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.

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Retirement Survey Bleak for Ocean State

Published in Pawtucket Times on February 1, 2016

Here we go again. This month, America’s tiniest state gets outed as being the most unfavorable state to live out your retirement years. According to a new WalletHub study, “2016’s Best & Worse States to Retire,” when compared to all 50 U.S. states and the District of Columbia, Rhode Island came in dead last when compared against 24 metrics falling in one of these three categories (Affordability, Quality of Life and Health Care).

WalletHub, an internet site that calls itself “a personal finance Web site, taps Florida as being the top state to live your retirement years, followed by Wyoming, South Dakota, South Carolina and Colorado. The in-depth analysis, geared to identifying the most retirement-friendly states, gives the Ocean States the distinct of being the worst place to live in your later years, followed by the District of Columbia, Hawaii, Connecticut and Vermont.

As to affordability, WalletHub looked at the adjusted cost of living, tax friendliness of a state, it’s taxation on pensions and Social Security income, and annual cost of in-home services. Rhode Island was ranked 51 (the worst) in affordability for retirees. In zeroing in on this specific variable, the state came in 41st in adjusted cost of living; 45th in annual cost of in-home services and 48th in taxpayer rankings.

For a state’s quality of life, WallettHub zeroed in on an array of variables including the number of theatres, museums, music venues, golf courses. The researchers also checked out crime rates, weather, the number people age 65 and older and whether the state’s labor is elderly friendly. A sampling of Rhode Island specific rankings for this variable include a ranking of 35th for Museums per Capita; 42nd for Theaters per Capita; and 48th for the number of golf courses per Capita; and 32nd in having employed residents age 65 and over.

As for health care, the study examined the number of family physicians, dentists, nurses, and health-care facilities per 100,000 residents, the ranking of the state’s public hospitals, the resident’s life expectancy and emotional health, even taking a look at the death rate for people age 65 and older. Rhode Island ranks 49th in number of family physicians per 100,000 Residents.

WallettHub analyst, Jill Gonzalez, says that for Rhode Island to become a mecca for retirees, state lawmakers must reconsider how they tax Social Security and pensions. The state’s current tax policy “is not at “all friendly toward retirees,” she adds.

According to Gonzalez, the state’s cost of living index is also high at 122 while the national index is 100. This means that if the cost of goods and services nationwide is $100, the Rhode Island retirees will pay $122. Annual costs to pay for home care are nearly $54,000 per year in Rhode Island and state policy makers must find a way to reduce this key community-based service.
Statewide Reactions to Web site Survey

These surveys aggregate data that does not encourage retirement here,” observes AARP Rhode Island State Director Kathleen Connell. “They do not fully measure quality of life or how the proximity to Boston and New York City make Rhode Island attractive to many retirees. But you often hear people talk about retiring in states where lower taxes and deflated housings prices suggest that retirement income will go dramatically farther.

“The tax issue is a reality driven by the state’s so-called ‘structural deficits’ that have resulted in cities and towns raising property and excise taxes. Meanwhile, hikes in fees and new surcharges have added to the tax burden. Legislative leaders face a great challenge in reversing this trend.

“Many people in their 40s and 50s who want to retire in Rhode Island can save more wisely for retirement and find a way to make it work. Anyone entering retirement now with little savings and expecting to rely primarily on Social Security is faced with difficult decisions.

“So, clearly the survey means different things to different people. Few would disagree that Rhode Island is a great place to retire – maybe one of the best places in the nation. If you can afford it.”

Edward Mazze, Distinguished University Professor of Business Administration, says, “I cannot disagree with the quantitative findings in the study. Behind the numbers are two critical factors that have an impact on retiring in Rhode Island – first, the Rhode Island economy has barely grown in the last eight years – second, the negative reputation of the state with government leaders going to jail, high property taxes, poor school systems and unfunded public pension and health programs.”

Mazze calls on the Rhode Island General Assembly to raise the state estate tax level to the same level as the federal estate tax level and exempt social security benefits from state taxes no matter what the income level. “The legislature has to reduce sales taxes and fees, be more transparent in its operations so that individuals trust government actions and fund the social services that retirees need,” he says.

But even with these negative findings retirees should Rhode Island as place to live because of its strategic location, transportation facilities and cultural and recreational activities. However, he acknowledges that “with the high cost of living in Rhode Island and fewer part-time job opportunities for retirees it is difficult to promote the state as a place to retire.”

Ernie Almonte, Rhode Island’s former auditor and partner at RSM US, LLP, a company that performs audit, tax and consulting services, says the changes in how the state taxes Social Security made by lawmakers last year was a good first step. But the former candidate for State Treasurer urges Governor Gina Raimondo and House and Senate Leadership to take a look at the state’s estate tax in the upcoming session. “I believe last year’s changes made by lawmakers was a move in the right direction but we cannot forget the legislative change to the estate cliff effect. “This certainly is a deciding factor for retirees looking to a place to settle down in their retirement years,” he adds.

Almonte also encourages state lawmakers to sit down with the Rhode Island Society of CPA’s to discuss tax policy. “Having a robust discussion on the role of tax policy to pay for necessary services and investments balanced by the ability to pay and the need to pay would be quite helpful to the long run,” he says.
House Speaker Nicholas Mattiello sees the business climate and economic outlook improving as he works to make the state’s tax structure more competitive with neighboring states. He says that the WallettHub survey did not take into account the repeal of state income tax for most Social Security recipients. The State offers retirees “a great quality of life with easy access to our beaches and we have excellent cultural attractions, restaurants, hospitals and universities, he says.

As she has said over her first year, Governor Gina Raimondo is “laser focused” on improving the quality of life for all Rhode Islanders, says deputy press secretary Katie O’Hanlon. “We’ve made a lot of progress over the past year, including eliminating state taxes on Social Security benefits for low and middle-income seniors and increasing funding for Meals on Wheels. However, we can always find ways to improve, says O’Hanlon.

It’s time for the Rhode Island General Assembly to get serious with enacting legislative proposals to attract retirees, more important to keep them from leaving for other retirement havens. Why not do a thorough review of tax policies of WalletHub’s best five places to retire and seek out best tax practices of other states? In the upcoming legislative session, Governor Raimondo and House and Senate leadership might consider reaching out to AARP Rhode Island and aging groups, along with the Rhode Island Society of CPAs, to organize a tax summit, seeking creative ways to tweak the state’s tax code to retain and attract retirees.

This WebHub study can be found at  http://www.wallethub.com/edu/best-and-worst-states-to-retire/18592/.