Published in RINewsToday on March 25, 2024
A few weeks ago, advocates for seniors gathered on Smith Hill, attending a Senate Committee on Health & Human Services hearing to push for passage of S. 2399. The legislation would expand income eligibility for the Medicare Savings Program (MSP), helping many lower income seniors and disabled residents pay their $175/month Medicare Part B premium and covering co-pays and deductibles for those with very low-income.
Thousands of low-income seniors and persons with disabilities on Medicare, but not eligible to participate in the state’s Medicaid program, struggle to pay their Medicare Part B premiums and co-pay costs for services and prescription drugs causing many to forgo needed health care as they cannot afford to pay the co-payments.
S. 2399, introduced by Pawtucket Sen. Sandra Cano (D-Dist. 8, Pawtucket), would expand eligibility for the Medicare Savings Program (MSP) by increasing the income limit to 186% of the federal poverty line and eliminating the strict asset limit. It also increases from 100% to 138% of the federal poverty line a part of the program that covers deductibles and co-payment.
S. 2399 was heard on March 12, 2024 and held for further study. At press time, H. 7333, introduced by Pawtucket Rep. Karen Alzate (D-Dist. 60, Pawtucket, Central Falls), has been referred to the House Finance Committee for consideration. No hearing date has been scheduled.
“With health care costs rising at an alarming rate, it is imperative that we make sure that no one goes without the care they need due to unaffordability. This bill adapts to the significant changes in our society and economy while also ensuring that our most vulnerable senior and disabled residents are able to access the care and medicine that is essential to their daily lives,” said Cano, who champions S. 2399 and in previous legislative sessions introduced legislation to expand the MSP.
“Too many of our low-income seniors and disabled residents are falling through the cracks and foregoing crucial health care services due to rising co-pays and out of pocket costs. This is unacceptable, but thankfully, we can do something about it. By passing this legislation, thousands or more Rhode Islanders will be able to receive the care that they desperately need while also keeping more money in their pockets that’s needed for daily living expenses,” said Alzate, who sponsored the House companion measure.
“We understand this is very important legislation. We had a very informative, thorough hearing on this bill, and I look forward to reviewing all the information we collected.” says Senate Health and Human Services Committee Chairman Joshua Miller (D-Dist. 28, Cranston, Providence).
The Policy Problem and its Solution
Currently, the income limit of $20,331 leaves thousands of older Rhode Islanders and disabled low-income persons on Medicare with significant gaps in coverage and hefty out of pocket costs.
If the MSP income limit is increased to $28,012, as required by the legislation, an estimated 17,000 persons would be newly eligible to have their Medicare Part B covered by being enrolled in MSP. Anyone enrolled in the MSP receives automatic enrollment in Part D “Extra Help,” a federal program which significantly lowers out-of-pocket Medicare prescription costs at no cost to the State. The federal government establishes the minimum income and asset thresholds for the MSP, and states are permitted to increase these limits and many have done so.
Advocates of Cano’s MSP legislative proposal say it also particularly helps Rhode Island’s older woman and minorities. “Since women and people of color and persons with disabilities are disproportionately represented in low-income populations, increasing access to the MSP promotes equity,” finds an advocacy partnership’s analysis of the legislative proposals. “Poverty rates among older adult Hispanic women are two and one-half times that of older Hispanic men and persons age 18 and over with disabilities are twice as likely to live below 150% of the poverty level, said the analysis.
The advocacy partnership’s analysis also noted that significant numbers of older adults and those with disabilities enrolled in Medicare face financial challenges meeting basic needs. The number of older adults living below or near poverty has increased, housing costs have climbed dramatically, food cost have increased and many more rely on food pantries.
Covering the $175/month Medicare Part B premium for 17,000+ Rhode Islanders (at no cost to the State) and additionally covering co-pays and deductibles for thousands of very low-income adults and persons with disabilities on Medicare will give them much needed financial relief. And enrollment in the Extra Help program to reduce drug-related costs provides significant additional financial assistance and improves access to critical medication.
Testimony At the Senate Committee Hearing
Nine organizations either testified at this hearing or submitted written testimony to urge passage of S. 2399. AARP Rhode Island did not testify at the hearing but signed up in support in the committee room. There was no opposition to Cano’s legislative proposal.
“I first became aware of the need to expand the income eligibility for MSP quite a few years ago when an older man in my neighborhood contacted me to tell me he lost out on the program because he was just a few dollars over the income limit. As a result, the Senior Agenda Coalition of RI (SACRI) has advocated for several years to increase the income cap,” says Maureen Maigret, SACRI’s policy Advisor.
