Senior Agenda Coalition of RI unveils legislative agenda to packed house of seniors

Published in RINewsToday on April 1, 2024

Last Wednesday, the main ballroom at the Crowne Plaza in Warwick was filled, to capacity. Hundreds came to the Senior Agenda Coalition of RI’s (SACRI)  2024 Legislative Leaders Forum to learn about the advocacy group’s issue priorities. House and Senate leadership, along with members of both caucuses came to listen, learn and to respond to SACRI’s four priority issues for 2024.

We’re back, and we are stronger than ever,” announced Maureen Maigret, SACRI’s Policy Advisor, to 275 attendees who came to this year’s annual legislative forum held on March 27, 2024.  Before she unveiled SACRI’s ambitious legislative priorities she painted a demographic picture of older Rhode Islanders.

The graying of Rhode Island’s population

“We know that 200,000 Rhode Islanders are age 65 and over, and this number is growing,” noted Maigret. According to the former state legislator and Director of the Department of Elderly Affairs, in just six years, 1 in 5 persons will be age 65 and over. Today, 20% of the population in 18 Rhode Island communities are in their mid-sixties and over.

Many seniors still work. They pay taxes, provide care to loved ones, volunteer to contribute to their communities, and religiously vote,” stated Maigret, who noted that they contribute over $3.28 billion to Rhode Island’s economy through Social Security benefits. 

Maigret pointed out that as the older population ages, the percentage of woman increases over men.  At age 65 and over , 56% of this age distribution are woman, 44% are men.  At age 85 and over, the percentage of women rapidly increase to 69% compared to 31% for men. And in nursing homes, 68% of residents are woman while 32% are men. 

According to the U.S. Census Bureau, many older Rhode Islanders have limited incomes. Twenty-seven percent of age 65+ households earn less than $25,000 a year, while 50% earn less than $50,000 a year.

With women leaving their jobs over the years to raise their family, it is no surprise to Maigret that women’s incomes are less than men, this ultimately resulting in a smaller Social Security benefit. The average Social Security benefits of women aged 65 and over ($20,333) is $5,000 less than their male counterparts ($25,204), she says.

Unveiling SACRI’s Legislative Agenda

“Keeping seniors strong” is the theme of this year’s legislative forum, Maigret told the hundreds of seniors and aging advocates in attendance before announcing the SACRI priorities. SACRI is pushing for legislative issues in the areas of:

·       Economic Security

·       Supports at Home

·       Community Connections

·       Housing Options

She called on the House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick), and Senate Majority Whip, Valarie Lawson (D-Dist. 14, East Providence), in attendance, to support House and Senate legislation, and state budget proposals to address these issues.

SACRI’s top legislative priority is to addressEconomic Security issues. Polls show that healthcare affordability is a major concern, and this impacts many seniors.  Maigret pointed out that Medicare premiums  and co-payment gaps have a major impact on low-income Rhode Islanders who struggle to pay for healthcare, food, rent and basic needs.”

According to Maigret, legislative proposals (S. 2399/H. 7333) would be a legislative fix to reduce high out-of-pocket costs for persons on Medicare. The bills would expand income eligibility for the Medicare Savings Program (MSP), helping an estimated 17,000 low-income seniors and disabled residents pay their $175/month Medicare Part B premium and covering co-pays and deductibles for those with very low-income.

Thousands of low-income seniors and persons with disabilities on Medicare, but not eligible to participate in the state’s Medicaid program, struggle each month to pay their Medicare Part B premiums and co-pay costs for services and prescription drugs causing many to forgo needed health care as they cannot afford to pay the co-payments.

And eligibility to join MSP qualifies those on Medicare to enroll in the federal Extra Help program that provides significant additional financial assistance to pay for

SACRI also calls on the state lawmakers to provide necessary funding in the 2025 Fiscal Year Budget to enhance programs to assist seniors to age in place in their communities. “It’s a very important legislative issue for seniors,” notes Maigret, stressing that most seniors want to stay at home when they need care.   

In large part due to the existing home care staffing shortage, 75% of those referred for state-subsidized home care wait two months or more for these services. A state study recommended home care rate increases to improve access to home health care services which would help to address the worker shortage and provide livable wages for home care workers.  Maigret urged Shekarchi and Lawson to put funding in this year’s budget to implement the study’s recommendations.

Meanwhile, SACRI supports increased funding for local Senior Centers to enable them to continue to provide “community connections” to seniors. “They do amazing work by offering meal programs, technology assistance and training and all kinds of social, health and recreations programs, says Maigret.

