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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.

Ratcheting up SSA’s customer service will take more funding 

Published in RINewsToday on May 1, 2023

Over two months ago, as required by law, Kilolo Kijakazi, Acting Commissioner of Social Security Administration (SSA) released the fiscal year 2023 operating plan to Sen. Patty Murray (D-Wash.), chair of the Senate Appropriations Committee. The report, released on Feb. 10, 2023, details how SSA plans to use its $14.1 billion budget allocation for the year. 

Kijakazi wrote in the report’s transmittal letter: “In FY 2023, we will build the foundation for improved services by rebuilding our workforce after ending FY 2022 at our lowest staffing level in over 25 years.”

According to Kijakazi, at the end of Dec. 2022 the initial SSA claims-pending level soared to almost 975,000 cases.  This was more than 380,000 cases higher than at the end of FY 2019. “The average initial claims wait time through Dec. 2022 was 206 days compared to 120 days in FY 2019.  It will take a multi-year effort and sustained funding to restore our average initial disability claims wait times to pre-pandemic levels,” she says.

While Kijakazi anticipates processing 129,000 or 7% more initial disability claims in FY 2022 (52 weeks), she expects wait times for a disability decision at the initial and appeal levels to increase for a period of time because backlogs will continue to grow while the agency hires and trains new staff. 

Although the FY 2022 outlay represents $785 million of the agency’s budget of $13.34 billion, it was less than the $14.8 billion President Joe Biden requested for administration funding. In February 10th correspondence to the House and Senate Appropriation Committees, Kijakazi stated that while budget increases will cover fixed costs and support staffing in the upcoming fiscal year, “some performance will show improvement in FY 2023, while others will show temporary degradation.” 

Conversations regarding SSA’s customer service challenges

In February 28th correspondence to SSA’s Kijakazi, AARP’s Nancy LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer, recognized increased funding was necessary for SSA to address its customer service problems. AARP recognizes that federal funding has not kept pace with increases in operational cost and demands, but the agency “needs to do more to constrain operating costs and increase productivity,” Kijakazi says.

LeaMond called the “expected decline in service troubling, given multiple assurances from SSA that the funding level received would be sufficient to at least maintain the modest customer service improvements made last year.”

“Your operating plan asserts that the already unacceptable average of call wait time of 33 minutes will be longer this year, increasing to 35 minutes, and people trying to call the agency will get a busy signal 15 percent of the time, more than double the rate last year.  This is an unacceptable step backward,” wrote LeaMond.

LeaMond says that SSA’s operating plan doesn’t address several customer service areas, especially the challenges of beefing up staff to improve in-person services and reducing wait times and busy rates that the public should expect when calling their local office.  She called for more details and when beneficiaries can expect improvements to online services.

“Even more concerning is the fact that the operating plans note that disability-related service improvements are not expected to occur before 2024 fiscal year,” adds Leamond. While the plan provides details about disability claims, and appeal workloads, as well as prioritization of claimants who have been waiting the longest, she calls on SSA to “act more quickly to improve the disability process.”

“The Social Security Administration (“SSA”) has large fixed costs, such as rent on its network of 1200 field offices, and those fixed costs increase every year. SSA’s funding does not come from the general government budget, but rather from Social Security’s accumulated reserve of $2.8 trillion. Yet for over a decade, Congress has restricted SSA from spending the funds necessary for adequate service,” says Nancy Altman, President of Social Security Works (SSW).

Adds Altman, “While Congress this year allowed SSA to spend more, the additional dollars did not even cover all the fixed costs. They certainly did not correct the many years of underfunding. Service will not significantly improve unless Congress allows SSA to spend more of  Social Security’s accumulated reserve  — at the bare minimum,  the $15.5 billion that President Biden has requested — but ideally significantly more.”

Biden budget seeks to fix SSA’s customer service issues

In a blog article penned on March 30, 2023, Kathleen Romig, Director of Social Security and Disability Policy at the Washington, DC-based Center for Budget and Policy Priorities, says that SSA has an opportunity to ratchet up its consumer service impacted by decades of restricted funds by receiving increased funding. “With additional funding in for the coming year, the agency could invest in the staff and technology it needs to better serve the public,” she says.

“Since 2010, SSA’s customer service budget has fallen by 17 percent after inflation, with its staffing falling a commensurate 16 percent – marking the lowest level in 25 years. These cuts happened even as the number of Social Security beneficiaries grew by 12 million, or 22 percent. Being forced to serve millions more people with fewer staff and resources has caused tremendous strain at SSA, and beneficiaries are suffering the consequences,” says Romig.

