Lawmakers can do more for Seniors next year

Published in RINewstoday on July 11, 2022

Just days before July 1, 2022, Gov. Dan McKee was joined for the signing of the $13.6 billion state budget (2022-H7123aa) for fiscal year 2023 by Lt. Gov. Sabina Matos, House Speaker K. Joseph Shekarchi, Senate President Dominick J. Ruggerio, House Finance Committee Chairman Marvin L. Abney and Senate Finance Committee Chairman Ryan W. Pearson.

Taking a Look at the Budget’s Dollars and Cents

Let us take a look as ho the state’s FY2023 budget, signed by McKee on June 27, 2022, impacts older Rhode Islanders.

The budget doubled the funding for the Livable Homes Modification Program, from $500,000 to $1 million, which reimburses half the total retrofit costs, up to $4,000, to support home modifications and accessibility enhancements to allow individuals to remain in community settings. The increase is intended to address an anticipated surge in applications.

For retirees, the Assembly raised from $15,000 to $20,000 the amount of annual pension income that is exempt from state taxation.

The FY 2023 Budget also allocated an additional  $200,000 to the Office of Healthy Aging’s budget for senior centers, bringing total funding to $1 million. That is a 25% increase.

The budget also makes significant investments in the quality of healthcare for seniors, providing rate increases to many kinds of providers of health care, nursing homes, home and community-based services for elderly (increase in starting pay to $15 hour), in addition to seeking a study by the Office of the Health Insurance Commissioner on appropriate reimbursement rate levels into the future.  The budget also includes substantial increase to reimbursement rates for Meals on Wheel meals ($400,000), ensuring that the program is able to provide high-quality therapeutic and culturally appropriate meals to participants.

Lawmakers also added $4 million to increase the “circuit breaker” tax credit available to qualifying elderly and disabled residents, raising the maximum credit from about $400 to $600 beginning in tax year 2022 and indexing that amount to inflation. They also made credit available to more Rhode Islanders by increasing the income threshold for eligibility from $30,000 to $ 35,000.

Those with military pensions will no longer have to pay any income taxes on them, beginning in the 2023 tax year. The governor had proposed phasing out military pension taxation over five years, but legislators instead made them tax-free in their entirety in one year.

Lawmakers also kept the Governor’s plan to invest $168 million in upgrades to Eleanor Slater Hospital, including $108 million to construct a new long-term care acute care hospital at the Zambarano campus in Burrillville.

The plan accelerates the six-year phase-out of Rhode Island’s motor vehicle excise tax, eliminating what would have been the final year of the tax next year.  The amended budget provides replacement license plates for free.

The state budget included a year-long pilot program to provide free service on the Rhode Island Public Transit Authority’s business route, the “R” line that runs from Pawtucket to Cranston.

It also added $11.5 million general revenue funds to launch a retail Supplemental Nutrition Assistance Program (SNAP) pilot program, beginning Jan. 1, 2023.  Eligible households would receive an incentive payment of 50-cents for every dollar spent on fruits and vegetables, subject to limits.  The state also requested a waiver from the Federal Nutrition Service to streamline the application process for elderly and disabled individuals seeking assistance from the SNAP program.

Lawmakers also allocated $10 million for rebalancing the state’s long-term care continuum, for funding home care agency workforce recruitment, retention and training.  Also, money in Rhode Island’s new budget includes $8.1 million to increase Medicaid Dental rates to increase access to dental services for older adults.

Finally, lawmakers kept in the $250 million total from the American Rescue Plan Act (ARPA) federal funds in the approved budget to address state’s affordable housing crisis.

Taking a peek at new state laws

The Rhode Island General Assembly passed H-7942/S-2623 which increases access and utilization of Accessory Dwelling Units (ADUs) and provides age-friendly housing options for older adults, family caregivers, and people of all ages and abilities.

