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1/1/10 Legislative year end report

The legislative season in Massachusetts has wound down as members entered the holiday season. This is not to say that the Legislature is not meeting, but they are only holding “informal sessions” during which local and routine matters are dealt with. There are few if any committee hearings or executive sessions, but those will recommence in January.

The major issue during the entire session has been the state fiscal crisis and how to address it. Because the Governor has a Constitutional duty to keep the budget in balance he has made a series of so-called 9C cuts to reduce appropriations in a wide variety of budget items. On the elder front these include cuts in home care services, Prescription Advantage benefits, adult day health services, protective services, Council on Aging funding and many more. Most recently the Administration proposed a series of 9c cuts which were then rescinded based on unexpected state revenue from settlement of a lawsuit. The rescinded cuts included among others reductions in adult foster care and group adult foster care rates, reduction of the scope of adult dental services, reduction in personal care attendant hours and reduction in day hab program hours.

The PASS Group has worked hard to ensure that cuts in programs benefiting elderly and disabled clients have been as minimal as possible. We are grateful on behalf of our clients that some proposed cuts were averted. However, this is only a temporary reprieve. There is still a possibility of further budget cuts in this fiscal year and a certainty that the Fiscal Year 2011 will contain further cuts. We will continue to work to prevent harmful changes in eligibility standards and provider rates and to advocate for improved financial protections for community spouses of nursing home residents.

At the national level health care reform debate has continued with passage of a Senate health reform bill. The bill addresses issues ranging from abortion to Medicaid expansion to prescription drug pricing. A proposal to expand Medicare to individuals age 55 to 64 has failed in the Senate but other provisions to improve Medicare drug coverage and add preventive services were included in the bill. The bill also includes a number of provisions improving access to community-based long term care. We will continue to update PASS Group clients on the final outcome of the health care reform legislation.

Best wishes to you all for a New Year that improves our health care system and honors our clients.

6/22/09 Legislature Passes FY10 Budget

On Friday, June 19th the Legislature passed and sent to Governor Patrick its final Fiscal Year 2010 Budget. Due to a major drop in state revenues, the budget includes deep cuts across the range of state programs and agencies. These cuts come on top of so-called “9C” cuts in FY2009 to balance that year’s budget. Many human services programs were slashed from FY09 levels and funding for some programs is eliminated altogether. Other programs will be forced to establish waiting lists for services or tighten eligibility criteria.

The PASS Group worked with other advocates to ensure that program cuts were as limited as possible. We led the effort to maintain the $72.80 Personal Needs Allowance for nursing home residents and the 10 day bed hold for medical and non-medical leaves of absence for MassHealth nursing home residents. We also worked to fund the Prescription Advantage Program of drug insurance at as generous a level as possible.

Some of the final appropriation levels and line item language for elder and health programs are as follows (FY09 numbers are post 9C cuts as reported by the Governor’s office):

• 0321-1600 Mass Legal Assistance Corporation funded at $9.5 million
FY09 funding level $11M

• 4000-0600 MassHealth Senior Plan
Nursing Home Personal Needs Allowance earmark of $72.80
Nursing Home pre-admission counseling earmark of $2.5M
Spouses excluded as paid caregivers in Caring Homes Program
Nursing home $50M wage pass-through not included

• 4000-0640 Nursing Home Supplemental Rates
10 day bed hold language for medical and non-medical leaves of
absence included

• 4000-0650 Community First Initiative not funded
FY09 funding level $6.5M

• 4408-1000 Emergency Aid to Elderly Disabled and Children funded at
FY09 funding level $72.476M

• 4510-0720 CNA/HHA Scholarship Program not funded

• 7003-0604 Career Ladder Grants Program (ECCLI) not funded

• 9110-1455 Prescription Advantage Program funded at $40M
FY09 funding level $50M

• 9110-1500 Enhanced Community Options Program funded at $45,789,340
FY09 funding level $48.199M

• 9110-1604 Supportive Senior Housing funded at $4,014,802
FY09 funding level $4.153M

• 9110-1630 Home Care Purchased Services funded at $100,307,274
FY09 funding level $102.5M

• 9110-1633 Home Care Case Management funded at $37,568,041
FY09 funding level $37.568M

• 9110-1636 Protective Services funded at $16,252,499
FY09 funding level $16.103M

• 9110-1640 Geriatric Mental Health Pilot not funded

• 9110-1660 Congregate/Shared Housing funded at $1,503,617
FY09 funding level $2.123M
Language authorizing expenditures for NORCs

• 9110-1700 Elder Residential Assistance Program funded at $136,000
FY09 funding level $153,000

• 9110-1900 Nutrition Program funded at $6,279,770
FY09 funding level $6.48M

• 9110-9002 Councils on Aging funded at $8,615,068
FY09 funding level $7.543M
Funding authorized for LGBT training and outreach

• Section 121 Commonwealth Care will no longer provide coverage to 28,000 legally present special status immigrants.

