2010 Budget














INITIAL PROPOSAL IN HOUSE ONE BY THE GOVERNOR FOR FISCAL YEAR 2010

ASAPS will have somewhat less(about 2 %) than in 2009.
COAs will see their formula grants return to the levels of 2009.
Line items for EOEA have been consolidated. For example all of the housing services will be on one line item(9110-1800)
 
 
FINAL 2010 BUDGET BY THE LEGISLATURE
 
The budget which was sent to the Governor mostly includes the less preferable Senate version.
Line items are funded at much lower levels or eliminated with only a few bright spots.
Here are a few examples:
 
  • Mental Health - No funding
  • Caregiving - No funding
  • Wage Pass Thru for CNAs - No funding
  • Home Care Purchased Services -Reduced funding
  • Protective Services -Level funded
  • COAs/Senior Centers- Level funded
  • PNA - Preserved
  • Bed Hold - Preserved at 10 days
ACTION STEPS:
 
  1. Contact the Governor(888-870-7770 or FAX- 617-727-9725) and ask him to sign the PNA and Bed Hold(and other items you support).
  2. Contact your state Senator and Rep and thank them for maintaining or preserving those identified items.

 

SENATE VERSION:

The Senate has completed its version of the budget and now it shall be combined with the House version all of which shall be debated by a Conference Committee of 6 people before returning to each house for another vote.
 
Legislative leaders and the Governor are uncertain that the taxes which are included are sufficient to meet expenses.
 
It is difficult to glean specifics in the Senate version of the budget as they combined a number of line items.
Next is a review of the Senate action compared with the House. It is followed with recommended action steps.
 
 
  • Mental Health was eliminated(it was funded at $ 125,00 in the House version which was a reduction). Support House.
  • Suicide Prevention(Line item 4513-1026) is higher in the House version. 
  • Protective Services was the same for each House and about the same as this year.
  • Councils on Aging were about the same as the House version and the same as this year.
  • Housing(combined line items) is lower than the House version.Support House.
  • Home Care Accounts(combined line items) is lower than the House version. Support House.
  • Bed Hold (medical and non-medical)was restored.It was also restored in the House but the language is altered.
  • PNA was restored in the House and in the Senate at $ 72.80/month.
  • Wage Pass Thru(for nursing home CNAs) was reduced in the Senate and not earmaked by the House. Its future is unclear.

 

ACTION STEPS: 

  • Contact your individual State Senator and Rep and ask them to support the preferable version of each item above and to maintain those items at the highest funded levels.
  • Ask them to so inform members of the Conference Committee - including  the Chairs of the House(Rep.Robert Murphy- 617-722-2990) and Senate(Senator Steve Pangiotakos- 617-722-1630) Ways and Means Committees.
 
Urge them to support taxes which are sufficient and appropriate to meet the need.
           
 
 
 
 
 

The Senate debated the budget the week of May 18.

The Ways and Means Committee recommended many cuts to the budget due to an expectation that revenues would be even lower than the House had indicated.
 
On May 20, the Senate agreed to new taxes:
 
  • Increase the sales tax from 5 to 6 1/4 % but only for 10 months instead of 12.
  • Give cities and towns the ability to raise some taxes(restaurant and hotels) on their own.
  • Add a sales tax to alcohol sales.
It is unclear what impact these new revenue sources will have on expenditures in the Budget. Will some items be reduced or eliminated or saved?
The Senate debate will continue this week.
     
    The House floor debate was completed on this week of 4/27 and  produced these results:
 
 
  •       Passage of 6 1/4 % sales tax.
  •       Restoring funds to the home care purchased services account
  •        Keeping a separate Medicaid account  for seniors and persons with disabilities.
  •        Maintain the 10 day bed hold.
  •        Maintain the $ 72.80 PNA
  •        Did not restore the elder mental health line item.
  • Suicide prevention funding(for the DPH)increased to 4.3 million.
ACTION STEPS:
 
 
  • Contact your state rep and thank them for these accomplishments.
  • Contact your State Senator and urge them to keep the above in their budget and to restore the elder mental health line item to at least $ 225,000.
     
 
 
    The Ways & Means Committee's proposed budget was released on 4/15. It reduced the overall budget from 2009.
     There are significant consequencies for elder services:
       
  •           The elder mental health line item(9110-1640) has been cut to about $ 100,00(from $ 225,000).
  •            The ASAPS(Home Cares) will see a reduction of about 4,000 people in their caseloads.
  •            There is no language for the Bed Hold  in the budget.
  •            There is no language for the PNA(Personal Needs Allowance) in the budget.
Amendments have been submitted and some are as follows:
 
 
  • Elder Mental Health(# 232)  by Rep. Scaccia
  • Bed Hold(# 485) by Rep. Fernandes.
  • PNA(# 427) by Rep Peisch.
  • Home Care(# 404) by Rep Wolf.                        
 
