Tag Archives for Long-Term Care Coordinating Council

Aging Advocates Call for Override of Governor’s Veto

Published in Pawtucket Times on July 14, 2003

The General Assembly is poised to override  Gov. Don Carcieri’s veto Tuesday.

The political rhetoric has intensified as the governor picks apart the 2004 budget, which was recently passed by the Democratic-controlled legislature, forcing Democratic Majority Leader William J. Murphy and Senate President William V. Irons to explain how they shaped the budget.

Carcieri has called the General Assembly’s 2004 budget flawed because lawmakers have “missed opportunities” to stop the legislature’s habit of deficit spending.

The governor’s media blitz, beginning last week, is intended to build support for his efforts to defeat the legislature’s attempt to override his veto. Carcieri has called for the elimination of subsidies for greyhound kennel owners [also supported by this writer] and the reining in public-employee personnel costs.

Carcieri also opposes the spending of $ 52 million in federal Medicaid expenditure relief funds and the one percent restaurant sales tax.

When the dust settles after Tuesday’s legislative session to override Carcieri’s veto, aging advocates hope for an override. The 2004 budget crafted by the Democratic-controlled General Assembly puts increased state funding into senior programs and services.  Both provider groups and senior advocacy groups expressed disappointment when Carcieri’s budget proposal did not allocate funding for new aging-related initiatives. Moreover, his fiscal blueprint for state spending made cuts to existing senior programs and services.

“Once again, senior advocates have looked to the General Assembly to provide essential programs and services for the state’s growing senior population,” says Susan Sweet, a long-time aging advocate and consultant to nonprofit groups who also serves as a consumer representative to the state’s Long-Term Care Coordinating Council.

“We have not been disappointed,” Sweet said, in reference to the passage of the General Assembly’s 2004 budget.  “It’s sad that the Carcieri administration does not recognize the improvements the General Assembly has made to the budget and the lives of older Rhode Islander.”

Joan Crawley, executive director of Pawtucket’s Leon Mathieu Senior Center, added, “Although I can appreciate Carcieri’s frustration with trying to balance the state budget, as a senior advocate, I applaud the legislators for making the very difficult decision to fund legislative grants on behalf of the state’s  senior centers,” she said.

“At the Pawtucket town meeting, gubernatorial candidate Carcieri assured us that seniors would be a top priority of his administration should he be elected governor. He even distributed a brochure outlining his senior initiatives. So far, he has failed to address any of those initiatives in is budget, Crawley says.

So, what’s in the General Assembly’s 2004 budget that will improve the quality of life of Rhode Island seniors?

The budget will allocate new state funds totaling $ 300,000 to pay for nursing facility care of legal immigrant Rhode Island seniors who are not eligible for Medicaid.

The budget will also allocate $ 50,000 to support the efforts of the Ocean State Adult Immunization Coalition to get the word out about the importance of seniors getting influenza and pneumococcal vaccinations.

Meanwhile, lawmakers have allocated state monies for community grants. Initially, senior centers (in Carcieri’s budget ) were targeted with a 10 precent cut. To the relief of senior center providers, lawmakers passed the 2004 budget with no cuts

As previously reported to All About Seniors, an 18-month study by B.D.O. Seidman, a consulting firm hired by the state Department of Human Services, found Rhode Island was underpaying its nursing facilities in excess of $ 30 million annually.

It seems that the Rhode Island General Assembly agrees with the report’s assessment, because lawmakers made a partial allocation of new Medicaid dollars to overhaul the state’s ailing Medicaid system.

With passage of the budget, nursing facilities will receive a total of $ 18.8 million in state and federal dollars – a three-year phase-in will bring the total federal and state dollars up to $ 30 million.

Finally, the recently passed 2004 state budget has allocated $ 50,000 to provide dental services to nursing facility residents.

The 2003 budget that was supposed to expire June 30 stays in effect until Carcieri signs the 2004 budget into law. Until that time, new programs, policies, or program appropriations will be effectively put on hold.

An override of Carcieri’s veto will result in many new senior programs and services being funded in the 2004 state budget.

If the popular Republican governor is able to rally is troops – both Republican lawmakers and Carcieri Democrats – to support his veto, then lawmakers must begin their efforts to hammer out another budget.

….

As noted in last week’s All About Seniors column, not one dime in state funding was allocated in the state’s 2004 budget to beef up the state Department of Health’s regulatory oversight. Providers, aging advocates, and even state officials have called for new state dollars to fill one full-time surveyor position (a nurse) to ensure that assisted living residences across Rhode Island are inspected on a timelier basis.

The General Assembly has put laws on the books to protect frail Rhode Island seniors who received assisted-living services. Yet, Carcieri and lawmakers have failed to allocate the necessary funding in the 2004 state budget to allow Health Department regulators to comply with    their legislative oversight duties to inspect the state’s 72 assisted-living facilities and 155 assisted-living bed in nursing facilities on a timely basis.