• Section 122 Prescription Advantage Program may provide coverage under current eligibility criteria but may adjust cost sharing to maintain fiscal viability.

Governor Patrick now has 10 days to review the budget and approve, veto or return for amendment the various line items. He has already promised to veto a provision increasing the sales tax if the Legislature does not pass an ethics reform bill before the end of June. It is clear that whatever items are vetoed all parties involved will continue to struggle to balance the budget for the rest of the fiscal year.


5/1/2009 - 2009 House Budget Debate Results

The House of Representatives has completed its deliberations, which began on April 27th, on appropriations for the Executive Office of Elder Affairs and the Office of Medicaid. In the midst of a state fiscal crisis, advocates have reasons to be pleased that the debate accomplished some significant budgetary gains for elders.

The initial House Ways and Means (HWM) Fiscal Year 2010 budget released on April 15th included some troubling cuts in programs
serving seniors. However, during the budget debate on Tuesday and Wednesday, advocates and legislators succeeded in partially restoring many of the most serious funding reductions.

In addition, several critical earmarks of funds within line items were restored. A quick summary of the budget debate results follows:

HOME CARE PURCHASED SERVICES (9110-1630): An increase of $15 million. The House Ways and Means budget funded Home Care services at $88.7 million, down from $106.7 million at the beginning of Fiscal Year 2009. Representative Alice Wolf and many other Representatives filed an amendment to restore funding to the FY09
level. The final House budget funds the account at $103.7 million.


(9110-1455): An increase of $10 million. The House Ways and Means budget funded this drug assistance program for seniors at $35 million, a $22.5M cut from the Fiscal Year 2009 budget.

Representative Alice Wolf and many cosponsors filed an amendment to increase funding to the initial FY2009 level of $57.5 million. The
final House budget increased funding for this account to $45 million.

NURSING HOME BEDHOLD (4000-0640): Language guaranteeing a nursing home bed hold of 10 days was not included in the House Ways and Means budget. Representative John Fernandes and
others successfully filed an amendment to restore this protective provision in the final House budget. The restored language requires
MassHealth to continue to pay for a nursing home bed for a resident for 10 days during the resident’s absence for medical treatment or


PERSONAL NEEDS ALLOWANCE (PNA) (4000-0600): The House Ways and Means budget eliminated language included in the last two budgets establishing the Personal Needs Allowance for MassHealth nursing home residents at $72.80. Representative Alice Peisch and cosponsors successfully filed an amendment to restore this language and earmark $5 million for its funding. The PNA is included in the final House budget at the $72.80 per month level.

LGBT ELDERS (9110-9002): The House Ways and Means budget omitted language in the Councils on Aging account establishing funding for provider training and outreach for LGBT elders and caregivers. Representative Liz Malia and others successfully filed an amendment to include this language in the final House budget.

MEDICAID SENIOR PLAN ACCOUNT (4000-0600): For many years MassHealth long term care services for seniors and persons with disabilities have been funded in a separate line item. The House
Ways and Means budget eliminated this account and allocated funding for long term care among other MassHealth accounts. Representative Alice Wolf and other Representatives successfully filed an amendment to reestablish the 4000-0600 account as a separate line item for elder and disability services. Representative Carl Sciortino and cosponsors successfully filed an amendment to include in the account an earmark of $2.5 million for implementation of a pre-admission counseling and assessment program. In  addition, language allowing the spouse of a recipient to qualify for payment under the Caring Homes Program and $35 million for nursing home rate increases were included in the final House budget



3/2/2009 - Fiscal Crisis on Beacon Hill

The 2009-2010 legislative session has gotten of to a somewhat delayed start, with the resignation of Speaker of the House Sal DiMasi delaying committee appointments. Speaker Robert DeLeo has now named Representative Charles Murphy to be the new Chair of the House Ways & Means Committee and has appointed Committee chairs and members. A glitch in the computerized bill filing system has also delayed the assignment of bills to their various Committees. With the filing of the Governor’s FY 2010 budget in January, the Legislature faces a heavy workload over the next several months.