It’s a win-win for both older Rhode Islanders and for the Rhode Island General Assembly, says Maigret. “S. 2399 would help Medicare beneficiaries to access care along with putting money back in their pockets to pay for food, rent and their basic needs. By increasing the Medicaid income to $28,012, the federal government will pay the full cost of the newly eligible Medicare beneficiaries,” she told the lawmakers.
Strongly supporting S2399, Karen Malcolm, of Protect Our Healthcare Coalition, noted that the legislative proposal is modeled on the MSP changes enacted in New York last year and approved by the Centers for Medicare and Medicaid Services. “Rhode Island should take advantage of the opportunity to expand access to affordable coverage for seniors and people with disabilities and bring new [federal] revenue to our state.”
H. Phillip West, Jr. lobbyist for the Village Common of Rhode Island, states MSP already makes an enormous difference for many beneficiaries. But, “Rhode Island’s low threshold for eligibility and low allowable assets leaves thousands of our needy neighbors out. The good news is that Senator Cano’s legislation address these defects,” he said.
In submitted written testimony, Heather Smith, MD, president of the Rhode Island Medical Society stated “From our perspective as physicians, we witness firsthand the adverse effects of financial barriers on patient health outcomes. Too often, individuals are forced to forgo or ration medications, delay necessary treatments, or skip preventative care due to concerns of affordability. These delays can exacerbate health conditions, lead to complications, and ultimately result in higher healthcare costs down the road.”
Alex Moore, political director of SEIU 1199NE, stressed the many benefits of passing S. 2399, specifically enhancing access to care, providing needed financial relief, leveraging federal funds, and strengthening the health care workforce. By supporting the legislative proposal, “we demonstrate our commitment to health and well-being of our state’s most vulnerable populations,” he stated in written testimony.
Even with the strong support of the aging community, the state’s Office of Healthy Aging has not yet taken an official position on S. 2399. “As with any other bills at this stage of the session, we are reviewing the impact of H 7333 and S 2399 on Rhode Islanders. We will continue to follow these bills as they make their way through the legislative process,” says Director Maria Cimini.
Samuel Salganik, JD, executive director of RIPIN, which offered testimony in support for S.2399, said, “This is one of the best investments available right now for our state government. At a cost of just over $5 million, the State can draw down more than $40 million in federal support to assist low-income seniors in Rhode Island,” says Salganik. “It’s a great deal for the state. I think that’s a deal that most of us would happily take,” adds Salganik.
Gov. Dan McKee’s recently released FY 2024 Budget does not include funding for to expand the state’s MSP. Now the ball is in House Speaker Joseph Shekarchi’s (D-Dist. 23, Warwick) court as his chamber collaborates with the Senate to hammer out budget resolution to be approved by the Rhode Island General Assembly to be sent for the Governor’s signature. Hopefully, Shekarchi will see the expansion of the state’s MPM as a win-win for lower-income and disabled persons on Medicare and the state. As supporters of S 2399 and H 7333 say, “it’s a no brainer.”
The Advocacy Partners for MSP Expansion was established to push for the passage of S 2399 and H 7333 during this legislative session. They are: the Senior Agenda Coalition of Rhode Island, Rhode Island Organizing Project, RIPIN, the Economic Progress Institute, the Protect Our Healthcare Coalition and the Ocean State Center for Independent Living.
To access the bills under consideration: http://webserver.rilegislature.gov/BillText/BillText24/SenateText24/S2399.pdf – http://webserver.rilegislature.gov/BillText/BillText24/HouseText24/H7333.pdf
Expanding the income eligibility for the Medicare Savings Program (MSP) is one of the legislative priorities of the Senior Agenda Coalition of Rhode Island. These policy issues will be discussed at its upcoming Legislative Leaders Forum scheduled on Wednesday, March 27, 2024, from 10:00 a.m. to 11:00 a.m., at the Crowne Plaza Hotel, 601 Greenwich Ave,, Warwick, RI.
The Senior Agenda Coalition of RI’s Annual Legislative Leaders Forum is this week:
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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.
RI Seniors, aging advocates call for an “age friendly” budget
Published in RINewsToday on March 27, 2023
Over two months ago, Gov. Dan McKee unveiled a sweeping $13.7 billion budget for the upcoming fiscal year. After its release, the Senior Agenda Coalition of RI (SACRI), representing 21 organizations, called this budget “unfriendly to seniors,” charging that it “short-changed” seniors. In an e-blast that was sent to 1,800 seniors and aging advocates SACRI urged them to contact their lawmakers asking that they put more funding into the delivery of aging programs and services.
