Tag Archives for Maria Cimini

Advocates call for Governor to reject budget cuts they say would harm older adults

Published in RINewsToday on Oct. 28, 2024

As the state’s Office of Management and Budget (OMB) holds its Revenue & Caseload Estimate Conference to discuss the economic and revenue outlook for the upcoming legislative session, the Senior Agenda Coalition of RI (SACRI) warns of “onerous budget cuts” proposed by state agencies overseeing programs and services for Rhode Islanders. At press time, the state’s Medicaid and the Office of Healthy Aging offices proposed 7.5 percent budget cuts to be included in the upcoming fiscal year 2026 budget. 

“It is unconscionable that at a time when our older population is growing – projected to reach one out of every four Rhode Islanders in a few years — to propose budget cuts for programs proven to keep them healthy and safe and that in the long term can save taxpayers money,” says SACRI Board Chair, Diane Santos.

According to Santos, the requests put forward by the Office of Healthy Aging (OHA) include a reduction in state funds for the Meals on Wheels home-delivered meals program projected to cause 13,000 fewer meals to be delivered to persons unable to shop and prepare meals; cuts in funding for local Senior Centers and programs for older adults; elimination of grants to provide security services in elderly housing; and decreased funding to support the Elderly Transportation program. 

Santos warns that proposed changes in Medicaid eligibility guidelines are projected to cause hundreds of vulnerable older adults and persons with disabilities to lose state Medicaid coverage for their nursing home care and cause nursing homes, many of which are already struggling financially and face critical worker shortages, to lose millions of dollars if implemented. In addition, changes in the Medicaid CNOM (Costs Not Otherwise Matchable) program could reduce federal dollars that match state funding and impact hundreds of persons receiving home care and adult day services that help keep them living at home, the proposed cuts could result in greater spending in other areas.

For example, says Maureen Maigret, SACRI Policy Advisor, “Brown University researchers have shown that funds spent on home-delivered meals can delay or even prevent costly nursing home care.”

Over the years, Maigret noted that SACRI has worked to boost state funding to communities to assist them to operate local senior centers and programs. These serve hundreds of older adults and families across the state with a wide range of programs that keep older adults healthy, informed and connected to their communities, she noted.

SACRI has called for the state’s budget to provide ten dollars for each person aged 65 and over to Rhode Island’s 39 cities and towns, says Maigret, calculating that this amounts to about $20 per older adult. “The proposed cuts now being considered fail to recognize the increased need for these services due to the significant growth of our older population,” says Maigret.

Drawing a line in the sand

At press time, SACRI and its partners delivered a letter to Gov. McKee urging him to not balance the state budget on the back of Rhode Island’s older adults, stressing that the “potential ripple impact on families will be significant.

“Nonprofits and those who will be impacted need to know that SACRI and its partners are closely watching this process and are ready to advocate to protect programs and services which may impact our varied constituencies,” says Carol Anne Costa, SACRI Executive Director.

Costa continued, “The fastest growing demographic in RI is people over the age of 65. That is an obstinate fact. And cuts to the budget must be re-prioritized.” The Office of the State Ombudsman agreed, “If anything, OHA should be getting an increase, as they manage to complete all of their obligations on a shoestring budget. And kudos to Maria Cimini and her team at OHA for the outstanding work they do,” says Kathleen Heren, the RI Ombudsman.

Costa noted that OHA is Rhode Island’s designated state unit on aging. It serves as the chief advocate for older Rhode Islanders, adults living with disabilities, and family caregivers. “Prioritizing reductions in spending in areas not directly tied to OHA’s core mission or that would not harm vulnerable older adults and persons with disabilities dependent on Medicaid to meet their long-term care needs is clearly a place to start [in determining budget cuts]. Administrative expenses and the millions of dollars being paid out to consultants could be heavily scrutinized for budget reductions,” she says. 