McKee also signed the Let RI Vote Act into law. This new law makes voting safer, easier, and more accessible for all Rhode Islanders. Some of the major provisions of the bill include no-excuse mail ballots and emergency voting; online mail ballot applications; permanent absentee list opt-in for nursing home residents; no witness or notary requirement to vote by mail;  multilingual voter information hotline, community ballot; and voter registration list maintenance.

A new law also seeks to develop broadband in Rhode Island by creating a Broadband Advisory Committee. It’s director will be responsible for connecting with federal agencies to access funds for broadband infrastructure deployment pursuant to federal grants, facilitating broadband service adoptions, expanding digital literacy for residents (especially seniors), experiencing economic hardship, and for future economic development.

Following the passage of S-2228, the definition of an elderly person in regard to exploitation has changed from someone 65-years-old to someone who is 60 years old, making the definition of an elderly person consistent with state law.

Finally, the proposed Perry Sullivan one-year exemption has been eliminated. This preserves $38.6 million for home and community-based services for 2023.

Gearing up for next year’s legislative session

“Despite the lack of passage of H-7616 sponsored by Rep. Lauren Carson to elevate the Rhode Island Office of Healthy Aging to full Department status, I’m confident that it will be reintroduced early in 2023. I also anticipate broad community conversations to fine tune the design and identify the needed resources,” says Vin Marzullo, a well-known aging advocate who served as a federal civil rights and national service administrator.

“AARP Rhode Island worked hard on Smith Hill during the 2022 legislative session to achieve a number of important wins for the age 50 and over Rhode Islanders,” stated Catherine Taylor, AARP Rhode Island State Director. “We will find it easier to vote, have access to more housing options and assistance for accessibility modifications, see our direct care workforce better paid and better trained, and so much more. And, as always, AARP Rhode Island is committed to ensuring that those age 50 and our families know about these changes and how they will improve our lives,” she says.

 “Although there was some very good news for seniors coming out of the 2022 legislative session, overall, the results were modest when we think about the projected growth of our older population, that 42% of older Rhode Island households have income less than $ 40,000 and that our Office of Healthy Aging is under resourced. So much advocacy work remains,” warns Maureen Maigret, chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council and Policy Advisor for the Senior Agenda of Rhode Island, representing 21 organizations to mobilize people to enhance the quality of life of older Rhode Islanders.

However, Maigret sees a big win in the state budget language calling for rate review for state contracted providers as far too many services important for all ages have become so difficult to access due to poor payment rates to providers for many years. One example is that dental rates under Medicaid have not increased since the early 1990’s so older adults have had an extraordinarily hard time getting detail care, she says.

“Another big win that the Senior Agenda worked tirelessly for was removing the suspension of the $38.6 millions of “Perry-Sullivan” funds for FY 2023 that was in Gov. McKee’s proposal,” says Maigret.

However, Maigret expressed disappointment that the state’s budget only calls for minimum wage for home care direct care staff of $15 per hour. “Advocates tried to get this up to at least $17 to address the homecare workforce crisis that leaves some seniors waiting months for service,” she says.

According to Maigret, other items that will help older adults and persons with disabilities with rising housing costs are the expansion of the Property Tax Relief program sponsored by Rep. Ruggiero and Sen. Coyle.

“While we are appreciative overall for the gains that have been made for Rhode Island’s seniors in this legislative session, it is just a start toward what our state needs to do to meet the needs of our aging population,” says Bernie Beaudreau, Executive Director of Senior Agenda Coalition of Rhode Island. “I am disappointed that the minimum wage of $15 per hour was set so low.  This wage level will not do much to attract workers and solve the severe workforce shortages that home care agencies are facing. We also have to be vigilant about the administration of this new law as we have already seen a draft regulation suggesting that $15 will be the “average wage,” not the “minimum wage” of home care workers.

Funding for Seniors in Raimondo’s FY 2020 Budget Blueprint

Published in the Woonsocket Call on January 27, 2019

By Herb Weiss

Almost two weeks ago, Democratic Governor Gina Raimondo formerly unveiled her $9.9 billion budget proposal to the Rhode Island General Assembly. The House and Senate Finance Committees then begin the task of holding hearings on budget plan, getting feedback from the administration and the public. Once the revised estimates of tax revenue and social-services spending is available in May, negotiations seriously begin between Raimondo, the House Speaker and Senate President to craft the House’s budget proposal. Lawmakers will hammer out and pass a final state budget for the fiscal year that begins July 1.

