FY 17 House Budget: Final Action on Amendments
Shades of Grey
The greying of our population in Massachusetts was reflected this week in the grey, overcast news from the House of Representatives on elderly funding.
On the evening of Tuesday, April 26th, the House completed work on a “Consolidated Amendment G Health & Human Services and Elder Affairs.” Like the rainy weather, most of the actions adopted in the House were overcast and gloomy. Elder-related amendments worth nearly $70 million in new funding were rejected, for the home care program and care managers, for homemakers, home health agencies, and adult foster care. Some money was restored (back-filled) for meals on wheels and housing supports—but overall a number of good initiatives were dismissed. Instead of moving programs forward, elder advocates fought “read guard” actions to keep funding from dropping below FY 16 levels.
In the home care accounts, the House budget added $4.089 million to the Enhanced Home Care (ECOP) account—but took away $4.86 million combined from the care management and purchased services accounts—resulting in a net loss of $771,317 below FY 16 levels. Elder population rising, home care funds falling.
As the focus now shifts to the Senate side, here is how the House budget finished up:
On the bright side:
- The Administration’s request to unilaterally “restructure” $15.4 billion in MassHealth funding (Outside Section 39) was not included in the House budget. This leaves any plan to “passively enroll” elders into the SCO managed care programs uncertain, since the SCO law requires voluntary enrollment. Elders would still have the choice to join managed care, or not.
- The Administration’s language requiring funds to be “transferred” from home care to the SCO program whenever an elder enrolls in SCO, was rejected..
- $750,000 was restored to the meals on wheels program.
- $642,000 was restored to the Naturally Occurring Retirement Communities (NORCs)
- Language authorizing a “study” of the cost of raising the home care income eligibility, and telling EOHHS that it “may” file a 1915i state plan amendment was adopted.
On the darker side:
- An amendment to require Accountable Care Organizations to provide independent, conflict free LTSS assessment and care coordination was withdrawn under pressure from provider groups and not even considered by the House.
- Amendments to raise the Enhanced Community Options Program by $5 million, to increase funding for ASAP contracts by $1.75 million, and to allow spouses to be paid as caregivers for MassHealth members, were all rejected.
- An amendment to raise the home care income eligibility and provide $3.7 million in new funding for elder applicants was rejected.
- An amendment to consolidate home care accounts as proposed by the Administration was rejected.
- Amendments totaling $59.2 million to provide wage increases for homemakers, higher rates for Adult Foster Care programs, rate increases for home health agencies, and funding for homeless elders, all were rejected.
Here are the results from that Consolidated Amendment:
||FY 16 Final
||FY 17 House
||Enhanced Community Options Prog.
||Home Care Purchased Services
||Home Care Management
|Outside Section (New)
||Raise home care income eligibility
|Outside Section 39
|*consolidated into 1630 and 1633
Consolidated Amendment G Actions:
- Line Item 9110-1660: NORCs. Budget amendment #820 sought to add $856,000 to the NORC program in this line item. The House has added $642,000 to this account, raising it from $1.417 million to $2.059 million.
- Line Item 9110-1900: Meals on Wheels. Amendment #51 sought to add $871,889 to the Meals on Wheels line item. The House restores $750,000 to Meals on Wheels, raising the line item from $6.506 M to $7.256 Million
- Line Item 9110-9002 Councils on Aging: New narrative in this item adds earmarks for 8 senior-related projects in local Rep districts, for a total add of $590,000, raising the total COA line item to $14.65 M:
- Technical change to Section 2D: Adding the list of Federal Older Americans act grants: amendment from Rep. Brodeur corrects an omission in the HWMS budget by adding into the budget a list of OAA federal grants.
- Outside Section 24A: Report on Home Care Income Eligibility: Adds language offered in Brodeur’s in amendment #1097, identical to that of HWMs in the most recent supplemental budget, calling to a report on the cost of expanding the home care income eligibility level at 275% and 300% of FPL, and providing that EOHHS ‘may’ file a 1915 i state plan amendment, which EOHHS has no plans to doOutside section 42A: Study of Common Application for MassHealth & DTA benefits: This new section allows MassHealth to study the feasibility of creating a “common application” for low income people to apply for MassHealth and DTA programs like SNAP, EAEDC, and AFDC.
Amendments that were rejected:
On the good news side, these two amendments were rejected:
- Amendment #1178 . REJECTED. This amendment would have caused a transfer of funds from the home care services account to a MassHealth account whenever an elder in the home care program subsequently enrolled in the SCO program.
- Amendment #1219. REJECTED. Same language as amendment #1178.
On the dark side, these amendments also were REJECTED:
· Amendment #785 Spouses as Caregivers: REJECTED. Rep. Benson’s amendment was rejected. Her bill, H. 70, has been given a favorable report by Health Care Finance, but likely will be referred to HWMs, where consideration would have to happen before the end of the session.
· Amendment #808 Conflict Free Assessments; WITHDRAWN. Rep. Sannicandro withdrew his amendment to the ACO program for conflict free assessments at the request of associations representing providers of Developmentally Disabled services, who feel they have struck a better deal with MassHealth.
· Amendment #1071 Enhanced Home Care Rate . REJECTED. Rep. Walsh’s amendment raising the ECOP rate was rejected.
· Amendment #1138 ASAP Contracts. REJECTED. Rep. Markey’s amendment would have restored ASAP contract funding by roughly $1.75 million to its FY 16 funding level.
· Amendment #1052 Homemaker Wage and Benefit Increase. REJECTED. This amendment created a new line item to pay for a $10 million rate add-on for home care aide workers in the basic home care, enhanced home care and MassHealth program (Community Choices).
· Amendment #522 Foster Care Reimbursement. REJECTED. This amendment added $30 million to the rates for Adult Foster Care Programs
· Amendment #699 Merging Home Care Accounts. REJECTED: This amendment consolidated the Enhanced Community Options Program (9110-1500) into the basic home care services account (9110-1630), and the care management account (9110-1633).
- Amendment #925 Homeless Funding. REJECTED. This amendment added $351,000 for homeless services
- Amendment #1026 Home Health Agencies rate hike. REJECTED. This amendment added roughly $18.9 million in a rate increase for home health agencies.
Other House Amendment “G” Action
4000-0300 EOHHS must report on number of members served in the “dual eligible initiative.”
To review the full text of Consolidated Amendment G, go to:
All data: Mass Home Care. 4 16 16.