Adds Mirelle Sayaf, Executive Director of Ocean State Center for Independent Living (OSCIL), “The proposed budget cuts pose a serious threat to the mission of the OSCIL, which is dedicated to supporting individuals with disabilities. Reducing funding, along with changes to Medicaid eligibility and essential programs, will harm those we serve. These cuts jeopardize vital services such as home care, nutritional support, and community engagement initiatives that empower individuals to live independently and maintain their quality of life.”

“Cutting the budget for the OHA when its resources are already extremely stressed to fully meet the needs of a growing older population is unjustified,” charges SACRI’s Maigret, who is also a former Director of the Department of Elderly Affairs.”

Maigret also opposes changes to Medicaid eligibility after advocates have spent years to ensure persons in need of long term supports and services have access to a range of affordable options, and avoidance of long wait lists for service. She calls for increasing resources to the Rhode Island’s cities and towns to help them support local programs for older adults and increasing eligibility for the Medicare Savings Program so lower-income persons on Medicare can afford needed healthcare.  But, Maigret also says that housing needs of older adults must be considered when allocating housing funds.

Food & Shelter important, too

Gerontologist Deb Burton, Executive Director of RI Elder Info also has some thoughts about the state’s proposed budget cuts.

“Cuts to Meals on Wheels that cause our most vulnerable, at-risk, elders to go hungry are simply unconscionable. Taking meals away from our elders cannot happen,” says Burton.

“We must bring back the housing stabilization unit for older adults. Older adult homelessness has increased more than 400% since COVID hit and rents skyrocketed. Rising housing costs, fixed incomes, and wait lists of 2-8 years for affordable elderly housing have all contributed to this crisis. In addition to these challenges, the application process for getting an apartment is onerous and nearly impossible if one does not have access to the internet,” adds Burton.

Eviction prevention is critical in addressing the elder homelessness issue, says Burton, noting that private sector partnerships and philanthropic donations can support a housing stability unit for older adults, ensuring sustainable funding for eviction prevention programs.

“We must find the strength and compassion to provide the funding necessary for food and shelter for our most vulnerable friends and neighbors. If we don’t, what does the future hold for ourselves?” asks Burton.  

A Final Call

“The November Revenue and Caseload Estimating Conferences will provide updated projections to inform budget development which will help set priorities. However, RI’s most vulnerable and fastest growing demographic must be prioritized in finalizing the FY2026 budget,” urges Costa.

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:

New Legislative Commission to work on improving programs, services to seniors 

Published in RINewsToday on June 19, 2023

During May, designated as Older Americans Month, the Rhode Island House of Representatives approved H 5224-SUB A, sponsored by House Deputy Majority Leader Lauren H. Carson (D-District 75, Newport), creating a legislative commission to study the services and programs for 240,000 older adults in Rhode Island – and to make recommendations for ways to improve and coordinate them. The number of seniors is expected to skyrocket to almost 265,000 by 2040, constituting an increase of nearly 75% since 2010.

On May 11, 2023, over three months since the resolution was dropped in the legislative hopper, it passed by a whopping bipartisan vote of 69 to 0 (with 6 members absent). There was no opposition to H 5224- SUB A from any organization. It seems that any House lawmaker or organization opposing this resolution would also oppose “motherhood and apple pie.”

With a number of House GOP concerns addressed in the state’s $14 billion budget, House Minority Leader Michael Chippendale directed his caucus to support passage. The House Republican Caucus also unanimously voted for H5224 – SUB A, and fully supported the mission of a legislative commission which is charged with collecting and analyzing the current state of affairs in regard to Rhode Island’s growing senior population.

Carson’s resolution calls for “a collaborative study of Rhode Island’s current services, and recommendations for potential initiatives that would help residents, agencies, providers, and the government to better assist the growing population of older adults in our state achieve well-being and maximum independence in ways that value, empower and engage them,” adding that such an effort is essential to the state’s future resilience and prosperity.