Local media coverage of Raimondo’s ambitious spending initiatives zeroed in on her call for expanding free tuition to Rhode Island College and adding some public pre-kindergarten, increasing minimum wage from $ 10.50 to $ 11.10 per hour, allowing mobile sports betting and legalizing recreational marijuana.

But, Raimondo’s budget proposal gives state lawmakers a road map for what programs and services are needed for a state with a graying population.

According to Meghan Connelly, DEA’s Spokesperson, a nearly 60 percent increase in the State’s population of residents aged 65 and older from the years 2016 to 2040 highlights the need for continued investments in programs servicing Rhode Island’s older adults and their family caregivers.

Connelly says Raimondo’s budget proposal, released on January 17, elevates Elderly Affairs from a division under the Department of Human Services to an Office within the Executive Office of Health and Human Services. The governor shifts financing for the office and 31.0 FTE positions to EOHHS to accomplish this recommended action.

“The projected increase in the state’s senior population – from 174,000 in 2016 to 265,000 by 2040 – coupled with the proven impact of community-based supports and services, highlights the need for continuing to invest in helping our seniors remain home, connected to their families and networks. Support of aging-related health-promotion initiatives are essential to maintain a high quality of life for Rhode Island seniors while minimizing aging-related healthcare costs,” says Connelly

“We are focused on making it easier for older adults to live independent, fulfilling lives for as long as possible,” said Michelle Szylin, Acting Director of the Division of Elderly Affairs. “The Co-Pay expansion [in the governor’s proposed budget] enables additional older adults to age-in-place, remaining safely in their homes and engaging in their communities.”

The Co-Pay expansion enables additional older adults to age-in-place, remaining safely in their homes and engaging in their communities. The governor’s proposal to expand the state’s Co-Pay program [by $ 550,000] will allow more seniors to reside in their communities, staying connected to their family and network of friends and neighbors.

Providing access to the Co-Pay program to individuals earning up to 250% of the Federal Poverty Level will allow more seniors to age-in-place with a better quality of life and delay nursing home admission. The DEA Co-Pay program was established in 1986 as an option for elders who would otherwise be ineligible for subsidized home and community care assistance because they did not qualify for the Rhode Island Medical Assistance program.

Recognizing the importance of the state’s Elderly Transportation Program to keep older Rhode Islander’s independent, Raimondo’s budget proposal calls for additional funding of $1.8 million from general funds to support the State’s elderly transportation program. This program provides non-emergency transportation benefits to Rhode Islanders age 60 and over who do not have access to any means of transportation. The program provides transportation to and from medical appointments, adult day care, meal sites, dialysis/cancer treatment and the Insight Program.

Raimondo’s proposed budget also increases Health Facilities regulation staffing to increase the number of inspections to state-licensed health care facilities. The governor recommends a $327,383 increase in restricted receipt funds for 3.0 FTE positions. These positions will bolster existing staffing to increase the number of inspections to state-licensed healthcare facilities.

The Governor’s proposed FY 2020 budget also through the Rhode Island Public Transit Authority continues to subsidize the transit of elderly and disabled Rhode Islanders through the Rhode Island Public Transit Authority.

Raimondo’s proposed budget also continues the support for the Independent Provider model P model with almost $200,000 in general revenue funds budgeted (about $770,000 all funds) to cover implementation costs. The goal of this model is to increase workforce capacity and create a new option for delivery of direct support services for both seniors and people with developmental disabilities.