On March 9th, Biden released a FY 2024 budget calling for increased appropriations to SSA. According to the Office of Management and Budget (OMB), the president’s budget provides an increase of $1.4 billion (a 10% increase) over the FY 2023 budget to cover salaries, benefits and rent increases. It would also improve customer service at field offices, state disability determination services, and teleservice centers.   

Each year, SSA processes more than 6 million retirement, survivors, and Medicare claims, and more than 2 million disability and SSI claims, says OMB, charged with producing the president’s budget. Biden’s budget increase boosts staffing levels from FY 2023, allowing the agency to process about a half a million more disability cases in FY 2024 that were completed in FY 2022, significantly reducing wait times for those decisions.

GOP debt limit bill drastically cuts SSA’s operating budget

Just last week, by a razor thin margin, House Speaker Kevin McCarthy (R-CA)’s Limit, Save, Grow Act of 2023 (H.R. 2811) passed by a partisan vote of 217-215. Four Republicans voted “no”. While this legislation to lift the nation’s debt limit allows the U.S. Treasury to pay the nation’s bills, it has no chance for passage in the Democratic-controlled Senate. However, it will force the president’s team to the negotiation table with Republican House and Senate leadership, hoping it will push compromise on future spending limits.

Failure to increase the debt limit would have catastrophic consequences for the U.S. and global economies, as well as for all Americans, who rely on the federal budget to provide public services. (from Social Security and Medicare to food safety inspection, air traffic control, school nutrition, and environmental. 

After the House vote, Alex Lawson, SSW’s Executive Director of Social Security, charged that 217 House Republicans just voted to cut Social Security. “Nearly every Republican in the U.S. House just voted to slash the already inadequate funding of the Social Security Administration (SSA). If this bill becomes law, it will force SSA to close field offices, reduce hours, and lay off thousands of workers. This will make it far harder for Americans to claim the benefits they’ve earned,” warned Lawson. “Cuts to SSA are cuts to Social Security, and we will hold every single one of these members accountable,” he says.

Max Richtman, President and CEO of the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM) agrees with SSW’s assessment. One day before the vote, he wrote House members to urge them to pass “clean’ debt limit legislation.

“If the spending cuts and other [GOP] legislative changes that are incorporated in this legislation were ever to become law, the negative impact would be felt by virtually every American family in every Congressional District in the country,” wrote Richtman.

According to Richtman, the GOP’s proposed debt limit legislation includes among its provisions a roll-back of ALL discretionary federal spending to Fiscal Year 2022 levels in FY 2024, with growth limited to one prevent annually for the next decade. “This is not a minor trimming of spending that has been portrayed by some, but a dramatic slashing that will have devastating impacts on the Americans who rely on the affected programs for their health and well-being,” says the nationally recognized Social Security advocate. 

Reluctance to cut Defense and Veteran Health funding would have at least a 23 percent reduction to all other programs for FY 2024, charges Richtman, this resulting in funding cuts to SSA’s customer service budget.

“Cutting funding by six percent would significantly affect SSA’s ability to serve the public and undermine the Agency’s core-mission – producing longer wait times for benefits and to reach SSA representatives, as well as reduced access to in-person programs, noted Richtman, stressing that face-to-face access with SSA’s employees is critical to those who are elderly and disabled.

SSA calculates that for every $100 million in additional funding cut the federal agency would be forced to lay off an additional 1,000 employees, this equivalent to closing 40 field offices, says Richtman.

Since 1960, Congress has acted 78 separate times to permanently raise, temporarily extend, or revise the definition of the debt limit – 49 times under Republican presidents and 29 times under Democratic presidents, says the U.S. Treasury.  Like in the past, this Congress must follow to raise the nation’s debt limit, and is expected to do so.

Ultimately, it is crucial for Biden and McCarthy’s negotiations to hammer out a “clean” debt limits bill that will not cut SSA’s operational funding further which could send the agency’s customer service efforts into a tailspin. It is time for Congress to fix SSA’s operational funding issues once and for all to improve customer service provided to 65 million beneficiaries. 

For a copy of SSA’s 2023 Operating Plan go to https://www.ssa.gov/budget/assets/materials/2023/2023OP.pdf.