That’s not all.  According to the state’s Department of Health, another seven assisted-living projects are expected to be up and running over the next 18 months.

Meanwhile, at Tuesday’s veto override, lawmakers will also take up legislative issues were not addressed in their haste to adjourn two weeks ago.  Maybe the state Health Department’s urgent need for more funding to adequately perform its oversight duties of assisted-living facilities will be acted on by lawmakers in both chambers.

Carcieri can become the white knight and save the day. He can choose to move forward and fix this policy flaw by either using contingency funds in his office budget or to take administrative action to hire one more full-time assisted living inspector.

Acting decisively to fix tis identified policy glitch is sound public policy that will ultimately protect the health and well-being of 1,700 assisted-living residents. Even with Carcieri’s calls for balancing the budget, taxpayers especially seniors won’t oppose allocated tax dollars to protect older Rhode Islander.

Congress is Close to Passing Prescription Drug Legislation

Published in Pawtucket Times on June 23, 2003

Within days of the July 4th congressional recess, the House and Senate continue their debates on enacting legislation to lower the cost of pharmaceuticals for the nation’s elderly.

The AARP will kick off a media blitz to get a point across to lawmakers that while they may take a short break during recess, the nation’s elderly don’t get a break when it comes to affording the costly medications they need.

“There’s no recess [for seniors] from high prescription drug costs,”  AARP declares in a press release sent to the nation’s media outlets.

In a written statement, Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, calls on Rhode Island’s congressional delegation to pass meaningful Medicare drug benefits, rather than the legislative proposals being debated in the House and Senate chambers.

“While it is nice that after many years of promises Congress has finally taken on this issue these proposals will cause nothing but heartburn and headaches for seniors if passed,” said Fogarty, noting that many seniors will pay more for the program than they will get back in benefits. He charged that others will even be left without prescription drug coverage when they need it the most.

Under the Senate proposal, seniors would pay a $ 35 monthly premium and then have to meet a $275 deductible before Medicare starts to kick in to pay for half of the drugs costs.  Once senior’s reach a cost cap of $ 4,500 for the last year, they would then have to pick up the entire cost until they reach yet another cap of $ 5,800 in total drug spending. At this point, Medicare would then pay 90 percent of the covered drug costs.

Fogarty noted the Congressional Budget Office found that one-third of seniors would pay more money to enroll in the plan than they would actually get back in benefits.

That’s because a senior with $ 1,000 in annual drug costs would actually end up

$ 1,057 annual for the benefits ($420 in premiums, a $ 275 deductible and half of the drug costs).  A senior with $ 2,000 in drug costs would pay $ 1,557 out-of-pocket for the benefits.

Fogarty also called attention to the major gap in coverage for those whose costs exceed the $ 4,500 limit until they reach that $ 5,800 mark.

Furthermore, Fogarty, who authored the state’s expanded prescription drug program, said a study by Columbia University found that only those annual drug costs about $ 1,100 would benefit through the plan.  

In the House chamber, the Republican proposal also calls for monthly premiums of $ 35 along with a lower annual deductible of $ 250 with Medicaid paying 80 percent of the cost of drugs up to $ 2,000.

There is a gaping hole in coverage (in this legislative package).” Fogarty warned “Seniors would then have to spend at least another $ 1,500 depending on their income, on medications before coverage would again begin.”

According to Fogarty, Consumer Union, the publisher of the widely-read magazine, Consumer Reports, noted the “skimpy benefits [in the House and Senate proposal] and the historically high growth of prescription drug costs means that most who lack coverage today would wind up paying more for prescription drugs in four years than they do now.”

Will seniors see a prescription drug proposal enacted this year?

Probably, said Jason Ormsby, director of policy at the Washington, D.C.-based Allilance for Health Reform.

“There is a tremendous drive that I have not seen in the last there years [to enact a prescription drug bill],” said Ormsby.

He noted the House passed a legislative proposal to assist seniors in paying for costly pharmaceuticals, but it died in the Senate.

“The somewhat similar House and Senate bills will have a good change to pass by the July 4th recess,” Ormsby predicted.  Once passed, the legislative proposal will go to conference committee to iron out the differences between the 600-page House and 350-pshr Senate bills,” he said.

The prescription drug benefits are just a small portion of these massive legislative proposals, he noted.

Robert Greenwood, vice-president of public affairs for the National Pace Association, added: “Many Democrats see the limitation of these bills.  This legislation passed presents a historic opportunity to get this law on the book so it can be amended and improved in future years.”

While not a meaningful drug prescription proposal, it’s the first step in the right direction.

Once enacted into law, the Rhode Island congressional delegation must begin their efforts to improve the law – improve access for all: make out-of-pocket costs and cost sharing affordable; lessen gaps in coverage; more important, put the breaks to the steady increase in high-cost drugs.