ACTION STEP:
 
Please contact your Mass State Representative to support amendments which will return these items or increase their monies.
         
 
II. Mass House Budget for 2010
 
House speaker DeLeo has indicated that currenrt revenues will necessitate billions in decreases for the Fiscal year 2010 budget.
 
The Ways & Means Committee will release its budget proposal in several weeks. It is unclear hwhat impact this will have on elder mental health priorities.
 
You still can contact your State Representative and advocate for elder mental health priorities(ex.- Line item 9110-1640; 4513-1026; line items in EOEA for home care-- see Public Policy 2010 budget for more).
 
 
 
V. 
MASS STATE BUDGET
Governor Patrick announced his revised budget  cutbacks for 2009 and his proposed budget for 2010.
2009 - (click for more information)
Councils on Aging will see reduced funding.
Most other elder related funding is not changed.
 
There seems to be much level funding of services.
The Councils on Aging should receive their lost funding from this fiscal year.
There is some re-organization within EOEA and Medicaid.
 
It is difficult to determine immediately what impact there will be on elder mental health in the budget.
We will have more information as it becomes available.
 
 
 
VI
 GUARDIANSHIP
 
 
 
III.
New House Committee Chairs
New assignments were announced.(for 2009-2010).
Some include:
 
 
  • Elder Affairs - Alice Wolf(Chair)
  • Mental Health/Sub Abuse - Elizabeth Malia(Chair)
  • Ways & Means - Charles Murphy(Chair); Barbara L'Italien(Vice Chair)
     
 
 
IV.

MOVING MASSHEALTH OUT OF ELDER AFFAIRS

 
The Governor has decided to delay or put off this move. There remains a desire by the administration to make this move but there is now a willingness to talk with stakeholders about this effort. 
We'll inform you of the next step(s).
Please read below.
 
The Patrick Administration(in Mass) has decided to move the long term care section of Masshealth out of Elder Affairs and back to Medicaid. It was  separated from Elder Affairs (a number of years ago) in order to have more services for elders in one place. Historically,  services for elders from the Commonwealth of Massachusetts have been located in various places. This has made it difficult for elders and providers to access services.
 
If this move is made it will bring different parts of Medicaid together but services for elders will again be scattered around state agencies.
 
The Governor or Legislative Leadership(ex.- House Speaker, Senate President, et.al.) have the authority to change this initiative.
 
 

ACTION STEP:

 
If you agree that this is a move in the wrong direction then contact
Governor Patrick(888-870-7770),
House Speake DeLeo, and/or Senate President Murray. Urge them to maintain Long term care services of MassHealth in Elder Affairs.
 
 
 
V. 
MASS STATE BUDGET
Governor Patrick announced his revised budget  cutbacks for 2009 and his proposed budget for 2010.
2009 - (click for more information)
Councils on Aging will see reduced funding.
Most other elder related funding is not changed.
 
There seems to be much level funding of services.
The Councils on Aging should receive their lost funding from this fiscal year.
There is some re-organization within EOEA and Medicaid.
 
It is difficult to determine immediately what impact there will be on elder mental health in the budget.
We will have more information as it becomes available.
 
 
 
VI
 GUARDIANSHIP
 
Governor Patrick  signed the Probate Court Reform Bill. It includes provisions to make significant changes in Massachusetts Guardianship Procedures. See below for more information(# VII).
It will be in effect as of July1, 2009. Implementation and rules will be written by a committee of he Probate Court.
 
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VII.
 
FEDERAL STIMULUS BILL AND IMPACT ON ELDERS
This bill has been passed by each house and signed by the President.
Read below for more information.
 
 
The Federal House Appropriations Committee passed this economic stimulus bill which goes on to the House.The Senate and the President are next and the hope is that it will be done by Mid February.
There are several pieces which will impact elders.
They include:
 
  • Additional funds for Meals on Wheels
  • Additional funds for congregate meals
  • Low income energy assistance
  • Raise the SSI in 2009 in a one time payment
  • Increased funds for states and their Medicaid programs.
For the full text go to:
 
 
 VIII.
Congress has made some important changes in Medicare services.
 

I. In section 203 the co-payment for mental health services will be reduced from 50% to 20%. This will be reduced at 5 % per year over 6 years.

2. In section 606 clinical social workers would be allowed to bill Medicare directly for services provided to residents who are in a Medicare A (SNF) bed.

 

 

XIX.

ELDER MENTAL HEALTH LINE ITEMS IN MASS BUDGET

A.. EOEA-Line item 9110-1640. Proposed $ 3.985 million and was reduced to $ 225,000.

B. DMH- Line item 5640-1000. Proposed for a million and failed.

C. The Governor's proposed budget for Fiscasl 2009 only calls for $225,000 in the EOEA line item and nothing in the DMH line item.

