Tag Archives for Medicaid

Senior Agenda Coalition of RI zeros in on key aging legislation 

Published in RINewsToday on May 30, 2022

As the General Assembly winds down, the Senior Agenda Coalition of Rhode Island (SACRI) is tracking 16 House and Senate Bills along with FY 24 Budget Articles that have an impact on the state’s senior population. In a legislative alert, SACRI details a listing of 16 House and Senate bills and FY23 Budget Articles relating to care givers, mobile dental services, supplemental nutrition, housing, tax relief and home care worker wages. 

The state’s largest organization of aging groups is focusing and pushing for passage of the following four bills during the upcoming weeks.

SCARI puts on its radar screen S-2200/H-7489 to push for passage. The legislation (prime sponsors Senator Louis DiPalma (D-District 12) and Representative Julie Casimiro (D-District 31), establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24-member advisory committee, to provide review and recommendations for rate setting, and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.  

Meanwhile, DiPalma and Casimiro have also introduced S-2311/H-7180 to require a 24-member advisory committee to provide review/recommendations for rate setting/ongoing review of social service programs licensed by state departments/agencies and Medicaid. The House and Senate Finance Committees have recommended these measures be held for further study.

Ratcheting Up the Pay for Rhode Island’s Home Care Workers

In testimony on April 28th, SACRI’s Executive Director Bernard J. Beaudreau says, “Because payment levels for services have not been updated in years, especially in our current inflation ,levels, the low-pay level of direct care workers has created workforce shortages, impoverished workers and has put at risk our ability to provide proper care for our aging elder population.”

“Shamefully, an estimated 1 in 5 Rhode Island home care workers live in poverty and most have insufficient incomes to meet their basic needs,” says Beaudreau, calling for enactment of this bill to raise the wages of the lowest paid care workers as a top priority. 

S-2200 was referred to the Senate Finance Committee and companion measure, H 7489, was referred to the House Finance committees for review.  After hearings in their respective chambers, both bills are being held for further study. 

At press time, the Rhode Island General Assembly is hammering out its state budget for Fiscal Year 2023, taking effect July 1, 2022, to June 30, 2023.  SACARI calls on the state to make it a budgetary priority to address Rhode Island’s home care crisis.

According to Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, who also serves SACRI as a volunteer policy adviser and Board Member, says that the Governor’s budget calls for suspending use of an estimated $38.6 million in state funds which, by law, should be used to enhance home and community-based services. This law, says Maigret, is referred to as the “Perry-Sullivan” law after its sponsors.

Maigret calls for these funds to be used to increase home care provider rates so they may be fair and competitive to home care workers and increase rates for independent providers.  Many of these workers are low-income, women, and women of color, she says.

Lowering the property taxes for Rhode Island’s low-income seniors

SACRI also calls for the Rhode Island General Assembly to provide property tax relief for low-income seniors and Social Security Disability Income (SSDI) recipients. As housing costs rise and property taxes increase, more older Rhode Islanders with limited or fixed incomes and those on SSDI are becoming housing tax burdened, says the Providence-based the aging advocacy coalition. 

In SACRI’s legislative alert, Maigret calls for the passage of H-7127 and S-2192, with primary sponsors Representative Deborah Ruggiero (D-District 74) and Senator Cynthia Armour Coyne (D-32), charging that Rhode Island’s property tax relief law needs urgent updating.

Rhode Island’s Property Tax Review Law, sometimes referred to as the Circuit Breaker Law, needs serious updating. Initially the law was enacted to help provide property tax relief for persons aged 65 and over and to those on SSDI, says Maigret.  It is currently available to those with incomes up to $30,000 (set in 1999) and provides a credit or refund up to $415 against a person’s state taxes owed.  Both homeowners and renters are eligible to a apply. 

H-7127 and S-2192 would make hundreds of older Rhode Islanders eligible to participate by increasing the income cap from $30,000 to $ 50,000. Maigret notes that if these bills pass, a person with household incomes of $35,000 who is not eligible now could be eligible to get a refund of up to $850 next year. “These changes would provide direct relief against high property taxes and make Rhode Island more in line with our neighboring states of Connecticut and Massachusetts,” she says.

Finally, Executive Director Beaudreau testified on May 17th before the House Finance Committee, calling for the passage of H-7616, Reinstating the Department of Healthy Aging. “The time is long overdue for the state to re-invest in serving the needs of aging population,” he says, noting that “the state’s total population of 65 years and older has grown by 20% from 152,283 in 2010 to 182,486 today.”

Beaudreau testified that the “data clearly indicates that Rhode Island should be increasing plans, resources and services to meet the need of the state’s aging population, not cutting back.” The state’s budget has not kept up with the growth needed in the Office of Healthy Aging, charged with overseeing the state’s programs and services for older Rhode Islanders. “Additional funding is needed for increasing the Department’s staffing capacity and increasing financial support of Senior Centers serving thousands of older Rhode Islanders every say,” he adds.

