Analysis of Governor Patrick’s 2014 Budget

Analysis of Governor Patrick’s 2014 Budget

FY 2014 Budget For Elder Home Care

Analysis by Mass Home Care

February 2, 2013

Once again, the Governor’s budget is a great disappointment to home care advocates. With the singular exception of Protective Services, which rises $4.8 M, all the home care line items are either level-funded or slightly reduced, based on Chapter 257 rates that were recommended the by DHCFP. Mass Home Care testified last year in opposition to those rates, which we consider to be arbitrary and capricious. Chapter 257 is being used to cut the cost of labor for the home care and enhanced home care programs. In the three home care accounts shown below in yellow, the Governor’s budget for FY 14 is $12.47 million lower than what Mass Home Care had asked the Governor to fund.

These appropriation levels mean we will have to focus in the House and Senate on improving the home care and ECOP items or expect worse waiting list in 2014 than we had in 2013. Apparently the Governor still has not heard the message that home care waiting lists must end! As of January 15, 2013, there were 1,224 elders waiting to get care at home.

Advocates are now turning to the House and Senate Ways & Means committee to ask for nearly $13 million in additional state funding for home care.


Over the past five fiscal years, home care programs have lost roughly $13.3 million, or -6.3% in unadjusted dollars. In December of 2012, a coalition of 5 elder advocacy groups sent a letter to Governor Patrick urging him to help us end the home care waiting lists. As of January 15, 2013, there were 1,224 people on a home care waiting list.

For a state that calls itself “Community First,” the idea of people waiting to get community care is an oxymoron. Ironically, we have a 12% vacancy rate for nursing homes beds statewide–but elders can’t get the home care they need.

There can be no doubt that home care has had an offsetting impact on the use of nursing homes. Over the past decade, nursing home days paid for by MassHealth have plummeted by roughly 32%. That’s more than 4 million fewer SNF beds used in 2011 compared to 2000. Access to community care has resulted in a savings to taxpayers of more than $703 million a year in avoided institutional costs.

In 2010, the Bureau of Health Care Safety and Quality projected that by 2015 we would have 10,772 surplus nursing home beds in Massachusetts. The private marketplace has been ‘rebalancing,’ but we still spend two-thirds of our MassHealth long term care dollars on institutions.

With these facts as a backdrop, the elderly coalition groups asked the Governor to increase his budget request for three home care line items by $15 million—which is what he asked for in FY 2009—5 budget years ago!

Since the Governor took office six years ago:

•The elder services line items have lost $36.4 million in buying power.

•For home care and enhanced home care, the Governor’s budget submissions have fallen from $195.107 million in FY 2009, to $179.982 million in FY 2013—a cut of $15.12 million:

Here are the 4 budget accounts we are focusing on for FY 2014:

•Home care purchased services (9110-1630) is the basic entry-level preventive program that helps consumers avoid premature institutionalization. This account, which serves roughly 32,000 elders, stands at $97.78 million, almost 9% lower than it was in 2009 at $106.7 million. Home care services took significant cuts in 2009 and 2011, and waiting lists had to be imposed in both years that reached historic levels in the autumn of FY 2011. The FY 13 year began with waiting lists, which may have to be re-imposed again this winter. We are asking the Governor to provide us with $106.7 million—the same level he recommended for FY 2009.

•The home care Case Management Account (9110-1633) is the companion account to 9110-1630. This line item pays for the care managers and RNs who coordinate services provided to clients in the home care purchased services program, and for all program operations costs at the 27 Aging Services Access Points (ASAPs). According to the Mass Center for Budget and Policy, in adjusted dollars this account has plummeted -42% since FY 2001. In FY 2009 the Governor recommended $40.37 million for this line item, which now stands at $35.74 million—12% lower than it stood 5 years ago. The home care Case Management account today is lower than it stood 8 years ago in FY 2006. We want the Governor to provide elders with the same funding he recommended in FY 2009: $40.468 million.

•The Enhanced Community Options Program (ECOP). As of mid November, there were more than 800 elders on the ECOP waiting list. ECOP is targeted exclusively to seniors who are not yet on MassHealth but are eligible to be in a nursing home. This is a program that many home care basic program clients will transfer into as their functional capacity declines. ECOP is the only alternative to a nursing facility for people who are not yet on MassHealth but who are only a few months from spending down their income and assets to become MassHealth members. In 2009, the ECOP appropriation stood at $48.024 million. Three years later, in FY 2012, the account had fallen -5% (- $2.23 million). In FY 2010, FY 2011, and FY 2012, the ECOP account was frozen. We are asking the Governor to provide us with the same amount of funding he requested in FY 2009: $48.024 million.

•The Elder Protective Services account. The protective services program investigates and resolves elder abuse and neglect, and deals with very complex and volatile family situations. Everyday the PS program received another 54 reports of elder abuse or neglect. The protective services programs, which are housed in designated Aging Services Access Points (ASAPs) have had to use other funds to cover the structural deficits in line item 9110-1636, because certain services implicit in this program are not funded by the state, including legal services to handle cases which end up requiring court-involvement. Protective services has been running a deficit in the range of $3 million annually for many years As a direct result of declining funds, reports of elder abuse are now being ‘triaged’—which means that some reports are not being investigated. The Governor requested $15.146 million for PS in FY 2009, and $16.628 million in FY 13. This is the only account where the Governor’s request in FY 13 was higher than it was in FY 2009. Last fall, the Division of Health Care Finance and Policy recommended a higher rate for the PS program, which would increase funding for DHCFP by roughly $3 million. To satisfy the new PS rates set according to Chapter 257, this account needs an appropriation of $22.063 million.

We have been making these “community first” arguments for years, but we feel that our voices are not being heard. In June of 2006, then candidate Deval Patrick said the following:

“The long-term care system in Massachusetts favors institutional care over care in the community and at home. This neither respects the wishes of most older adults, nor follows the law of requiring care in the least restrictive environment, nor spends public dollars prudently… A large portion of older and disabled adults see community care as the best choice. Massachusetts has made efforts and significant progress toward the rebalancing of the long term care system through support of community-based services…However, there is far more that needs to be done to fundamentally rebalance the system.

Care in the least restrictive setting is a civil right. We hope the General Court will lift his FY 2014 numbers higher to help us keep the elderly living independently at home, where they so passionately want to be.

If we fail to end the home care waiting lists, we will continue to disappoint seniors who just want to live at home with dignity and independence. Instead, they will wait for the care they need at home, in a state that boasts it is ‘Community First.’