According to House Communications Director Larry Berman, 21 House legislative Commissions will be operational when Carson’s legislative commission becomes operational. The House Policy Office will staff the Commission.  The number of meetings (open to the public) has not yet been determined. The meeting agenda will be determined by its Chair, with input provided by the 16 Commission members, House lawmakers, members of the public, and aging advocates. 

Because H 5224 – SUB A only creates a House legislative commission, there is no need for a companion measure to be introduced in the Senate,” says Berman who notes that this Commission will begin in the Fall of 2023. It is charged to report its findings and recommendations to the House of Representatives no later than May 7, 2024. The Commission would then expire on August 7, 2024.

Providing a Road Map to Fix Systemic Policy Flaws

“This commission will provide valuable information to the House next year to provide a roadmap for providing service and programs for older Rhode Islanders, including funding options that will be strongly considered,” stated House Speaker K. Joseph Shekarchi  (D-Dist. 23, Warwick), after passage of the special legislative committee.

“We have had excellent results with other commissions that have studied housing and shoreline access that have led to legislation that the General Assembly has adopted.  Representative Carson is an extremely thoughtful and dedicated legislator who will work hard with commission members to develop great plans for the future,” says Shekarchi.

“Rhode Island should invest much more than we do in services that enable people to age in place and safely remain in their communities. Those services are far more cost-efficient overall, and encourage an active, more fulfilling lifestyle for people as they age. Considering that nearly a quarter of our population is over 60, and Baby Boomers will continue to swell those ranks, now is the time,” said Carson. “This commission will take a look at the services we have, how we could improve and better coordinate them and offer them to more individuals, where the gaps and needs are, and what we need to do to better enable our population, as we grow older, to safely remain in the community and lead full lives,” she says.

The 16-member commission, all appointed by the House Speaker, will include three members of the House of Representatives, two Rhode Island residents over the age of 65, three directors from the Rhode Island Senior Center Director’s Association, a community action program director from the Rhode Island Association of Community Action Agencies, a member of the Long-Term Care Coordinating Council, and a member of a Rhode Island organization representing adults with disabilities.

In addition, the directors of the Office of Healthy Aging, the Department of Health, AARP Rhode Island, Age-Friendly RI and the Senior Agenda Coalition of RI or their designees will participate.

H 5224 – SUB A instructs the commission to study key statistics about services for older adults in Rhode Island, examining strengths, vulnerabilities, and demographic and financial statistics; assess the current state, federal and local services currently available, as well as any duplication of services; recommend ways to coordinate services within agencies and focus on better service delivery, including housing options and various living arrangements, health status and health care resources; provide recommendations for the creation of a portal to coordinate aging services in employment, education, independent living, accessibility and advocacy, as well as local older adult centers and services; provide recommendations on mental health, transportation, food access, and health care; provide recommendations for the funding of services through state, federal and private grants and for more efficient distribution and use of these dollars; and explore more regionalization of services.

Towards the Creation of a Strategic State Plan on Aging

“The newly established legislative commission to study the services and programs for our rapidly growing older population can become the launching pad for the state to move forward to create a multi-sector Strategic State Plan on Aging to coordinate Rhode Island’s programs and services for older Rhode Islanders, says Maureen Maigret chair of the Aging in Community Subcommittee of Rhode Island’s Long-Term Care Coordinating Council who also serves as a policy consultant and board member of the Senior Agenda Coalition of RI.  She notes that 10 states have already developed this “master plan” and she hopes Rhode Island will also join their ranks. 

At the Senior Agenda Coalition  of RI’s August 2022 Gubernatorial Forum, she warned that the state’s aging and long-term services were fragmented, spread across a number of state agencies, charging that these agencies often lacked stable leadership and a coherent and overarching vision. Creating a Strategic Plan on Aging builds on work being done now by the Office of Healthy Aging and Subcommittees of the Long Term Care Coordinating Council, and would be a fix for this,” says Maigret. 

According to Maigret, at the August Forum Gov. Dan McKee stated he would issue an Executive Order for initiating a Master Plan on Aging, but that has not happened. Aging advocates are still waiting for this to happen.