As the House Finance Committee continues to hold hearings on bills that might ultimately be rolled into the upcoming FY 2024 Budget, last week the SACRI brought 220 seniors, aging advocates and professionals in the aging network to the Warwick Crown Plaza to personally urge House Speaker Joe Shekarchi (D-Warwick) and Senate President Dominick Ruggerio (D-Providence, North Providence to hammer out an “age-friendly” budget.
SACRI Board Chair George Neubauer began this year’s Legislative Leaders Forum by quoting President Joe Biden’s call to Congressional lawmakers at the annual State of the Union Address to maintain Medicare and Medicaid. The President urged lawmakers to “stand up for seniors”. Setting the stage for why this event was organized, Neubauer told the packed room: “Today, we are here to speak up for ourselves.”
Painting a Portrait of Rhode Island Seniors
“Effective advocacy includes good data and good stories,” said Maureen Maigret, a SACRI Board member and policy advisor for the group setting the stage for the speakers. She presented demographic data on the state’s graying population, discussed the increased needs of state’s aging programs and services to keep people at home, and detailed SACRI’s budget policy fixes.
“We speak up for 200,000 seniors and our numbers are growing,” says Maigret, also a former State Representative and Director of the RI Department of Elderly Affairs. By 2030, 1 in 5 Rhode Islanders will be aged 65 and over,” she says.
While many think that seniors are a drain on the economy, they are not. According to Maigret, $3 billion dollars in Social Security benefits are pumped into the state’s economy. Twenty percent of seniors are still working and paying taxes and employers are very aware that seniors have extensive job experience skills and are usually very reliable employees.
“Additionally, seniors are part of an invisible workforce of unpaid caregivers who take care of family members and friends, also,” says Maigret, noting that AARP Rhode Island recently released a study reporting that there are 121,000 unpaid caregivers, with the value of their unpaid care estimated to be $2.1 billion dollars (just under $19 per hour).
“Seniors also contribute thousands of hours of volunteer work to their local communities, lending a helpful hand to senior centers, friendly visitor programs, Meals on Wheels, and to the Village Common of RI at four Village communities and multiple other agencies,” adds Maigret.
“An overwhelming 70% of Rhode Island seniors want to age in place and remain in their communities,” says Maigret, noting that “after age 65, 3 out of 5 of these individuals will need some support to stay in their homes.”
SACRI survey on areas of concern for seniors
With Rhode Island’s top House and Senate leadership listening, Maigret touched on the findings of a SACRI survey that identified an array of concerns expressed by their older constituents. Health and care issues came up on the top of this list, followed by isolation and loneliness, lack of knowledge of community support services, the need for transportation, loss of mobility, high housing costs, and lack of income.
The survey findings indicate that needed information is not reaching older adults to navigate the long term care system, says Maigret. Forty percent do not know about programs and services offered by Rhode Island’s Office of Healthy Aging (OHA) and The Point, the state’s aging and disability resource center. She noted that the Governor’s FY 2024 budget didn’t allocate any state dollars to operate The Point, whose mission is to direct seniors to needed programs and services.
“Even with Social Security, a large number of seniors have low incomes,” says Maigret, with 50% of older households living on less than $50,000 a year, another 27% living on less than $25,000. “The cost of long-term care is staggering and unaffordable with semi-private rooms in nursing facilities going for $94,900 a year,” she pointed out. “Assisted living facilities is out of reach for many, too, costing about $54,000 a year. Bringing a home care aide 40 hours per week into a person’s home costs a whopping $56,160,” she adds.
Maigret urged Shekarchi and Ruggerio to reallocate more state dollars to home care services. While other states, on average, spend 45% of Medicaid long-term care dollars on home care, Rhode Island only spends 22% with hundreds of seniors having to wait over 3 months to get home care services.
Maigret says that SACRI supports a legislative agenda that calls on the Rhode Island General Assembly to craft a “Better Budget for Better Care,” which will result in a permanent investment to improve the care provided to seniors. SACRI also urges that lawmakers raise direct workers pay to $20 per hour to attract workers into home care agencies and nursing facilities. To assist seniors to access needed programs and services, $500,000 must be allocated into the House budget to better market available information and referral services offered by The Point.