Seniors benefit from, and enjoy going to Senior Centers, adds Maigret, reflecting on a comment told to her by a senior attending Warwick’s Pilgrim Senior Center. “It’s my home away from home,” she says.

Governor Dan McKee’s Fiscal Year 2025 Budget would distribute $1.4 million (about $7 per person aged 65 and over in each community) to the local communities for Senior Centers and programs. SACRI calls on the General Assembly to increase this budget allocation by about $660,000 (making the funding tied to $10 per person aged 65 and over. “It’s a small funding request,” says Maigret.

Finally, SACRI urges the General Assembly to continue to address the lack of options and affordability of housing for seniors. Maigret notes that this problem is the result of the state’s growing older population with fixed incomes, combined with low housing production, skyrocketing rent increases, and high property taxes, 

There are many legislative remedies to address the state’s housing crisis, says SACRI, calling on the General Assembly to use a portion of the proposed Housing Bonds to support affordable housing options for older Rhode Islanders. She also suggested that lawmaker’s continue funding the Home Modification Program, expanding the Property Tax Relief Program and finally promoting  accessibility features in new housing developments.

Like previous years, SACRI worked hard to drive home the point of putting a spotlight to its legislative agenda by having “storytellers” translated the priorities into personal stories.  

House Speaker talks turkey at Legislative Forum

Aging is a very important and personal issue to House Speaker Shekarchi, who is taking care of his 98-year-old father, who remains at home. “That is where he wants to be, he says. “I know that not everyone is fortunate – not everyone has the same support system,” says Shekarchi. “But it’s important that seniors have options so they can choose what’s best for them,” he says

“We need to provide support for seniors to age in place and to remain in their homes, living independently,” states Shekarchi. A great option – which is also the top legislative priority for AARP Rhode Island this year – is creating Accessory Dwelling Units (ADUs). They enable seniors – even young college graduates – to live independently while remaining near family and others, he adds.

“As for seniors who live in assisted living facilities and nursing homes, we need to ensure those facilities are adequately staffed, and that caregivers are paid a sustainable wage,” says Shekarchi. 

“We expect this to be a very challenging budget year, with many worthwhile, but competing, priorities,” says Shekarchi.

“I know the Senior Agenda has legislative priorities in 2024 that I promise we will consider very carefully. And I have a request for all of you. Please stay involved, make your voices heard at the State House,” Shekarchi suggests, “give us feedback. You can testify in person at the State House, or in writing by letter or email.

Valarie Lawson, Senate Majority Whip, took the opportunity to discuss the Rhode Island HEALTH Initiative… a Senate legislative package designed to address affordability and accessibility of health care in the state.

According to Lawson, the HEALTH Initiative seeks to ensure the strength of the state’s community hospitals, attract, and retain primary care doctors and makes sure Rhode Islanders can access quality, affordable care. The legislation includes a bill by Sen. Alana DiMario to create a drug affordability commission in Rhode Island … which is a critical step to make the state’s prescription drug system less complicated and less costly. And Sen. V. Susan Sosnowski’s legislation to transform and mandate a continuous Medicaid reimbursement rate review process by the Office of the Health Insurance Commission.

Lawson noted the Senate was working on the SACRI MSP priority legislation and that she is a co-sponsor of the bill. She said that the Senate shares the Senior Agenda’s  priority of making Rhode Island a place where residents can age with comfort and security. “At the State House… we rely on your voices to help guide us,” she said.

Call to Action

Diane Santos, SACRI Board Chair, ended the forum with a Call to Action for attendees to let their voices be heard by contacting their local legislators to express their concerns and to support programs to help keep seniors strong.

SACRI Legislative Leaders Forum organizational partners included: Cranston Enrichment Center, Edward King House, Leon Mathieu Senior Center, Meals on Wheels RI, Pilgrim Senior Center, Ocean State Center for Independent Living, St. Martin de Porres Center, The RI Organizing Project and The Village Common of RI.

To watch the 2024 Senior Agenda Coalition Leaders Forum Conference, go to: https://capitoltvri.cablecast.tv/show/9023

Medicare Savings Program bill will be a win for low income seniors, and Rhode Island

Published in RINewsToday on March 25, 2024

A few weeks ago, advocates for seniors gathered on Smith Hill, attending a Senate Committee on Health & Human Services hearing to push for passage of S. 2399.  The legislation would expand income eligibility for the Medicare Savings Program (MSP), helping many lower income seniors and disabled residents pay their $175/month Medicare Part B premium and covering co-pays and deductibles for those with very low-income.

