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Benefits for seniors from Rhode Island’s next budget

Published in RINewsToday on June 17, 2024 

With a 35-2 vote in the Senate early on Friday the Senate gave its approval for a $13.963 billion budget for the 2025 fiscal year, comprising 13 articles that direct additional funding toward education and children, raises Medicaid reimbursement rates, health care support, and includes a $120 million affordable housing bond. The 300-page budget bill – read here, 2024-H 7225Aaa has now gone to Gov. Dan McKee, who is scheduled to sign it at an event Monday, June 17, at 11:15 a.m. in the State Room on the second floor of the State House.

Rhode Island’s FY 2025 Budget and Seniors

House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick) reeled off specifics as to how this year’s budget proposal impacts senior programs and services, noting that it aims to lower the rising housing and health care costs that impact the quality of life of older Rhode Islanders. “We have asked the voters to approve an additional $120 million in funds to increase affordable housing production. The budget accelerates a commitment to raising Medicaid reimbursement rates for services to care for our most vulnerable seniors and people living with disabilities to stabilize our health care and human service provider networks,” noted Shekarchi. 

Under the budget proposal tax relief is provided to seniors who rely on retirement income, raising the exemption to $50,000 for qualified single filers and $100,000 for joint filers. It also repeals the suspension of annual cost of living (COLA) adjustments for retirees in the state pension system who retired before 2012 and moves up the timeline for resumption of COLA for other state retirees. 

Lawmakers changed the calculation for pension benefits to base it on the highest three consecutive years of earning instead of five. Finally, the House Speaker noted that this budget fully funds Medicaid rate increases for home care and other services that help seniors age with dignity in the community and stay in their homes if they so desire, and also increases support for services provided in nursing or assisted living settings. 

Adds Senate President Dominick J. Ruggerio(D-Dist. 4, North Providence, Providence), “I am pleased that the budget will invest in many Senate priorities, particularly in the areas of health care, child care, education and providing some needed relief to retirees,” says Ruggerio. “Specifically, the budget incorporates $2.7 million for primary care provider training sites, as well as $500,000 for tuition assistance for students who enter the primary care field and remain in Rhode Island. The budget also includes funding for purchasing medical debt for pennies on the dollar,” he says. 

But how does the aging network view this spending plan? 

According to Maureen Maigret, Policy Advisor with the Senior Agenda Coalition of RI (SACRI), under the spending plan approved by the Assembly $103.2 Million in all funds was added to the Governor’s proposed budget to fully fund the social and human service provider rate increases as recommended by the state’s Office Health of Insurance Commissioner (OHIC) based on the comprehensive legislatively mandated Rate Review Study performed in 2023. According to Maigret, who served as a member of the Advisory Task Force for the Rate Study, the full funding was especially important for those older adults and persons with disabilities seeking access to home and community services. 

“Too many persons on Medicaid have been waiting three months or longer to access needed home care supports which can cause health to deteriorate or to consider nursing home placement at far more expense to the state,” Maigret said. Maigret noted the increases would raise rates for providers of home care, assisted living, shared living and adult day services – all critical to helping persons with support needs to be able to stay at home where most persons with care needs prefer to live. 

Senior Agenda Coalition has worked for many years to promote better access to home and community-based services and to advocate for better wages for the direct care workers who provide this care,” she added, noting that these individuals are usually women, mostly women of color, and for too long have been undervalued and underpaid she noted. In 2022 the SACRI advocated with the legislature to set a minimum wage of at least $17/hour; however, the budget only called for a minimum of $15/hour. With full funding for the recommended home and community care provider rates, we would like to see these essential workers get a minimum starting wage of at least $25/hour in order to recruit and retain the necessary workers. 

SACRI also successfully pushed along with other housing advocates for the addition of $20 Million more to the Housing Bond to go on the November ballot for a total of $120 Million, Maigret added, noting that the coalition continues to advocate for paying adequate attention to the housing needs of older adults in the allocation of the bond funds. “Increasing affordable housing options for this population is critical,” says Maigret, stressing that census data shows that 53% of older RI renters pay more than 30% of their income on housing and studies show that 43% of extremely low-income RI renters are seniors. In the housing space, passage of bills to streamline development of Accessory Dwelling Units (ADUs) advanced by House Speaker Shekarchi along with most of his housing package was also a major win for expanding housing options and development. 