But do not forget oral health of seniors, says SACRI.  According to the aging coalition, the importance of accessing quality oral health care in nursing homes is key to a nursing facility resident’s health, well-being and quality of life. Poor oral health care results in a higher incidence of, pneumonia cardiovascular disease diabetes, bone loss and cancer; all situations increasing the frequency of accessing medical care resulting in higher costs. 

Improving oral health care to Rhode Island’s seniors and special populations

SACRI calls for the passage of S-2588 and H-7756, bills that would provide for reimbursement for patient site encounter mobility dentistry visits to be increased to $180 per visit. The state’s reimbursement for mobile dentistry site visits began in 2008, only in nursing homes, but failed to provide funding for dental care in other settings. 

These bills would also expand the availability of this service to additional community-based group homes, assisted living facilities, adult day health and intellectual and developmental disability day programs. Passage of these bills will increase access to special populations who have difficulty in accessing basic dental services.

S-2588, referred to the Senate Finance Committee, was held for further study.  The House companion measure is scheduled to be heard on May 28th at a House Finance Committee hearing. 

Reimbursement for this service has not increased since it was initially funded over 14 years ago and does not cover the cost of delivering this critical service, says SACRI.

SACRI says “Make your voice heard!  Call House Speaker Joseph Shekarchi (401 222-2466) and Senate President Dominick J. Ruggerio (401 222-6555) and your legislative delegation to urge supporting SACRI’s priority legislation. 

To see a listing of SACRI’s 2022 Priority Legislation, go to https://img1.wsimg.com/blobby/go/049a7960-1c2a-4880-afdd-8d1e0e283acc/downloads/SACRI%20Bill%20Tracker%202022.pdf?ver=1653052514912.

For more details about SACRI, go to https://senioragendari.org/

New efforts on Smith Hill to increase Medicaid reimbursement rates

Published in RINewsToday on April 18, 2022

On March 8th, a press conference on Smith Hill put the legislative spotlight on introduced rate setting legislation intended to fix Rhode Island’s long-time problem of paying insufficient reimbursement rates to human-service agencies delivering social, human and clinical services to Medicaid recipients. 

Over 80 human service providers, clients, and aging advocates, came to support Sen. Louis DiPalma and Rep. Julie Casimiro’s two pieces of legislation to fix a broken Medicaid payment reimbursement system. These bills would provide for periodic rate review/setting processes to ensure accurate and adequate reimbursement of social, human and clinical services.

“Senate President Dominick J. Ruggerio came, giving his blessings, too. “It is critical that we undertake a review of reimbursement rates so that we have a thorough understanding of the data and we can make informed decisions,” said the top Senate lawmaker. “These bills will help bridge the gap and bring reimbursement rates where they need to be,” he said.

The Reimbursement Fix…

DiPalma and Casimiro’s bills do not specify dollar amounts for adequate hourly wages but would hammer out the “periodic rate review and setting process.”

The first bill (2022-S 2311 / 2022-H 7180) establishes a process which would require the Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of social service programs licensed by state departments, agencies and Medicaid. 

The second one (2022-S 2200 / 2022-H 7489) establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.

At press time, legislation has been referred to the Senate and House Finance committees for review. 

“Years of stagnation in our state’s Medicaid reimbursement rates have negatively affected hundreds of thousands of Rhode Islanders who rely on a wide range of services,” claims DiPalma, (D-District 12, Middletown, Little Compton, Newport and Tiverton), a long-time advocate at the Rhode Island General Assembly for human services providers and disabled Rhode Islanders.  

DiPalma says a comprehensive rather than a piece meal approach is now needed to address this reimbursement issue. Stressing that the two bills would fix the continuing reimbursement issue. “For our providers, the people they serve, and the future of our state, it is imperative we act now,” he warns. 

Rhode Island’s healthcare system is suffering a crisis of care that’s only worsened due to the pandemic, charges Casimiro (D-Dist. 31, North Kingston and Exeter), noting that the state’s human health agencies are understaffed and under-supported and it is hurting the state’s most vulnerable residents.  

“Our reimbursement rates have remained too-low and unchanged for many years and the residents of our state cannot access the crucial services they need if there is no one there to provide the care,” said Casimiro, urging Rhode Island lawmakers to stop the exodus of human services workers for their jobs.  Proper oversight of the rate setting process and appropriate reimbursement rate increases will ensure a high-level of care provided, sorely needed now, she says.    