The fiscal crisis in the nation continues to affect Massachusetts state government. Declining revenues have resulted in large budget shortfalls for both FY2009 and FY2010. In addition to cuts already made by Governor Patrick for FY2009, the FY2010 budget will need to reduce state spending significantly. For this reason it is highly unlikely that any new programs at significant cost will be funded. It is also highly unlikely that any bill with a significant cost will be enacted.

Fortunately for the state, Massachusetts will receive significant additional funding from the federal stimulus legislation recently passed by Congress. The legislation will increase federal dollars for the state MassHealth Program by approximately $600 million. Other provisions will increase funding for Senior Nutrition Programs, provide a one-time extra payment of $250 to Social Security and SSI recipients and expand services and programs under the Community Services Block Grant Program. These federal expansions offer some fiscal relief as we go forward

The PASS Group has filed several bills which support the ability of elders to live independently and with dignity in the community. Over the next several months we will be focused on helping elders to survive these difficult economic times with the financial resources they require. We will also be working with advocacy groups to ensure that elder policy issues are given the thoughtful attention they deserve by both the Patrick Administration and the Legislature.


1/4/2009 - 2009 Legislation

As the 2007-2008 legislative session closes we are looking forward to the next session, to the next budget and to the filing of new legislation. Although it is still unclear how the failing economy will affect Massachusetts, PASS Group advocates are working with client groups to file legislation that will improve the lives of low-income, elderly and disabled individuals. A few of these bills are:

• A bill sponsored by Senator O’Leary and Representative Fallon to clarify when elders with long term care insurance qualify for an exemption from MassHealth estate recovery .

• A bill to increase the Personal Needs Allowance (PNA) to $72.80 for MassHealth nursing home residents. This bill sponsored by Senator Tucker and Representative Reinstein will put into statute the increase that was included in the last two budgets.

• A bill to provide assistance to individuals struggling with credit card or medical debt sponsored by Senator Jehlen and Representative Canavan. This bill will extend the protections for consumers now provided under federal law against harassment from collection agencies and apply these protections to actions by creditors.

• A bill sponsored by Senator Creem and Representative Story to protect victims of domestic violence from housing discrimination and to make it easier for them to find housing and leave dangerous housing situations.

• A bill sponsored by Representative Provost to provide meaningful appeal rights to psychiatric hospital residents who have been denied exercise of their fundamental rights.

We are looking forward to working on these and other important bills as the new session begins.


11/7/08 Governor issues 9C Cuts

On October 15th , Governor Patrick announced .he would be implementing budget cuts in all state agencies. In total $1.053 billion was cut from the budget. Some agencies have cut programs but most have attempted to maintain the services used by the most vulnerable populations. Among cuts affecting PASS Group clients are the following:

Elder Programs:

The Prescription Advantage drug insurance program (9110-1455) suffered a $6.9 million cut. According to Elder Affairs, the savings will come from cuts in co-payment assistance. As of January 1, 2009, certain categories of beneficiaries with higher incomes will not receive co-pay assistance until they have reached the Medicare coverage gap or “doughnut hole”. .

Home Care Purchased Services (9110-1630) also suffered a $3.968 million loss which may lead to 1,810 elders losing home care services. .

The Community First Initiative (4000-4650) also received a significant cut from an appropriated $20 million down to $6.5 million. As a result the program will not be implemented in Fiscal Year 2009.

Another program which is located within the office of MassHealth is the MassHealth Senior Plan (4000-0600) which is reduced by $60 million. The cuts will be felt mostly in supplemental payments made to acute care hospitals but also the adjustment reflects some reduced enrollment projections

Disability Programs:

The Department of Mental Health took a significant cut of $33.5 million. .The major reduction was in community services with the elimination of day rehabilitation, supported employment and social clubs as well as a $1 million reduction for clubhouses. $1.2 million was also cut from child/adolescent community services.

