Almost two weeks ago, Democratic Gov. Gina Raimondo formally unveiled her $9.9-billion budget proposal to the Rhode Island General Assembly.
The House and Senate finance committees will 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 the 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 roadmap for what programs and services are needed for a state with a graying population.
According to Meghan Connelly, a spokesperson for the Rhode Island Division of Elder Affairs, a project increase of nearly 60 percent 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 Jan. 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 full-time equivalent 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 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 percent 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 full-time equivalent positions. These positions will bolster existing staffing to increase the number of inspections to state-licensed healthcare facilities.
The governor’s proposed budget continues to subsidize transit for elderly and disabled Rhode Islanders through the Rhode Island Public Transit Authority.
Raimondo’s proposed budget also continues support for the Independent Provider model of at-home care with almost $200,000 in general revenue funds budgeted 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 FY2020 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 for the state’s home modifications program through the Governor’s Commission on Disabilities.
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 percent, costing nursing home providers approximately $4 million.
“We are beginning the budget process with a 1-percent increase in the COLA [or cost-of-living adjustment],” says Scott Fraser, president and CEO of the Rhode Island Health Care Association, 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.”
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.”
“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 have resulted in significant increases in staff workload just to maintain operations, let alone the impact on cash flow and financial stability,” adds Nyberg.
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,” he says. “We think that such an expansion will help this at-risk population for whom no publicly-funded programs and services currently exist.”
“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,” says AARP Rhode Island Advocacy Director John DiTomasso. “By increasing the income eligibility from 200 percent of the poverty level to 250 percent, more older Rhode Islanders will be able to obtain home care services at reduced hourly rates. 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.”
“Upon a first look at the budget, I am very pleased that some of the Senate’s top priorities are incorporated,” says Senate President Dominick Ruggerio. “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.”
Adds 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 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 FY2020 budget, go to visit rilegislature.gov/sfiscal/Budget%20Analyses/FY2020%20SFO%20Governor's%20Budget%20-%20First%20Look.pdf.
Herb Weiss, LRI’12, is a Pawtucket writer covering aging, healthcare and medical issues. To purchase “Taking Charge: Collected Stories on Aging Boldly,” a collection of 79 of his weekly commentaries, visit herbweiss.com.