“We look forward to joining with older-adult focused direct service, advocacy, non-profit, and state colleagues, and older adults themselves, to discuss how Rhode Islanders want to age and what we can build collectively to make that possible, says Director Maria Cimini, of the state’s Office of Health Aging (OHA).

“At the OHA we are thrilled there is interest and a commitment of time and resources to understand and plan for our state’s aging population, from where we sit, this opportunity will equip us to advocate for policies that empower and uplift our senior population, fostering dignity, purpose, and respect for all older adults,” adds Cimini.

Don’t Forget the Rhode Island’s Poor and Minority Elders

Susan Sweet, long-time advocate for poor and disadvantaged elders and the founder of The R. I. Minority Elder Task Force which provides limited financial assistance to low-income seniors in crisis reports: “We are seeing a large uptick in elders in crisis situations lacking basic needs such as food, utilities, housing, and personal items. Minority group members, immigrants, retirees as well as general population seniors are suffering more intensely since Covid, inflation, and lack of affordable housing matters have exacerbated the existing poverty among elders. In particular, homelessness among elders is at a peak we have not seen before.”

Sweet is hopeful that this new Legislative Commission will consider and react to the particularly difficult situations that confront the poor and minority elder populations. “I have seen many plans for services to elders that either ignore or do not implement agenda items addressing these populations and I hope that this commission will prioritize the severe privations that they face on a daily basis,” she says.

“With the lessons learned over the past 2 years and the devastating impact of COVID on our older adults, it’s critical that we reexamine our aging infrastructure, the needs for services, and the local service capabilities to this growing population,” Vin Marzullo, who served 31 years as a career federal civil rights & social justice administrator at the National Service agency.

“A serious, adult conversation is long overdue with the aging community, service providers and lawmakers about designing our plan for a more “Age-Friendly” RI, – which supports local senior centers as the local hub for the delivery of services,” suggests Marzullo.

The nursing home industry supports the mission of the newly enacted legislation committee. “Included in their charge is to, among other things, provide recommendations regarding available health care services.  Rhode Island’s nursing facilities play a vital role in health care for our older adults – providing care and services to over 18,500 seniors each year.  Many of these individuals are provided with short-term skilled nursing, physical, occupational and/or speech therapy following a hospitalization – enabling them to safely transition from the acute hospital level of care back home with continued services,” says John E. Gage, President and CEO of the Rhode Island Health Care Association.

“Of course, every Rhode Islander wants to remain independent, healthy and in their home for as long as possible.  When this is no longer viable, however, our state needs a strong spectrum of care, including home care, assisted living residences and skilled nursing facilities to support them as their care needs change.  Workforce is perhaps the most daunting challenge facing these health care providers, and this will need to be a focus for years to come,” notes Gage.

H 5224 A cosponsors are Representatives Samuel A. Azzinaro (D-District 37, Westerly), Thomas E. Noret (D-District 25, West Warwick), Susan R. Donovan (D-District 69, Bristol, Portsmouth), House Majority Whip Katherine S. Kazarian (D-District, East Providence), Karen Alzate (D-District 60, Central Falls, Pawtucket), Jason Knight (D-District 67, Barrington, Warren),  and Kathleen Fogarty (D-District 35, South Kingston.

A copy of H 5224 A may be accessed here: http://webserver.rilegislature.gov/BillText/BillText23/HouseText23/H5224A.pdf.

The House Floor vote (5/11/23) – 48 minute 48 second mark may be accessed here: https://ritv.devosvideo.com/show?video=d12583542bad&apg=84a99049.

The Health & Human Services Committee heard this resolution on March 15, 2023.  See the 1hour and 50-minute hearing by going to https://ritv.devosvideo.com/show?video=e3ea82fcb949&apg=6aae3d42) 

Herb Weiss, LRI -12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 43 years.  To purchase his books, Taking Charge: Collected Stories on Aging Boldly and a sequel, compiling weekly published articles, go to herbweiss.com.