The legislature also addressed SACRI and its advocacy partners push to increase income eligibility for the Medicare Savings Program (MSP) that helps lower-income Medicare enrollees not on Medicaid afford needed healthcare and save dollars for other needed basic needs by covering Part B premiums ($176/month in 2024) as well as required co-payments for some with very low-incomes. “The budget includes a provision requiring the state to seek federal approval to increase the eligibility for the Medicare Savings Program for “qualified individuals” (currently persons with annual income between $18,312 and $20,331) up to 185% of the federal poverty level ($27,861),” says Maigret, adding that the Coalition plans to monitor the approval process and to seek additional legislation, if needed, next Legislative session to further expand the program. Maigret says that lawmakers expanded the Temporary Caregiver Insurance Program up to 8 weeks but SACRI was disappointed that siblings and grandchildren were not added to the list of persons for whom a worker could get paid leave.

“We will continue to advocate for these additions and to increase the number of weeks of leave up to 12 which is provided by most states that have such a program,” she says. And finally, SACRI will continue to advocate for additional funding for the Office of Healthy Aging to provide each of our communities with at least $10/per person age 65 and over to help support local senior centers and programs for older adults, says Maigret, as well as increasing the income cap to $50,000 for eligibility for the state Property Tax Relief Program (called the Circuit Breaker program) that provides a tax credit or refund for older homeowners and renters and those on Social Security Disability. 

FY 2025 Budget Helps State’s Nursing Homes  

James Nyberg, Executive Director  of LeadingAgeRI is pleased with the infusion of much-needed funds in the FY 2025 Budget to help support financially-distressed nursing homes as they continue to provide quality care in a very difficult environment.  “The providers are clearly in distress and we need to avoid any further closures to ensure access to care, resident choice and well-being, and support for the workforce,” he says.  “We also are grateful that the OHIC-recommended rate increases for various programs, including assisted living and adult day services, were expedited with full implementation this October.  Assisted living providers are scheduled for a 10.8% rate increase and adult day a 19.8% increase.  This will help support our home and community-based providers and those for whom they care, says Nyberg, who serves on the Advisory Task Force for the Rate Study. Lastly,

LeadingAgeRI supports the FY 25 Budget’s increase in the housing bond to $120 million, and calls for a portion of it to be used to expand safe and affordable senior housing, the lack of which is well-documented, including a recent report by the Long-Term Care Coordinating Council. According to Nyberg, one legislative priority that remains is to establish a Medicaid rate add-on for private rooms in nursing homes, since Medicaid is the primary payer for nursing home care.  “This would be an important step in helping to support a more homelike environment and resident privacy and dignity,” he says.

“RI nursing homes have been chronically underfunded since the implementation of the reimbursement methodology over thirteen (13) years ago,” charges John E. Gage, President & CEO of the Rhode Island Health Care Association, representing 62 nursing home providers. “Cuts to the annual inflation index, failure to re-base rates every three years since, and skyrocketing costs since the beginning of the pandemic have put RI nursing facilities at significant financial risk,” he says.

“The FY ’25 Budget passed the Rhode Island General Assembly includes funding for the first-ever rebase of Medicaid Rates since the inception of the Priced Based Reimbursement System back in 2013,” says Gage, noting that this increase represents a 14.5% increase with an estimated increase in revenue of $66 million beginning October 1, 2024, based on actual expenses from the most recent Medicaid Cost Reports from 2022. 

Additionally, Gage says that the budget as passed includes $10 million in State Fiscal Recovery Fund Grants to stabilize RI’s nursing facilities from July 1, 2024, through the implementation of the new rates on October 1. 

Pension changes initiated 

“Our primary task during this past General Assembly session has been to strongly support Bill H-8193, introduced by Rep. Pat Serpa, which would see the return of the COLA which was so ruthlessly slashed away in 2011. It applied to all current and future retirees, including teachers, state workers, and some municipal employees, says Sandra Paquette, representing Advocates for COLA Restoration and Pension Reform, a non-profit representing 4,700 retirees.

However, the actual pension provision in this year’s budget provides for the restoring of a compounded COLA to those who retired prior to July 1, 2012, notes Paquette. “Initially, this was a disappointment to our organization, as we had hoped for much needed relief for all who have been so detrimentally affected by Rhode Island Retirement Security Act — creating a financial crisis in the lives of so many lifetime workers. But further thought and consideration caused us to realize that the pension benefits in this year’s budget represent a huge step in a 13 year’s duration of no progress whatsoever in alleviating the injustice, she adds.