Providers call for ratcheting up RI’s Medicaid payment rates

Long-time aging advocate and former Representative, Maureen Maigret, translated the rate payment issue into a “dollar and cents” example. Maigret, a policy consultant who previously chaired the Long-Term Care Coordinating Council’s Aging in Community Subcommittee, noted that the Bureau of Labor Statistics show in 2020 in Rhode Island the average wage for a home health aide was less than $15 per hour and nursing assistants slightly $16. “These low wages do not come close to meeting one’s basic needs, forcing workers to work more than one job or, as more are doing, just abandoning this type of work altogether for better pay, she added, stressing that this was before these workers faced 7% inflation and gas prices reaching over $5 per gallon,” she said.

“High workforce turnover rates are especially troubling for patients receiving homecare, who value building a long-term relationship with someone coming into their home frequently, says Bernie Beaudreau, Executive Director, the Senior Agenda Coalition of Rhode Island, “Seniors cannot age with independence and dignity if homecare workers are not treated with respect in wages and working condition,” he says.

This legislation is a step in the right direction and provides the state an opportunity to move toward the realignment of reimbursement rates that accurately reflect the actual cost of the delivery of behavioral health treatment and services,” says Susan Storti, President and CEO of The Substance Use and Mental Health Leadership Council of Rhode Island.

“These bills ask our state a clear, direct question: do we, or do we not, support inclusive lives in our communities? We must reply with an equally clear answer: ‘Yes, we do’ and pass S-2311 and H-7180, says Tina Spears, Executive Director, Community Provider Network of Rhode Island, noting that for CPNRI and its members it is all about inclusion of children and adults with disabilities and behavioral health conditions in our society. 

Time to pay providers adequately  

With all 38 Senators co-sponsoring both his Senate bills, DiPalma is pleased with the positive reception his legislation has received in the upper chamber. “We cannot delay any longer. The time to act is now,” he says, stressing that it’s important for lawmakers to get these bills over the “goal-line. “There are hundreds of thousands of Rhode Islanders counting on us to get this done,” he adds.

DiPalma says that a Senate hearing is being planned  to consider S 2311 and S 2200 on Thursday, April 28 at the Rise of the Senate in the Senate Lounge. All are encouraged to attend the hearing and voice their support. 

National Aging Coalition pushes to bring back House Aging Committee in DC

Published in RINewsToday on March 28, 2022

In 1992, aging advocacy groups fought unsuccessfully to keep the House Select Committee on Aging  (HSCoA) from being eliminated. The House had pulled the plug on funding for the HSCoA as a cost-cutting measure and to stream-line the legislative process at the end of the 102nd Congress without much notice in the Democratic rules package adopted in Jan.1993 during the beginning of the 103rd Congress.

As the dust settled after the dissolving of the HSCoA, Congressman Michael Bilirakis (R-FL), a former committee member, stated in an article, “Congress Eliminates Committee on Aging,” published March 31, 1993, in the Tampa Bay Times,” I honestly don’t’ think other committees would cover all aging issues.” AARP agreed with Bilirankis’s assessment. “Seniors need a specific forum,” said Tom Otwell, spokesperson for AARP. “The population is getting older, and issues are certainly not going away,” he said. 

During its 18 years of existence, its Congressional oversight on a myriad of aging issues included Social Security, Medicare, nursing homes, aging bias and elderly housing. This oversight influenced the introduction and passage of major legislation enhancing the quality of life of America’s seniors. 

Thirty years later, the Washington, DC-based Leadership Council on Aging Organizations (LCAO), representing 69 national aging advocacy groups, recognized the opportunity to bring back the HSCoA by endorsing H. Res. 583, a resolution introduced in the 117th Congress by Congressman David Cicilline (D-RI) to reestablish the HSCoA when introduced Aug. 10, 2021.  The Rhode Island Congressman has also introduced this resolution during the last three congresses.

H. Res. 583 would reestablish the HSCoA without having legislative jurisdiction, this being no different when the initial permanent committee previously existed. The 214-word resolution would authorize a continuing comprehensive study and review of aging issues, such as income maintenance, poverty, housing, health (including medical research), welfare, employment, education, recreation and long-term care. These efforts assisted the House’s 12 Standing Committees in the creation and advocacy for legislation they drafted. At press time, the resolution has been referred to the House Rules Committee for consideration.

According to the Congressional Research Service, it’s quite simple to create an ad hoc (temporary) select committee in the House chamber. All it takes is a simple resolution that contains language establishing the committee – giving a purpose, defining membership, and detailing other issues that need to be addressed. Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill. 

Calling for co-sponsor support

While supporting Cicilline’s proposal, LCAO went one step further by calling on House lawmakers three weeks ago, in correspondence, to become co-sponsors. LCAO asked its members to co-sponsor the bill in order to drive the House Democratic Caucus to approve it and bring it to the House floor for a vote. As a House committee, it only needs the House’s approval, where there is now a majority of Democrats.