Thousands of low-income seniors and persons with disabilities on Medicare, but not eligible to participate in the state’s Medicaid program, struggle to pay their Medicare Part B premiums and co-pay costs for services and prescription drugs causing many to forgo needed health care as they cannot afford to pay the co-payments.

S. 2399, introduced by Pawtucket Sen. Sandra Cano (D-Dist. 8, Pawtucket), would expand eligibility for the Medicare Savings Program (MSP) by increasing the income limit to 186% of the federal poverty line and eliminating the strict asset limit.  It also increases from 100% to 138% of the federal poverty line a part of the program that covers deductibles and co-payment.

S. 2399 was heard on March 12, 2024 and held for further study.  At press time, H. 7333, introduced by Pawtucket Rep. Karen Alzate (D-Dist. 60, Pawtucket, Central Falls), has been referred to the House Finance Committee for consideration. No hearing date has been scheduled.

“With health care costs rising at an alarming rate, it is imperative that we make sure that no one goes without the care they need due to unaffordability.  This bill adapts to the significant changes in our society and economy while also ensuring that our most vulnerable senior and disabled residents are able to access the care and medicine that is essential to their daily lives,” said Cano, who champions S. 2399 and in previous legislative sessions introduced legislation to expand the MSP.

“Too many of our low-income seniors and disabled residents are falling through the cracks and foregoing crucial health care services due to rising co-pays and out of pocket costs.  This is unacceptable, but thankfully, we can do something about it.  By passing this legislation, thousands or more Rhode Islanders will be able to receive the care that they desperately need while also keeping more money in their pockets that’s needed for daily living expenses,” said Alzate, who sponsored the House companion measure.

“We understand this is very important legislation. We had a very informative, thorough hearing on this bill, and I look forward to reviewing all the information we collected.” says Senate Health and Human Services Committee Chairman Joshua Miller (D-Dist. 28, Cranston, Providence).

The Policy Problem and its Solution  

Currently, the income limit of $20,331 leaves thousands of older Rhode Islanders and disabled low-income persons on Medicare with significant gaps in coverage and hefty out of pocket costs.

If the MSP income limit is increased to $28,012, as required by the legislation, an estimated 17,000 persons would be newly eligible to have their Medicare Part B covered by being enrolled in MSP. Anyone enrolled in the MSP receives automatic enrollment in Part D “Extra Help,” a federal program which significantly lowers out-of-pocket Medicare prescription costs at no cost to the State. The federal government establishes the minimum income and asset thresholds for the MSP, and states are permitted to increase these limits and many have done so. 

Advocates of Cano’s MSP legislative proposal say it also particularly helps Rhode Island’s older woman and minorities. “Since women and people of color and persons with disabilities are disproportionately represented in low-income populations, increasing access to the MSP promotes equity,” finds an advocacy partnership’s analysis of the legislative proposals. “Poverty rates among older adult Hispanic women are two and one-half times that of older Hispanic men and persons age 18 and over with disabilities are twice as likely to live below 150% of the poverty level, said the analysis.

The advocacy partnership’s analysis also noted that significant numbers of older adults and those with disabilities enrolled in Medicare face financial challenges meeting basic needs. The number of older adults living below or near poverty has increased, housing costs have climbed dramatically, food cost have increased and many more rely on food pantries.

Covering the $175/month Medicare Part B premium for 17,000+ Rhode Islanders (at no cost to the State) and additionally covering co-pays and deductibles for thousands of very low-income adults and persons with disabilities on Medicare will give them much needed financial relief.  And enrollment in the Extra Help program to reduce drug-related costs provides significant additional financial assistance and improves access to critical medication.

Testimony At the Senate Committee Hearing

Nine organizations either testified at this hearing or submitted written testimony to urge passage of S. 2399.  AARP Rhode Island did not testify at the hearing but signed up in support in the committee room.  There was no opposition to Cano’s legislative proposal.

“I first became aware of the need to expand the income eligibility for MSP quite a few years ago when an older man in my neighborhood contacted me to tell me he lost out on the program because he was just a few dollars over the income limit. As a result, the Senior Agenda Coalition of RI (SACRI) has advocated for several years to increase the income cap,” says Maureen Maigret, SACRI’s policy Advisor.