For a summary of H.R. 2811, Limit, Save, Grow Act of 2023, go to 

https://www.govtrack.us/congress/bills/118/hr2811/summary

For a copy of President Biden’s FY 2024 Budget, go to:  https://www.whitehouse.gov/omb/briefing-room/2023/03/09/fact-sheet-the-presidents-budget-for-fiscal-year-2024.

Scully Selected to Head Federal Health care Agency

Published in the Pawtucket times on May 14, 2001

Thomas A. Scully, a Washington, D.C.-based health care association executive who holds a law degree from Catholic University and has previous experience on Capitol Hill as a senate staffer and as a high-level White House official, has been tapped by the new Bush administration to run the Health Care financing Administration (HCFA), the federal agency providing health care to 74 million Medicare, Medicaid and the State Children’s Health Insurance Program.

The nomination of Scully, president and CEO of the Federation of American Hospitals, a trade group that represents 1,700 for-profit hospitals, went to Capitol Hill in early May.  When confirmed as HCFA administrator by the U.S. Senate, Scully will replace Nancy Min DeParle, who left last October for a teaching stint at Harvard University. With her departure, a string of acting directors temporarily took the reins of the federal agency.

At press time, Jill Kozney, a spokesperson for Chairman Chuck Grassley of the Senate Finance Committee, stated that a confirmation hearing has not been scheduled yet. “Not every piece of paper work is in, but the chairman would like to act on the nomination as soon as possible,” the Senate staffer says.

A Washington Insider

As Washington insider, Scully brings a potpourri of health policy experiences to HCFA. The health care association executive comes with legal expertise gleaned from his legal practice, which focused on regulatory and legislative work in health care. Scully also brings an understanding of the intricacies of Capitol Hill, gained by serving as a staff assistant to U.S. Senator Slade Gorton (R-Wash.), and as associate director of the White House Office of Management and Budget (OMB) and later as deputy assistant to the president and counselor to the director of OMB under the senior Bush administration.

Ties to the former Bush administration were forged when Scully served on the communications staff of the Bush-Quayle campaign in 1988 and as deputy director of the congressional affairs for the president-elect’s transition team.

“Scully is smart, quotable, and politically savvy,” says Edward Howard, executive vice president of the Alliance for Health Care Reform. “He’s described as a problem solver rather than an ideologue,” Howard adds.

Howard expects Scully to turn his attention to internal problems at HCFA, because the agency has “substantial management problems.” He notes that HCFA has lost a number of good people and Congress will most certainly give the agency new tasks to handle.

“At least Scully will not have to spend one and a half years to learn about the programs he supervises, because he knows them well with his past OMB experience and at the Federation of American Hospitals,” Howard adds.

Bill Benson, former deputy assistant secretary for aging and president of the Maryland-based Benson Consulting Group, warns “Don’t look for Scully to, be much of a consumer advocate,” because he will be sympathetic to providers because of his ties to the hospital provider community.

“That does not mean Scully’s going to be in any position to get hospitals any more money but he will be more attuned to less regulation and more flexibility in rules, and regulations or health care providers,” Benson states.

According to Benson, one of Scully’s first tasks will be to carry out Health ad Human Service Secretary Tommy Thomson’s wish to reorganize HCFA because “this agency is one that everyone loves to hate, especially Republicans.”

Providers Rally Around Scully

Meanwhile, provider groups give thumbs up to Scully’s nomination as HCFA administration.

“Tom Scully has a unique combination of both real-world perspective and public service experience,” states Rick Pollack, executive vice president of the American Hospital Association. “That makes him a great choice for HCFA administrator.”

“From crafting Medicare regulation and budgets to building strong relationships with lawmakers on both sides of the aisle, Tom has the right mix of knowledge or the job,” Pollack adds.

In a letter being distributed to U.S. senators, who must vote to confirm Scully, Dr. Charles H. Roadman, II and AHCA Legislative Counsel Bruce Yarwood states: “As HCFA administrator, Tom Scully will have the responsibility for leading dramatic change.”

The opportunity for HCFA reform is the brightest it’s been in years,” Roadman predicted, expressing confidence that the controversial survey and enforcement apparatus will be closely scrutinized by Scully and the Bush White House.

In a public statement, the American Association of Homes and Services for the Aging’s senior vice president Suzanne M. Weiss states that her nonprofit provider group looks forward to working with the new HCFA administrator.

“As we look for ways to improve the current nursing home and inspection and enforcement system and reimbursement system.  We hope Mr. Scully will be o pen to our efforts in his new position,” Weiss says.