Tag Archives for Medicare SAvings Program

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.” 

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

Published in RINewsToday on April 1, 2024

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

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

The graying of Rhode Island’s population

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

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

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

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

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

Unveiling SACRI’s Legislative Agenda

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

·       Economic Security

·       Supports at Home

·       Community Connections

·       Housing Options

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

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

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

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

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

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

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

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

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

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

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

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

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

House Speaker talks turkey at Legislative Forum

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

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

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

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

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

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

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

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

Call to Action

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

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

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

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

Published in RINewsToday on March 18, 2024

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

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

Widening income gap creates challenges

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

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

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

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

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

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

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

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

Rhode Island’s “Forgotten Middle”

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

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

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

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

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

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

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