The time is ripe for the HSCoA to be reestablished, say LCAO. “Every day, 12,000 Americans turn 60. By 2030, nearly 75 million people in the U.S. – or 20% of the country – will be age 65 and older. As America grows older, the need for support and services provided under programs like Social Security, SSI, Medicare, Medicaid, and the Older Americans Act also increases,” noted in correspondence signed by 30 Coalition members.

LCAO stressed that the HSCoA worked effectively in partnership with the House’s 12 Standing Committees with jurisdiction over aging programs and services. “The House Aging Committee, which flourished in the 1970s under chairperson Claude Pepper, partnered and magnified the work of the standing committees in a team effort and a bipartisan manner, holding many joint hearings with them and helping to pass the end of mandatory retirement 359-2 in the House and 89-10 in the Senate, as well as protecting Social Security, exposing nursing home abuses and setting transparency standards, expanding home health care benefits as a way older persons could often delay or avoid the need for being forced into nursing homes and so much more. Ways and Means, Education and Labor, Energy and Commerce and Space, Science and Technology were just some of the Committees who benefited from the partnership and appreciated the House Aging Committee’s help in reaching senior citizens,” stated LCAO. 

As seniors now settle into living in a post-pandemic world, passage of H. Res. 583 becomes even more important. “Historically, the HSCoA served as a unique venue that allowed the open, bipartisan debate from various ideological and  philosophical perspectives to promote the consensus that, in turn, permeated pandemic, and the coronavirus continues to take its toll, exacerbating the problem of social isolation and family separation across generations.  Addressing the needs of older Americans in a post-pandemic world will require vigilant oversight and action,” noted LCAO.

Op Ep tells the story and the need for passage of Cicilline’s resolution 

Robert Weiner, former Clinton White House spokesman and Chief of Staff of the HSCoA under Congressman Claude Pepper,(D-FL) and Ben Lasky, senior policy analyst at Robert Weiner Associates News and Public Affairs, recently penned an op-ed for the Miami Herald which calls for the passage of Rhode Island Congressman David Cicilline’s H. Res. 583, to reestablish the HSCOA. With threats of Social Security “reforms” (cuts) and the mishandling of Covid in nursing homes which led to hundreds of thousands of deaths, the Committee is needed once again.

Weiner and Lasky say the largest part of Pepper’s congressional legacy, especially as he grew older, was chairing the HSCoA, which featured banning mandatory retirement (with Colonel Sanders as a witness), protecting nursing homes, expanding home health care, and protecting Social Security with solvency through 2034.

“Pepper’s bill that banned mandatory retirement passed 359-2 in the House and 89-10 in the Senate,” they said.

They argue, “The elderly are now threatened with Social Security reforms,” (meaning cuts). Senior citizens also disproportionately died from Covid in nursing homes in Florida, New York and around the country. More than 200,000 have died in nursing homes. Forbes called ‘The Most Important Statistic’ the fact that 42% of US Covid deaths in the first five months of the pandemic happened in nursing homes and assisted living facilities. That number later went down to around 33%. When standards, distance standards, vaccines, and transparency started to kick in (under pressure in many facilities), it got a little better but for many it was too little too late. Tens of thousands died because health care workers failed to follow the transparency, staffing, and safety standards that Pepper had passed into law in nursing homes.”

They continue, “Once vaccines became widely available in 2021, a majority of nursing home workers remained unvaccinated for six more months. Nursing homes and assisted living facilities were let off the hook by governors from Ron DeSantis (R-FL) to Andrew Cuomo (D-NY) for hiding their number of Covid deaths.”

Weiner and Lasky assert, “Older voters vote Democratic and Republican. It’s close. In 2020, while Joe Biden won the popular vote by 7 million, Donald Trump won the senior vote 52% to 47%. It’s not a matter of party. Seniors’ quality of life is not political.”

They conclude, “With Pepper’s legacy as the guide, pandemic deaths, nursing homes, home care, Social Security, and Medicare would be improved by Sunlight of Oversight.”

For the benefit of America’s seniors, House Speaker Nancy Pelosi and her leadership team must consider giving H. Res 583 their political support and blessing, calling for a vote in House Rules Committee, if passed allowing for swift consideration on the floor.  As Weiner remembers, “the last HSCoA was so well received and successful because of the strong relationships and bonds to the Standing committees and successful outreach to seniors.” The former HSCoA staff director notes that during his tenure membership grew from 29 to 50 members. “After the committee began, in just a few years, everyone wanted to be on it.” 

AARP’s Otwell’s observations that the nation’s population is getting older, and the issues are not going to go away  and that “Seniors ‘need a specific forum” are true even 29 years later. House lawmakers must pass H. Res. 583 for America’s seniors to give them this specific forum that they deserve.

To read the Miami Herald Op Ed, go to www.miamiherald.com/opinion/op-ed/article259629314.html