Governor’s Budget is Silent Regarding Many Senior Issues

Published in Pawtucket Times on March 24, 2003

Many of Gov. Don Carcieri’s policy initiatives can be found sprinkled throughout Fiscal Year 2004 Budget address.

While Carcieri’s 3,200-word speech identified his administration’s priorities – that is, maintaining human services, investing in education and creating jobs and fixing the state’s crumbling roads and bridges- it was silent on issues of interest to aging advocates and seniors.

At an AARP debate of gubernatorial candidates, Carcieri was asked if he would budget $15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing home residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million, for a total increase of $ 30 million.

At the debate, Carcieri acknowledged it would be difficult to find $15 million to fix the system because of the state’s looming budget deficit.

After a first read, Alfred Santos, executive director of the Rhode Island Health Care Association, found the recently released administration budget did not allocate the $ 15 million in new funding to allow nursing facilities to be reimbursed for the actual cost of care that they provide to frail residents.

Santos hopes to schedule a meeting with Gov. Carcieri and his policy staff to discuss Medicaid reimbursement and staffing issues.

“One of the biggest disappointments for seniors in the governor’s budget is his failure to include funding to allow more low-income persons to choose Medicaid waiver-funded assisted living,” noted Maureen Maigret, who serves as Lt. Governor Fogarty’s director of policy and executive director of the state’s Long-Term Care Coordinating Council.

“This has been a priority for the senior advocacy community, and the governor was supportive of this funding during his campaign,” says Maigret.

Maigret told All About Seniors that more than a year ago, the federal government had approved an additional 180 units in the state’s Medicaid assisted living waiver to respond to Rhode Islander consumer demands.

“Failure to fund these units is short-signed in terms of saving taxpayer dollars and denies low-income seniors the option to choose a less restrictive care setting,” said Maigret, who calls the state’s current assisted living waiver program a great success.

According to Maigret, in the last fiscal year, there was a decrease in state-funded nursing home use of about 50,000 days and an increase in Medicaid funded Assisted Living of about the same number of days. “We have reached the funding cap for these Medicaid-funded assisted-living units and have a waiting list of 35 persons,” she said, noting that some of these persons will now be forced to enter nursing facilities at twice the cost of the state.

Meanwhile, Maigret added that the governor’s budget does not address the dire need of more regulatory staff in the Health Department to monitor assisted living and enforce state standards.

On the other hand, the Rhode Island Pharmaceutical Assistance for the Elderly Program (RIPAE) is intact, Maigret said.

“With the costs of prescription drugs increasing at such alarming rates, RIPAE is a vital safety net for thousands of Rhode Island seniors.

Maigret noted that changes this year in Blue Chip and United Health senior plans may further impact many seniors’ accesses to prescription drugs, as these plans have new features which limit benefits for brand name drugs. Legislation proposed by Fogarty and introduced by Sen. Elizabeth Roberts and Rep. Peter Ginaitt will address this pharmaceutical issue, she said.

Finally, Maigret said senior advocates must watch other areas of the state budget that will ultimately impact seniors. Some community grants, such as those that support senior centers, are targeted for 10 percent cuts. While nursing homes are in line for an annual cost of living increase (COLA) in their Medicaid rates, no similar COLA is included for home and community care providers.

Maigret added the governor’s budget cuts about $ 10 million (state and federal funds) to continue its efforts of downsizing the Eleanor Slater Hospital Cranston campus, with a proposal to close two more wards. To offset these closures, the budget includes about $ 800,000 to fund about 20 more nursing home placements and new funds to increase capacity to serve persons with mental illness in community residential settings.

The push to get residents back into the community concerns Roberta Hawkins, state ombudsman and executive director of the Alliance for Better Long-Term Care. She opposes the closure of wards because there are persons in the community who require a higher level of care, a level that is only available at the Eleanor Slater Hospital.

Hawkins noted the administration budget does not include Medicaid funding to pay for dental services to seniors in the community and those residing in nursing facilities.

“The short-sidedness of this fiscal policy ultimately will increase care costs when the resident must be hospitalized for malnutrition, dehydration and bed sores, all caused by dental problems,” Hawkins said. “On a human level, who would want to constantly suffer from pain all night because of a toothache or gum problems?” she added.

Sandy Centazao, president and CEO of Meals on Wheels of Rhode Island, is still waiting to see if Carcieri will ultimately institutionalize her nonprofit group’s funding rather than continue to allocate it as a legislative grant. She expects this decision to be made before the enactment of the state’s FY 2004 budget on July 1.

With a looming recession and a nation at war, Carcieri and the General Assembly must ultimately make difficult decisions as to how to slice the state’s FY 2004 budget. The state’s final budget must  provide the funding and adequate resources to enable long-term care providers to take care of the state’s burgeoning older population. It’s the right thing to do, even n times of uncertainly.