D, The Fiscal 2009 budget maintained $225,00 in the elder mental health line item(9110-1640).There was no increase in funding.

 

X. 

Guardianship

This bill(S. 2622)now a law in the Mass  will:

1. Create a new standard for "incapacitated person" based on functioning(lack of capacity). Diagnosis will not be the only criteria.  
2. The guardian's powers will be limited(ex.- the  guardian will go to the Probate court when a nursing home placement is in the works).  
3. The guardian must submit detailed annual reports.
4. There is a requirement for a more comprehensive and integrated medical certficate.
 

It has been passed by the entire legislature and signed by the Governor.  

We will update when we have more information about the regulatory and implementation process.

It should be in place  7/09.  

 
 

XI. RESIGNATION OF ELDER AFFAIRS SECRETARY Mike Festa, the Secretary of Elder Affairs , has announced his resignation from that position.  Ellie Shea Delaney will fill that post until a decision has been made  about someone to fill it on a permanent basis.    

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NEWS FLASH



FEDERAL HEALTH CARE LEGISLATION


Congress is speeding up a process to place legislation on the President's desk in the Fall. Committee work could be done by the July 4th break and each house could complete its work by the August recess.
 
If we want to preserve Medicare we must reform the general health care system. The rising cost of medicare is due in part to the rising cost of health care for everyone. As long as 45 million have no health care and millions more have inadequate health care the costs of care will be unaffordable for everyone else. The cost of mental health care - including that for elders- is impacted by some of the same factors.
 
If this is not passed now it may not be done for a long while.
 
Important issues:

 


There has been much discussion about healthcare legislation now pending in Congress. This debate can be useful and constructive. The President did not submit a bill and there are at least five different bills (each of which varies) in Congress. However, some characteristics attributed to the bills are incorrect and in some cases destructive.


  1. EUTHANIZE GRANDMOM AND OTHERS


There has been talk about "death panels" and forcing people to die. No bill has this provision. There

are provisions which allow patients to speak with their physicians about advanced directives(health

care proxy, durable power of attorney, DNR, feeding tubes, ventilators, etc.) Anyone would elect to

have this conversation. The MD would be paid for this time and would have to review a variety of

advanced directives.


         2. CARE WILL BE RATIONED


Care is rationed now. Currently, private insurance companies regularly reject people for health insurance if they have pre-existing conditions, place annual and life time conditions on coverage, discontinue coverage when you are ill, etc. Most, if not all, of these bills would prohibit those actions by insurance companies.


        3. AMERICA WILL BE BANKRUPT


Most of these bills will cost about one trillion dollars in ten years.

Currently,

    • We spend about two trillion dollars each year for health care.

    • Employers are ending health care as a benefit as they cannot afford it.

    • We are spending so much more for premiums, co-pays and deductibles that many are dropping their coverage.

    • Others are facing personal bankruptcy due to their health care expenses.



         4.   WE WILL ALL BE FORCED TO ACCEPT A GOVERNMENT PLAN(which we have never had in this country).


Medicare is a government plan and it is more cost-efficient than private plans. Some of the plans have a public/government option and some have a co-op option. In either case individuals would choose to continue their current insurance plan or a government or co-op plan. A government plan would be like Medicare for those under 65. The co-op plans have as yet little detail. There are no single payer plans (where the government is the only source of payment) on the table.


5. INDIVIDUAL MANDATE

In most of the bills everyone will be required to have a plan. Those without a plan could have a financial penalty thru the IRS.

     

            6 . SENIORS WILL LOOSE THEIR BENEFITS  .

No.


However, there are new benefits (in most plans).

  • Elimination of co-pays and deductibles for preventive services

  • Fill the donut hole for prescription coverage.


And, there will likely be cuts for providers including;

  • Looking more closely at and eliminating "unnecessary" or "redundant" tests.

  • Reduce funding for Medicare Advantage plans.

  • Decrease payments for hospitals and physicians.



        7. WILL THERE BE A LONG TERM CARE BENEFIT?


In Senator Kennedy’s version there is a long term care benefit. It would be elective and would involve an additional premium. This is the only bill which has a long term care provision.

Long term care is defined in the bill as community and home based care, assistive living, and nursing home care. It is the first time that there could be a federal insurance program which provides these benefits for most people respective of age, disability, or other status.

It has been passed in Committee and can be debated on the floor of the Senate.



Action Steps
  1. Please contact our two Senators(Kennedy and Kerry), along with your congressional representative to support health care legislation which provides long term care and includes single payer or at least a government option.
  2. Contact your relatives and friends in other States to do the same.

 

 
 
 
 
 
ACTION STEPS:
  
I. Contact the following and urge them to:
 
  1.      Override




 

 
 
 

  

 
 
 
 
 

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