As for the Department of Mental Retardation, many of the core populations who receive services from this agency are protected by legal settlements. As a result, DMR experienced a lower reduction than DMH for a total of $7.3 million. The two largest reductions for DMR were $3 million for State Facilities for the Mentally Retarded (5930-1000) and $1.8 million for the Autism Division (5920-3010). ..Part of the reduction will come from a facility closure.

The largest reduction for the Massachusetts Rehabilitation Commission is $1.1 million for Employment Assistance for Adults with Severe Disabilities (4120-3000). Another major reduction is in the Massachusetts Commission for the Blind with the elimination of the Ferguson Industries program (4110-4000). Community Services for the Blind (4110-1000) is also reduced by $432,234 and Independent Living (4120-4000) under MRC is reduced by $412,500.


7/3/08 Conference Committee Budget Enacted

The Fiscal Year 2009 Conference Committee Budget was released July 2nd and was approved by both the House and the Senate the next day. As with all budgets the results were mixed, but a few significant victories are included. Following is a quick summary of important items:

Line item 4000-0600 - PNA

The nursing home Personal Needs Allowance (PNA) was funded at $72.80 a month. The House budget cut the PNA to $65 and the Senate maintained it at its current level of $72.80. Residents use this funding to purchase personal items such as clothing, shoes, toiletries and phone calls.

Continued stay reviews for nursing home residents will continue to use the current “Score 3” clinical eligibility criteria for MassHealth reimbursement. The Senate had removed continued stay reviews from the protective Score 3 criteria. This will prevent MassHealth from denying nursing home payments to all but extremely frail and sick residents.

Nursing home payment rates may increase to $45 million to fund labor and benefit costs for their workers. The rates may be reduced, however, if projected cost savings from elder Medicaid utilization do not equal this amount.

Line item 4000-0650 - Community First

The Community First Waiver initiative is funded at $20 million. Of that amount, up to $5 million may be used to fund the settlement agreement in Rolland v. Celluci, a case mandating improved services for nursing home residents with developmental disabilities.


Line item 9110-1640 - Geriatric Mental Health

The Geriatric Mental Health account is funded at $225,000. The House budget funded it at this level but the Senate zero-funded the account.

Line item 9110-1650 - Family Caregivers

The Family Caregivers account is funded at $253,000. The House budget funded it at this level but the Senate zero-funded the account.

Line item 9110-9002 - COA

The Councils on Aging account is funded at $8.615 million. . This funding level will enable the COAs to reach their goal of $7 per elder. Included in the account is $80,000 for the LGBT Aging Project

Line Item 9110-1455
Outside Section 93 - Prescription Advantage

The Prescription Advantage Program was funded at $57.533 million. Language in the account requires that program enrollment be continuously open. The Outside Section specifies that the Secretary may increase member cost-sharing to reflect prescription drug price trends, but must notify the Legislature 90 days in advance of any increase.


2/4/08 Governor Patrick Releases Fiscal Year 2009 Budget Proposal

On January 23rd Governor Patrick released his Fiscal Year 2009 Budget. Overall most human services accounts were flat funded or contained a modest cost of living increase. Notable exceptions include expanded funding for early childhood education and expanded funding for homelessness prevention initiatives. The Citizenship for New Americans Program also received a significant funding increase from $500,000 to $1.25 million.

Accounts within the Executive Office of Elder Affairs are generally flat funded or minimally increased. One exception to this is the Prescription Advantage Program line item which is decreased by approximately $2.9 million. This decrease in funding occurred because the account has been under expended in prior years and because enrollment in the program is relatively static at 68,000 members. An additional new account was included in the budget for $45.8 million dollars to implement the new Community First Waiver Initiative. The Community First Initiative is designed to keep frail elders out of institutional care and to help transition those in nursing homes back to the community.

One overall troubling issue in the Governor’s budget is the removal of earmark language from line items. For example, language setting the nursing home Personal Needs Allowance at $72.80 was included in last year’s MassHealth Senior Care line item. This budget removes that language from the line item but lists it elsewhere as an earmark the Governor “intends to honor”. This format occurs throughout the budget and offers no guarantee that the specific earmark will be funded.

As always, the Governor’s budget is the first of three budget documents for the fiscal year. The second budget will be issued by the House of Representatives in the Spring, followed by the Senate budget in early Summer. The goal is to have a final budget signed by the Governor by July 1st.


