Author: wendyp

April 29, 2014 – Now that the years of state budget cuts to aging services are over, a strange phenomenon is setting in. Regardless that the reduced service capacity is woefully inadequate to meet current need, perform the mission, or prepare for future population growth; the “new status quo” has taken root in the minds of legislators and other policy makers.

Worrying examples include Medi-Cal rates for CBAS and PACE, IHSS, Older Californians Act services, and MSSP. Today I’ll focus on MSSP, the Multipurpose Senior Services Program.

MSSP is an outstanding success at keeping frail older adults with multiple chronic conditions in their homes. It prevents costly acute and long-term institutionalization, thus saving the state an estimated $117 million annually in return for the investment of roughly $20.3 million in state general funds (this investment also leverages federal match, dollar for dollar).

So you would think the state would use this awesome tool to manage Medi-Cal’s highest risk population, especially since MSSP is a part of the Coordinated Care Initiative, right? Not unless the new status quo is challenged and funding is increased. This is because the total number of MSSP “slots” is set at 9,440 statewide, limiting the number of people who can be served at any point in time. It doesn’t matter if more eligible people urgently need MSSP’s intervention, or if a CCI Managed Care Plan determines that a patient needs MSSP. The number of slots is set. The governor proposes this status quo in his FY 2014-15 budget.

In Alameda County, we face a critical shortage of MSSP slots – only 380 slots between the two MSSP providers in Oakland and Fremont. Hundreds of eligible seniors wait, and often die or enter nursing homes while on the wait list.

This is unacceptable. Advocates are asking the state to invest an additional $5.1 million of state general fund dollars to MSSP’s budget in FY 2014-15. This investment would enable MSSP to serve 2,762 more frail seniors annually, and would add 100 slots in Alameda County. Not the capacity we need, but a start.

With a governor whose austere budget plan calls for few restorations, we face an uphill battle to challenge status quo thinking of legislators. But it is essential that we try.

Please join us in insisting that California build adequate capacity in the safety net of services to meet the needs of our growing senior population. Write to the Assembly and Senate budget committees today. Click here and here for sample letters.

 

Return to State Budget page.

January 8, 2014 – The court settlement that preserved Medi-Cal coverage for Adult Day Health Care will expire on August 31, 2014. That settlement gave the benefit its new name – CBAS, for Community-Based Adult Services – and transitioned the benefit from Medi-Cal fee-for-service to a Medi-Cal Managed Care Plan benefit in Alameda and many other counties. The settlement thus gave CBAS the distinction of being the first LTSS to move into Medi-Cal Managed Care. It also bought time, enough to allow California’s Department of Health Care Services to change its opinion about eliminating the program.

In October 2013, DHCS acknowledged that “CBAS is a key component of LTSS under the Coordinated Care Initiative” and “an important Home and Community-Based Service that provides alternatives to institutional care.” More, DHCS and the California Department on Aging launched a CBAS Stakeholder Workgroup. Its purpose is to develop a future (post-settlement) direction for CBAS, and to prepare for amending the CBAS section of the federal 1115 Waiver (itself set to expire in August 2014).

This bodes well, as does the meaningful participation of an impressive and broad set of workgroup members. The Workgroup will meet three times (Jan. 9, Feb. 4 and March 6) before they must complete their deliverables in April. The door is open for the public and service providers to participate at the meetings (in person and by webinar), and to offer comments and recommendations in writing (by emailing CBAScda@aging.ca.gov) or by phone (916-419-7545) through April 2014.

To sign up to receive email notices, and to view meeting materials, go to http://www.aging.ca.gov/programsproviders/ADHC-CBAS/Stakeholder_Process/

 

Return to the CCI Policy Developments page.

January 8, 2014 – Have you ever felt ignored? In a proactive move, ahead of the Governor’s budget proposal scheduled for release this week, California’s Assembly Democrats recently released their 2014/15 Blueprint for a Responsible Budget (click here to check it out). The plan responds to the Legislative Analyst’s Office recommendations for keeping us on the path of fiscal stability now that we have a structurally balanced budget. It would build reserves and increase investments, and be smart about it. Unfortunately, the Blueprint makes no mention of seniors.

Over the past ten years, California has dismantled its safety net for seniors. While the population of seniors grew exponentially, state funding dropped by half (click here for the charts). State funding vanished for many programs, including cornerstones of the Older Californian’s Act. We are talking about services designed to help seniors successfully navigate the challenges of aging so that they can maintain a steady state. Food, caregiver respite, day care, foster grandparents, senior companion, case management, senior employment…the list of cuts and eliminations is stunningly long (click here to see it). Some programs are just barely holding on – at least in some counties – with local and federal funding. But nowhere is there capacity to serve the need.

Why is there no mention of restoring these services in any of the grand plans for California’s turn-around? It can’t be because they are too costly. Returning the Older Californian’s Act budget to its 2006 levels would only take $30 million, a small sum when we are looking at putting aside a $2 billion surplus for fiscal 2014/15. It can’t be because seniors don’t contribute to the Blueprint priorities of expanding opportunities for California’s families, investing in education, reducing poverty and investing in jobs…See foster grandparents, caregiver respite, day care and senior employment in the previous paragraph.

Certainly we’re in for a lively debate about how California can craft a final budget that reflects our priorities. Let’s just not forget that “our” priorities include those of seniors. I hope you will join me in attending state budget hearings and contacting your legislators to remind them.

Stay tuned.

Return to the State Budget page.