stretching exercises, with nutritional information, and support for all stages of osteoporosis. It is based on the research done by Miriam Nelson around the benefits of strength training in older adults. When followed diligently, the Bone Builders program and exercises can help the body to increase bone density and reverse the effects of osteoporosis. Bone Builders is a free, ongoing program open to all those with concerns about osteoporosis. All classes are about 50 minutes in duration.
Addison County RSVP Bone Builders Class Schedule
Class locations, days, and times listed here: http://www.volunteersinvt.org/boneclass1.php
For further information about Addison County classes, please call the RSVP office at 802.388.7044.
Bennington County RSVP Bone Builders Class Schedule
Class locations, days, and times listed here: http://www.volunteersinvt.org/boneclass2.php.
For further information about Bennington County classes, please call the RSVP office at 802.447.1545.
Caledonia, Essex, Lamoille, Orange, Orleans and Washington County RSVP Bone Builders Class Schedule
Class locations, days, and times listed here: http://www.volunteersinvt.org/boneclass3.php.
For further information about these classes, please call the RSVP office at 802.888.2190.
Rutland County RSVP Bone Builders Class Schedule
Class locations, days, and times listed here: http://www.volunteersinvt.org/boneclass4.php.
For further information about Rutland County classes, please call the RSVP office at 802.775.8220.
Windham County RSVP Bone Builders Class Schedule
Class locations, days, and times listed here: http://www.volunteersinvt.org/boneclass5.php.
For further information about these classes, please call the RSVP office at 802.254.7515.
Windsor County RSVP Bone Builders Class Schedule
Class locations, days, and times listed here: http://www.volunteersinvt.org/boneclass6.php.
For further information about these classes, please call the RSVP office at 802.885.2083