It’s a win-win for both older Rhode Islanders  and for the Rhode Island General Assembly, says Maigret. “S. 2399 would help Medicare beneficiaries to access care along with putting money back in their pockets to pay for food, rent and their basic needs.  By increasing the Medicaid income to $28,012, the federal  government will pay the full cost of the newly eligible Medicare beneficiaries,” she told the lawmakers.  

Strongly supporting S2399, Karen Malcolm, of Protect Our Healthcare Coalition, noted that the legislative proposal is modeled on the MSP changes enacted in New York last year and approved by the Centers for Medicare and Medicaid Services. “Rhode Island should take advantage of the opportunity to expand access to affordable coverage for seniors and people with disabilities and bring new [federal] revenue to our state.”

H. Phillip West, Jr. lobbyist for the Village Common of Rhode Island, states MSP already makes an enormous difference for many beneficiaries. But, “Rhode Island’s low threshold for eligibility and low allowable assets leaves thousands of our needy neighbors out. The good news is that Senator Cano’s legislation address these defects,” he said.

In submitted written testimony, Heather Smith, MD, president of the Rhode Island Medical Society stated “From our perspective as physicians, we witness firsthand the adverse effects of financial barriers on patient health outcomes. Too often, individuals are forced to forgo or ration medications, delay necessary treatments, or skip preventative care due to concerns of affordability. These delays can exacerbate health conditions, lead to complications, and ultimately result in higher healthcare costs down the road.”

Alex Moore, political director of SEIU 1199NE, stressed the many benefits of passing S. 2399, specifically enhancing access to care, providing needed financial  relief, leveraging federal funds, and strengthening the health care workforce. By supporting the legislative proposal, “we demonstrate our commitment to health and well-being of our state’s most vulnerable populations,” he stated in written testimony.

Even with the strong support of the aging community, the state’s Office of Healthy Aging has not yet taken an official position on S. 2399.  “As with any other bills at this stage of the session, we are reviewing the impact of H 7333 and S 2399 on Rhode Islanders. We will continue to follow these bills as they make their way through the legislative process,” says  Director Maria Cimini.

Samuel Salganik, JD, executive director of RIPIN, which offered testimony in support for S.2399, said, “This is one of the best investments available right now for our state government.  At a cost of just over $5 million, the State can draw down more than $40 million in federal support to assist low-income seniors in Rhode Island,” says Salganik. “It’s a great deal for the state. I think that’s a deal that most of us would happily take,” adds Salganik.

Gov. Dan McKee’s recently released FY 2024 Budget does not include funding for to expand the state’s MSP.  Now the ball is in House Speaker Joseph Shekarchi’s (D-Dist. 23, Warwick) court as his chamber collaborates with the Senate to hammer out budget resolution to be approved by the Rhode Island General Assembly to be sent for the Governor’s signature. Hopefully, Shekarchi will see the expansion of the state’s MPM as a win-win for lower-income and disabled persons on Medicare and the state.  As supporters of  S 2399 and H 7333 say, “it’s a no brainer.”

The Advocacy Partners for MSP Expansion was established to push for the passage of S 2399 and H 7333 during this legislative session. They are: the Senior Agenda Coalition of Rhode Island, Rhode Island Organizing Project, RIPIN, the Economic Progress Institute, the Protect Our Healthcare Coalition and the Ocean State Center for Independent Living.

To access the bills under consideration: http://webserver.rilegislature.gov/BillText/BillText24/SenateText24/S2399.pdf – http://webserver.rilegislature.gov/BillText/BillText24/HouseText24/H7333.pdf

Expanding the income eligibility for the Medicare Savings Program (MSP) is one of the legislative priorities of the Senior Agenda Coalition of Rhode Island. These policy issues will be discussed at its upcoming  Legislative Leaders Forum scheduled on Wednesday, March 27, 2024, from 10:00 a.m. to 11:00 a.m., at the Crowne Plaza Hotel, 601 Greenwich Ave,, Warwick, RI. 

The Senior Agenda Coalition of RI’s Annual Legislative Leaders Forum is this week:

Study takes look at income inequity of Black and Hispanics’ “Forgotten Middle”

Published in RINewsToday on March 18, 2024

Millions of Black and Hispanic middle-income older adults will lack the financial resources to pay for senior housing and health care expenses as they age, warns a new report released by  NORC at the University of Chicago, commissioned by the Long-Beach, California-based SCAN Foundation, an independent public charity dedicated to creating a society where older adults can access health and supportive services of their choosing to meet their needs.