“And we are delighted that after so many years, older persons in the state retirement system who retired prior to 2012 will finally see a COLA,” says Maigret, “This is especially important for those who do not receive Social Security benefits.”

Editor’s Note: Added comments

Union thoughts…

Jesse Martin, Executive Vice President of SEIU 1199 NE and President of Rhode Island SEIU State Council said, “For months, union members of Rhode Island SEIU State Council have been working to raise awareness of issues that matter most to working Rhode Island families and, as a result, made great strides in healthcare, wages, funding, retirement, career training and more to the benefit of all. This year’s budget contains emergency funding to keep Linn Health open until August, provides funding to paraprofessional healthcare workers to help them advance in their careers, streamlines the hiring process at DHS and DCYF in order to attract new qualified candidates and finally enables domestic workers to earn the minimum wage. We thank all our elected leaders who offered their steadfast support and prioritized the needs of working Rhode Islanders.” 

The Rhode Island SEIU State Council, which is representative of all four SEIU affiliate locals, represents a variety of workers across the state, including healthcare, Department of Children and Families, Janitorial, Family Child Care, Department of Labor and Training, Security, Workforce Development and more. Nationwide, the Service Employees International Union represents over two million members.

Kathleen Gerard, Advocates for Better Care in Rhode Island, added, “”We were very glad to see the passage of the full Medicaid reimbursement increases recommended by the OHIC this session, and will continue to advocate for measures that ensure that our public funds are put towards the public good of improved wages for direct care staff and improved care for residents.” 

Aging in Place in Your Rhode Island Community

Published in Pawtucket Times on May 2, 2022

As the graying of the nation’s population continues, older persons are choosing to live out their remaining years remaining in their communities in their homes, whenever possible. A new just-released study of adults age 50 and older from the AP-NORC Center for Public Research and the SCAN Foundation, finds a majority of older persons would like to age in place and are confident they can access needed services that will allow them to stay at home in their community for as long as possible.  

Gathering Thoughts About Aging in Place

According to this new national study released last week, two-thirds of the respondents think their communities meet their needs for accessing services like health care, grocery stores and social opportunities. The researchers found that all types of health care services are widely perceived as easy to access in their communities, and most feel that local health care understand their needs (79%) and take their concerns seriously (79%).

But, a closer examination of the small proportion of older Americans (Blacks and Hispanics) who feel less prepared and less supported in their community raises concerns about equity in access to the resources necessary to age in place.

However, the study reported that a few respondents say they had a hard time accessing needed services because of communication obstacles like a language barrier (11%), cultural barrier (8%) or age gap (8%); issues with affordability (15%); or issues of respect for their religious (4%) or cultural (3%) background. 

Those in urban areas—and suburban areas especially—describe their communities as having more supports for aging in place than those in rural areas. Older adults in suburban areas see their communities as doing the best job with meeting needs for healthy food, internet access, and the kinds of foods they want to eat. Suburban areas are also seen as better than rural areas in particular at meeting needs for health care and social activities. Older rural Americans are less likely than those living elsewhere to use a range of services simply because they aren’t available in their area. They are less likely to feel that community services are easy to get and designed for people their age than those in urban or suburban communities as well. And they are less likely to think a variety of health care services would be easy for them to access.

Income disparities are also associated with access to critical aging services. Those with incomes of $50,000 and below are less likely than those earning more to have access to services that are in their language (73% vs. 82%), close by or easy to get to (58% vs. 65%), respectful of their religious beliefs (57% vs. 65%), or designed for people their age (53% vs. 63%). When it comes to medical services, they are also less likely to have easy access to dental care, physical therapy, pharmacies, nursing homes, and urgent care than those earning more.

Additionally, those age 65 and older generally feel more prepared and report better access to important community services than those ages 50-64.

Aging in Place in the Ocean State 

For older adults aging in place, in their own homes, is by far the preferred model, says Mary Lou Moran, Director, Pawtucket Division of Senior Services at the Leon Mathieu Senior Center. “In fact, the theme of this year’s federal observance of Older Americans Month “Age My Way” focuses specifically on this very topic. The coordination, accessibility, and connection to services and programs is critical to the successful delivery of services and is where much work needs to be done,” she says. 

