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Department of Elder Affairs

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4000-0600	Sr. Care Plans	1,648,865,000	1,697,117,500	1,783,969,375	1,926,481,999
4000-0625	HHA Wage Incr.	--	4,000,000	0	0
4510-0720	Nurse's Aide Training	1,000,000	0	0	0
9110-0102	Asst. Living Regulation	368,000	246,447	246,160	247,217
9110-1455	Prescription Advantage	73,684,000	110,000,000	90,159,453	90,249,126
9110-1460	Presc. Advtg. Co-pay Subs.	new	5,000,000	0	0

This chapter focuses on the House of Representatives’ FY06 budget recommendations for programs serving persons with disabilities at the Department of Elder Affairs (DEA). For additional information on the impacts of FY01–FY05 budget cuts and more details about program services, go to the People First website at www.mass.gov/mddc/peoplefirst/index.html and click on the DEA chapter in the Volume I table of contents.

HOUSE BUDGET OVERVIEW

Good News and Bad for Programs Supporting Seniors and Persons with Disabilities

The House budget contains key positive provisions for seniors and persons with disabilities. A $229.3 million increase is proposed for Senior Care Plans (line item 4000-0600), to pay MassHealth costs for providing care in the community or a nursing home. The House budget maintains the10-day “bed-hold” provision for nursing home residents, to preserve stable living arrangements by continuing MassHealth coverage of an individual’s bed for a leave of up to 10 days, with funding of $9 million.

As in H1 for FY06, an outside section in the House budget provides $50 million for wage increases for nursing home workers. The Prescription Advantage program is fully funded, with provisions for retaining benefits for seniors and persons with disabilities who need it beyond January 2006, when most will convert to new federal Medicare coverage. Neither budget would impose stricter clinical standards for nursing home admission.

The bad news is that neither budget includes funding for home health aide wage increases, nor for worker training programs for home health aides and nursing assistants.

Line Item Analysis

Account: Senior Care Plans
Line Item: 4000-0600 (Office of Medicaid)

The Senior Care Plans account funds MassHealth costs of low-income seniors and persons with disabilities. Participants may reside in nursing homes, remain in the community and receive MassHealth-funded acute care or home health care, or enroll for Medicare premium assistance.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4000-0600	Sr. Care Plans	1,648,865,000	1,697,117,500	1,783,969,375	1,926,481,999

FY06 Needs

Advocates will be working to prevent further changes to access or eligibility in FY06.

House Budget Recommendations

The House budget funds Senior Care Plans at $1.9 billion, an increase of $229.3 million (13.5%) over the FY05 allocation, which is an increase of $142.5 million (8%) over H1 for FY06.

Account: Home Health Aide (HHA) Wage Increase
Line Item: 4000-0625 (Office of Medicaid)

The Home Health Aide (HHA) Wage Increase account provides funds to increase the very low wages that MassHealth pays HHAs, home health nurses, and physical and occupational therapists.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4000-0625	HHA Wage Increase	--	4,000,000	0	0

FY06 Needs

Home care advocates are supportive in particular of rate increases for home health workers, homemakers, and personal care homemakers. Rate increases proposed to date do not go far enough to address the severe workforce crisis faced by home care agencies throughout the Commonwealth.

House Budget Recommendations

Both the House budget and H1 for FY06 discontinue funding for this initiative.

Issue: Certified Nursing Assistant (CNA)/Home Health Aide (HHA) Scholarship Program
Line Item: 4510-0720 (Massachusetts Department of Public Health)

The Certified Nursing Assistant (CNA)/Home Health Aide (HHA) Scholarship Program provided funding for training and professional development opportunities for CNAs and HHAs. The money was in line item 4512-0720 at the Massachusetts Department of Public Health (MDPH). Training and retention of these workers is crucial to a quality system of care for elders and people with disabilities in nursing homes and in the community.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4510-0720	Nurse's Aide Training	1,000,000	0	0	0

FY06 Needs

In the FY06 budget debate, advocates will be working to reinstate this program.

House Budget Recommendations

Neither the House budget nor H1 for FY06 restores the CNA/HHA scholarship program.

Account: Assisted Living Regulation
Line Item: 9110-0102

The Assisted Living Regulation account funds limited state regulation and certification for assisted living facilities. Residents who live in assisted living are usually seniors or younger people with disabilities who need supportive services. This account is one of the only methods available to the state to monitor quality of care in these facilities.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
9110-0102	Asst. Living Regulation	368,000	246,447	246,160	247,217

FY06 Needs

The regulation of assisted living facilities is essential because of the volume of these facilities in the state and the need for a minimum standard of care.