Finally, the governor’s FY 2020 budget also allocates funding to an array of programs and services for seniors. Here’s a sampling: $800,000 to support the state’s senior centers through a grant process (the amount was doubled last year); $ 530,000 to support Meals on Wheels; $ 85,000 to implement security measures in elderly housing complexes; $ 169,000 for the long-term care ombudsman through the Alliance for Better Long Term Care, which advocates on behalf of residents of nursing homes, assisted living residences and certain other facilities, as well as recipients of home care services; and $ 500,000 funds the state’s Home Modifications program at Governor’s Commission on Disabilities.

Nursing Facility Provides Take a Hit

Raimondo’s proposed budget plan seeks to freeze the state’s Medicaid payment rates to hospitals, slashing funding by an estimated $15 million overall for the year, and to limit the rate increase for nursing homes to 1%, costing them nursing home providers about $4 million.
“We are beginning the budget process with a 1 percent increase in the COLA (Cost of Living Adjustment), says Scott Fraser, President and CEO of Rhode Island Health Care Association (RIHCA), warning that “this is not enough.”

“Since 2012, nursing facility costs have risen 21.6 percent while Medicaid payment rates have only gone up by 9.6 percent, adds Fraser, noting that by statute, rates are supposed to be adjusted annually for inflation. “We will be advocating for additional funding for nursing facilities throughout the remainder of the budget process,” he warns.

Jim Nyberg, Director LeadingAge RI, an organization representing not-for-profit providers of aging services, joins with RIHCA in calling on Rhode Island lawmakers to restore the full inflation adjustment. “Ongoing increases in minimum wage (up 42 percent since 2012) make it harder for publicly funded providers to compete for skilled workers,” says Nyberg, noting that most of his nonprofit nursing homes have 60 percent to 70 percent of their residents on Medicaid. “A rate increase is needed help nursing homes recruit and retain the direct care workers that are so critical to providing quality care,” he says.

“Since 2016, our nursing homes and consumers have been severely disrupted by UHIP, financially and operationally. The ongoing problems with Medicaid application approvals and payments has resulted in significant increases in staff workload just to maintain operations, let alone the impact on cash flow and financial stability, adds Nybrg.

Nyberg’s group is also advocating to expand the CoPay program for individuals under the age of 65 with dementia. “This has been proposed in the past but not included in this budget. We think that such an expansion will help this at-risk population for whom no publicly-funded programs and services currently exist,” he says.

Lawmakers, AARP Rhode Island Gives Comments

AARP Rhode Island is encouraged to see that the Governor placed an increase in the State Budget for the Department of Elderly Affairs home healthcare Co-Pay program,” said AARP Rhode Island Advocacy Director John DiTomasso. “By increasing the income eligibility from 200% of the poverty level to 250%, more older Rhode Islanders will be able to obtain home care services at reduced hourly rates,” he added. “This will help large numbers of people to extend the time they can age in place in their home and in their community rather than in more costly state-paid long-term care facilities,” says DiTomasso.

Senate President Dominick J. Ruggerio says, “Upon a first look at the budget, I am very pleased that some of the Senate’s top priorities are incorporated. The Governor had to close a significant deficit, and difficult choices had to be made. However, the budget is a statement of priorities, and initiatives like the no-fare bus pass program for low-income seniors and disabled Rhode Islanders are a priority for us in the Senate. I am very pleased to see this program funded in the budget, along with many other services for seniors, and I look forward to deeper analysis of all aspects of the budget in the months ahead.”

AddsD House Speaker Nicholas Mattiello, “The House Finance Committee will soon begin holding public hearings and reviewing every aspect of the Governor’s budget proposal. We will make certain that the level of care and services to older adults will be maintained and hopefully enhanced. We are facing significant budget challenges this year, but we will always keep the needs of our seniors at the forefront of the discussions.”

Older Rhode Islanders and aging groups must continue to push the House to at a minimal maintain the governor’s senior agenda. Hopefully, as Mattiello said, senior programs and services can be enhanced.

For a Senate Fiscal Analysis of Raimondo’s FY 2020 budget, go to http://www.rilegislature.gov/sfiscal/Budget%20Analyses/FY2020%20SFO%20Governor’s%20Budget%20-%20First%20Look.pdf.