10/9/07 Mike Festa named Secretary of Elder Affairs

Representative Michael Festa has been named by the Patrick Administration as the Secretary of the Executive Office of Elder Affairs. In his role as Representative from Malden, Secretary Festa was a champion for community-based care for the elderly and a leader in passing the Equal Choice legislation to expand community care options.

In addition, Sandra Albright has been named as the new Undersecretary of Elder Affairs. The long-time director of Kit Clark Senior Services, Ms. Albright brings decades of experience and expertise to her new position. The PASS Group looks forward to working with Secretary Festa and Undersecretary Albright in the coming months.


7/18/07  Governor Patrick signs the FY2008 budget


On Friday, July 13, 2007 Governor Patrick signed the Fiscal Year 2008 Budget and issued his veto message.  Compared to prior Administrations the Governor issued very few vetoes, leaving most appropriations and line items as they were passed by the Legislature. 

One disappointment was the Governor’s veto of $2 million for rate increases to adult day health programs.  The Massachusetts Adult Day Services Program is seeking an override of that veto. 

Of special note to nursing home advocates is the language in the Budget increasing the Personal Needs Allowance (PNA).  The PNA is a monthly deduction from the income of nursing home residents on MassHealth that is used to pay for a resident’s personal expenses.  The FY2008 Budget increases the PNA from $60 to $72.80, the first increase since 1990.  The Coalition to Reform Elder Care (CORE), which is coordinated by Greater Boston Elderly Legal Services, took a lead in championing this increase. 

Another success in the budget was the funding of the Department of Public Health’s Birth Defects Monitoring Program.  The earmarking of $450,000 for this program will allow DPH to continue the identification and monitoring of birth defects in the Commonwealth and will secure additional federal research funding for birth defects.  The March of Dimes Massachusetts played a strong role in obtaining this funding.


6/30/07 Conference Budget Report

On Friday, June 29th the Conference Committee on the Fiscal Year 2008 Budget issued its budget report.  The Conference Committee budget contains good news for PASS Group clients.

Among the items supported by the PASS Group clients and included in the Conference Budget are the following:


  • The monthly .Personal .Needs Allowance for MassHealth, EAEDC and SSI nursing home and rest home residents is raised from $60 to $72.80 a month;
  • MassHealth nursing home residents are entitled to a 10 day bed hold for medical and non-medical leaves of absence;
  • Funding for the Department of Public Health birth defects monitoring program is appropriated at $450,000;
  • Not less than $2 million is appropriated to increase MassHealth rates for adult day health programs;
  • The Executive Office of Elder Affairs is prohibited from changing the current system of adult day health transportation services;
  • Continuous open enrollment is required in the Prescription Advantage drug assistance program;
  • Current clinical admission criteria for MassHealth nursing home residents are kept in place.


The Conference Committee budget now goes to the House and Senate for passage and on to the Governor’s office for his review.  The Governor has 10 days to approve the budget and veto any items he disapproves


6/1/07: News from Beacon Hill


The Senate Fiscal Year 2008 budget debate concluded on May 24th with mixed results for advocates.  Most human services accounts received level funding or small increases, and most amendments to increase expenditures were rejected.  This was the first budget for the new Senate President Therese Murray and the new Chair of Ways & Means Steven Panagiotakos.  Hopefully their cautious fiscal approach with human services will loosen up over time.

Some highlights of the budget process for PASS Group clients include:

  • Inclusion of language in the Ways & Means Budget preserving clinical admission standards for MassHealth nursing home recipients
  • Inclusion of language in the Ways & Means Budget preserving nursing home beds for MassHealth residents who are hospitalized or go on overnight visits
  • Adoption of an amendment by Senator Creem to fund the Department of Public Health’s Birth Defects Monitoring Program, thereby guaranteeing Massachusetts continued federal funds for birth defects research
  • Adoption of an amendment by Senator Baddour to increase funding for adult basic education, including English language instruction
  • Adoption of an amendment by Senator Baddour to prohibit changes in transportation systems and reimbursement methodologies applicable to adult day health programs
  • Adoption of an amendment by Senator Montigny to require continuous open enrollment for the Prescription Advantage drug program
  • Inclusion of language  increasing the Personal Needs Allowance for MassHealth nursing home residents from $60 to $72.80.


The budget now moves to Conference Committee, where the House and Senate budgets will be consolidated into a final document.  Many changes can occur in the Conference process, and we will keep you informed as to the outcome of their discussions.


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