House Budget Recommendations

The House budget would increase funding for this account by $770 (one-third of 1%), while H1 for FY06 proposes a small decrease. In short, both budgets recommend close to level funding.

Account: Prescription Advantage
Line Items: 9110-1455 and 9110-1460

The Prescription Advantage (PA) account (line item 9110-1455) funds drug insurance coverage for about 90,000 elders and people with disabilities. All Massachusetts seniors are eligible. Participants pay sliding-scale premiums, deductibles and co-payments based on income.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
9110-1455	Prescription Advantage	73,684,000	110,000,000	90,159,453	90,249,126
9110-1460	Presc. Advtg. Co-pay Subs.	new	5,000,000	0	0
Totals:		73,684,000	115,000,000	90,159,453	90,249,126

FY06 Needs

Prescription Advantage is expected to operate in its current form for the first six months of FY06. After January 1, 2006, when the new federal Medicare Modernization Act (MMA) drug benefit is implemented, PA will serve primarily as a wrap-around benefit for enrollees who are eligible for the new federal Medicare drug benefit. At that time, all Prescription Advantage members will be required to enroll in the Medicare Part D drug plan. Advocates will be working with DEA and the legislature to craft a new “wrap-around” benefit to proactively provide back-up state drug coverage to fill potential gaps in the new Medicare program.

House Budget Recommendations

Both the House budget and H1 for FY06 fully fund the Prescription Advantage program (line item 9110-1455), at $90.16 and $90.25 million, respectively. Both budgets use Outside Section language to determine what will happen when the Medicare Modernization Act (MMA) is implemented. Outside Section 22 of the House budget stipulates that all persons eligible for prescription assistance through Medicare will use that option first. Prescription Advantage will continue as a supplemental assistance plan for drug costs of eligible Medicare-enrolled seniors and persons with disabilities, and for those ineligible for Medicare. The amount of assistance provided would be determined by DEA using a sliding income scale. Outside Section 163 in H1 for FY06 contained similar provisions, and also stated that the program would not accept new enrollees who are 66 or older during the second half of FY06.

Both budgets propose to discontinue Prescription Advantage Co-Pay Subsidies (9110-1460) in FY06. It remains to be seen whether this elimination is a problem, because the restructured Prescription Advantage program may serve the same purpose.

Issue: Nursing Home Clinical Eligibility Standards
Section: Outside Section 257 (FY05)

The Clinical Eligibility Standards are rules used to determine if an income-eligible senior or person with disabilities under age 65 meets the physical criteria for MassHealth nursing home coverage.

FY06 Needs

In FY06, advocates will seek to ensure that clinical eligibility standards for nursing home care do not become stricter, to enable more persons who need intensive nursing care to receive it.

House Budget Recommendations

Neither the House budget nor H1 for FY06 changes nursing home clinical eligibility standards.

Issue: Certified Nursing Assistant (CNA) Wage Pass-Through
Section: Outside Section 409 (FY05)

The Certified Nursing Assistant (CNA) Wage Pass-Through provides wage increases for the lowest paid direct service workers in nursing homes, with the intent to reduce turnover and staff shortages.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
Outside Section	Nursing Home Wage Pass-Thru	35,000,000	O.S.	O.S.	O.S. 21

FY06 Needs

In FY06, advocates will seek continued funding to raise the incomes of crucial front-line workers.

House Budget Recommendations

Outside Section 21 of the House budget preserves the wage pass-through for direct care staff in nursing homes with an earmark of $50 million. Language specifies that the money may be spent on wages, benefits or training; recruitment and retention of staff; or increasing nursing home staff-patient ratios. The funding and language are the same as in Outside Section 156 of H1 for FY06.

Issue: Nursing Home Bed-hold
Sections: Outside Sections 533 and 701 (FY04) and Outside Section 409 (FY05)

The Nursing Home Bed-hold regulation has served to literally hold the bed of a nursing home resident when they are away from the facility for a limited period for hospitalization or non-medical family visiting, by continuing MassHealth reimbursement to the nursing home during the absence.

FY06 Needs

Advocates struggle each year to maintain and expand the bed-hold provision. At stake is the ability
of nursing home residents to have stable living arrangements.

House Budget Recommendations

Outside Section 21 of the House budget provides up to 10 days of bed-hold for nursing home residents, funded with an earmark of $9 million. H1 for FY06 does not provide for bed-holds.