The “Forgotten Middle” study’s analysis, a third follow-up to its landmark 2019 Forgotten Middle Study, shows the number of middle-income seniors of color will increase from 12% in 2020 to 25% by 2035, yet this population will be least likely to afford senior housing and care when compared to the middle-income seniors as a whole.  

Widening income gap creates challenges

The study, released last month, points to widening gaps among Black and Hispanic middle-income seniors around home ownership, home equity, financial assets, and marriage rates compared to their white peers. This gap results in fewer financial resources to afford senior housing and care. The researchers say that case studies and an analysis of existing literature highlight the challenges middle-income older adults may face in rural areas.

“Wealth is not distributed evenly across the Forgotten Middle. Now we know that Black and Hispanic older adults are the worst off,” said Sarah Rayel, senior director in NORC’s Health Care Strategy department in a Feb. 15, 2024 statement announcing the study’s findings. “Black and Hispanic middle-income older adults have fewer liquid assets and less equity than other middle-income older adults, which is making it harder to leverage their home to support future housing and health care needs,” she says. 

The “Forgotten Middle” consists of older adults aged 75+ who do not qualify for Medicaid but lack sufficient resources to pay for assisted living, senior housing, and future care needs as they become afflicted with age-related physical and cognitive challenges. Consistent with previous NORC research findings, middle-income seniors are defined as having annuitized income and assets ranging from $26,000 to $103,000 in 2020 dollars.

The researchers found that home ownership by younger Black older adults is declining and expected to fall substantially by 2035 with Black and Hispanic homeowners projected to have lower home equity. 

The analysis and findings also reveal that marriage rates are expected to drop below 50% across all racial groups, leaving those living alone at a greater risk of adverse health events and social isolation. By 2035, only a quarter of Black older adults and 40 percent of Hispanic older adults will be married, says the researchers.

According to the report’s findings, Black and Hispanic older adults tend to have higher rates of health complications across multiple health indicators, including chronic conditions and mobility limitations. These health complications likely increase the need for additional care.

And the findings noted that middle-income older adults in rural areas may face distinct challenges in their ability to age well due to poorer health outcomes, lower financial resources, lack of support services, and workforce shortages.

“Every older adult deserves to age well, with purpose, regardless of economic circumstances,” said Dr. Sarita A. Mohanty, president and CEO of The SCAN Foundation. “The impending crisis facing people who won’t qualify for Medicaid and won’t be able to afford private home care will impact older adults of color much more acutely. Policymakers, as well as the healthcare and senior housing communities have substantial work to do to ensure that race does not become a hindrance to aging well.”

Rhode Island’s “Forgotten Middle”

For many years, the Senior Agenda Coalition of Rhode Island has been concerned about the so-called “Forgotten Middle” – older persons who are not eligible for Medicaid and other benefits – as they may have income and assets just above the state eligibility guidelines, says Maureen Maigret, SACRI’s policy advisor. According to Maigret, older Rhode Islanders and persons with disabilities living in the community cannot have income over the federal poverty level ($15,060 for a single person; $20,440 for a couple) or, with just a few exceptions, assets of more than $4,000 for a single person or $6,000 for a couple. Most other Medicaid populations can access Medicaid at higher incomes of 138% of the FPL and with no asset limits.

”We believe this is a major inequity for older persons.  As the NORC study points out, persons of color are especially impacted by a wealth gap as they age,” she says noting that they are more likely to have lower incomes during their working years so saving for retirement is a challenge, they have less home equity and are less likely to have retirement accounts.

“Women also are significantly more impacted by a wealth gap in their older years, and this is more pronounced among older women of color,” says Maigret. Citing Rhode Island specific-Census data, she remarked that Hispanic older women are two and a half times more likely to have income below the poverty level compared to older men. And 25% of Black older women vs. 17% of Black older men are living below the poverty level. 

“This is why the Senior Agenda Coalition has consistently worked to address economic security issues and why this year we are advocating to expand the Medicare Savings Program (MSP), also referred to as Medicare Premiums Plan (MPP),” she says. This legislation, now being considered by Rhode Island lawmakers, would help low-income people on Medicare pay for Premiums and co-payments freeing up their limited dollars to pay for basic needs such as food and rent.

Researchers says that findings from their data analysis and literature review revealing disparities across the “Forgotten Middle” must be considered in future policies.  

For a copy of NORAC’s “Forgotten Middle” study, go to  https://www.norc.org/research/projects/understand-historically-marginalized-communities-forgotten-middle.html.

For additional information on the study’s findings and research design rayel-sarah@norc.org.