Moran says that senior centers located in communities throughout the state deliver needed information and assistance to older adults on accessing the needed  services to age in place.  Social isolation, access to transportation, food and housing insecurity, economic stability, and connectivity to services, are obstacles to enabling a person to stay in the community in their homes, adds Moran.

Over the years, Rhode Island’s inadequate Medicaid rates have become major obstacles to allowing a person to stay at home. However, recent state legislation, H 7616, to recreate a Department of Healthy Aging, spearheaded by Reps Carson, Ruggiero, McLaughlin, Contvriend, Speakman, Ajello and Potter, addresses some of the challenges that service providers are facing when trying to assist individuals to age in place. Moran adds, as the number of older adults continues to grow exponentially, the time has come to fully put the needs of our elders in the fore front to enable them to age with choice, dignity and respect.

According to Maureen Maigret, policy consultant and Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, “Rhode Island is fortunate to have a number of government-funded programs that help older adults to age in place.” These programs include Meals on Wheels home-delivered meals program; Medicaid home and community services including home care, adult day services; assisted living and self-directed programs; Caregiver respite and support services; Home Modification grants to help make homes accessible; and elder transportation assistance for those age 60+ for medical trips, to get to adult day.  She also mentioned the Office of Healthy Aging’s Home Cost Share program for persons age 65+ and persons underage 65 with dementia who are not Medicaid eligible with income up to 250% of the federal poverty level and the wonderful programs offered at the state’s senior centers.

However, Maigret says that for some of these services such as home care there may be wait lists due to worker shortages. (People can find out about these programs or to find out what benefits they may be entitled to by calling the POINT at 401-462-4444).

There are also private services available for almost any service needed to help people age in place if they have the financial means to pay for them,” says Maigret.  

The National Village to Village Movement Comes to Rhode Island

While some of these volunteer programs in RI may offer some type of services such as transportation, a relatively new initiative has come to Rhode Island. “The Village Common of Rhode Island (TVC) provides a variety of supports through the efforts of almost 200 trained and vetted volunteers,” says Maigret. 

Maigret says that the goal of TVC is to help older persons to stay in their own homes and connected and engaged with their community. “This “neighbor helping neighbor” model started 20 years ago in Beacon Hill Boston and now there are 300 nonprofit “villages” operating across the country. TVC supports include transportation, running errands, home visits and telephone assurance, minor home repairs and light yard work, assistance with technology, and a virtual caregiver support program. A robust weekly calendar offers virtual events, and a monthly newsletter keeps members and guests informed. All this is done with a lean 1.5 person staff, a working board of directors and almost 200 volunteers,” she notes. 

“I had heard about the “village” model some years back and supported efforts to start a “village” in Rhode Island, she says. “It amazes me that a small band of committed volunteers were able to put all the pieces in place to operationalize a “village” and to see what has been accomplished. There are now active “villages” in Providence, Barrington, Edgewood/Cranston and Westerly with almost 300 members and more “villages” are under development. One of the priority goals of the Board is to reach out to underserved neighborhoods in our urban and rural areas to listen to people and find out what is important to them and what type of “village” program might work in their area,” she says. 

“We know that transportation is a huge issue for folks living in our rural areas and that is a huge concern. And, based on findings of the 2021 RI Life Index: Older Adults in Rhode Island(from RI Blue Cross Blue Shield//Brown University School of Public Health), we know that older persons of color living in our core cities have lower perceptions of community life, access to healthcare and experience lower food security and access to technology,” adds Maigret.  

“Research on the fairly new “village” programs shows promise in fostering feelings of being connected to others and suggest older women living alone with some disability most likely to experience improved health, mobility and quality of life (https://pubmed.ncbi.nlm.nih.gov/28509628/.),” says Maigret, noting that this is an important finding as Rhode Island has such a high portion of older adults living alone.

TVC President Anne Connor (74) says she has been a member and volunteer since 2015. “That we are volunteer supported is noteworthy and having an Executive Director, Caroline Gangji, (formerly acting Executive Director at Age Friendly RI), improves our ability to serve our members”, says the retired librarian and paralegal.

As TVC founder Cy O’Neil once said, ” …you don’t create a fire house when the house is burning.”  TVC is more than services – it is the relationships we build that are key to our success, says Connor.  

For details about The Village Common Rhode Island, go to https://www.villagecommonri.org/.

For specifics programs and services offered by the Rhode Island Office of Healthy, go to  https://oha.ri.gov/.