“Meanwhile, SACRI also is pushing to add five new positions at the OHA, with two being assigned to its Adult Protective Services Unit to increase increased caseloads,” says Maigret. By allocating funding to help more lower income Medicare beneficiaries pay their Medicare Part B premiums, seniors will have more money to pay their bills.
Telling Powerful Stories
SACRI pulled together a few “real life” stories to illustrate why Rhode Island lawmakers must craft an “Age Friendly” FY 2024 Budget.
Jeanne Gattegno, working in the elder abuse sector, shared her thoughts as to why OHA’s Adult Protective Service Unit (APSU) is underfunded. “Elder abuse is a crime and anyone suspecting abuse must report it. When its reported it must be investigated by the APSU,” she says.
According to Gattegno, in 2021, there were over 6,200 calls to OHA, over 1,400 calls were elder abuse complaints, and 2,800 were investigated as self-neglect. “There are five workers in the APSU. Just do the math. It’s an incredibly difficult job and it’s life and death and there are not enough people to help,” warns Gattegno.
Allyson Manning, an overworked Registered Nurse at a local nursing facility, highlighted her typical day working with two Certified Nursing Assistants to take care of 26 residents. Due to low wages, the facility can’t fill the third CNA position to assist the other two CNAs on the shift.
Serving as Team Leader, Manning says that there is not enough time to take care of her 26 residents. During this shift her chief responsibility is to pass medications, perform treatments and assessments. She often finds that her primary functions as an RN are late or difficult to carry out, due to the need to assist the CNAs with their tasks of toileting, washing, dressing and feeding residents.
“We are not attracting the people we need to these [CNA] positions. They are low paid jobs, but it is really rewarding work but it is hard work., she says. When hired, CNA’s are not staying long, turnover is high says Manning. While initially working full-time, she now only works two days a week.
Giving Their Thoughts…
RI Speaker of the House, Joe Shekarchi remarked that he clearly understood the very powerful stories shared by Gattegno, Manning and others. “I didn’t need to hear those stories because I live those stories every day. When his 97-year-old father recently fell at home and broke his pelvis, he was admitted to the Bethany House.
“I see how hard they work and the limited staff they have,” says the House Speaker, understanding the labor shortage’s impact on nursing facilities. “I see when my father hits the call button and it takes a long time [to answer] not because they are slow, but because they are doing three or four things at the same time,” he says.
“It’s important that seniors have options so they can choose what’s best for them,” says Shekarchi. “We need to provide supports for seniors to age in place and remain in their homes living independently,” he added, acknowledging that it is not always easy to do.
Shekarchi also recognized his effort with the Senate President made historic investments to require minimum staffing last year. Unfortunately, it hasn’t happened because the nursing facilities are now facing labor shortages, he says.
According to Shekarchi, last year the General Assembly also provided more funding to make home care more accessible for seniors. Lawmakers also provided tax relief on pensions for older taxpayers and military veterans, strengthened laws to protect seniors from financial exploitation, and made it easier to apply for SNAP benefits and expanded property tax relief for seniors. He expects to continue his efforts this legislative session.
Shekarchi also reported that he has introduced a bill, supported by AARP RI, to allow zoning for constructing Accessory Dwelling Units (ADUs) in garages or basements. He called on seniors and aging organizations to support his housing bill.
The House Speaker also discussed proposed legislation by Rep. Lauren Carson (D-District 75, Newport) proposed legislation that would create a House Study Commission to coordinate Rhode Island’s programs and services for seniors, expressing the need for such a study commission.
Like Shekarchi, Senate President Dominick Ruggerio outlined a number of legislative successes last year. He recognized passage of Sen. Josh Miller’s legislation authoring the creation and implementation of a pharmaceutical redistribution program. Former Sen. Cindy Coyne’s legislation became law, too, lowering the age at which a victim can be considered an elder under the state’s financial exploitation law from 65 to 60.
With the state’s growing number of seniors, Senate President Ruggerio stated that senior issues are more important than ever.
“We need to do everything we can to ensure seniors and retirees can enjoy their older years with dignity and security,” he said. “Because after a lifetime of hard work and contributing to our communities… older Rhode Islanders deserve nothing less.”
“The Senior Agenda Coalition is a powerful tool in its work. At the Statehouse we rely on your voices to help guide us as leaders,” says Ruggerio, noting “we don’t have all the answers and appreciate your input.”
To watch SACRI’s 2023 Legislative Leaders Forum, go to https://ritv.devosvideo.com/show?video=7cd34a907d29&apg=c7e3a6c7.
Herb Weiss 