BOSTON, March 4 —

Gov. Charlie Baker released his first state budget for the year beginning July 1, 2015. According to the Elder Office of Elder Affairs, the main message out of the governor’s budget was that there would be no home care wait list in FY 16 and that the Enhanced Community Options Program, and Home Care Basic programs received sufficient funding to maintain caseloads into FY 16.

The Enhanced Community Options Program (ECOP), which currently keeps 6,300 elders a month out of nursing homes, would receive $7.18 million more than in FY 15 appropriations under the Governor’s plan, and the basic home care account, which has a monthly caseload of around 28,250, would receive $3.78 million more than appropriations in the previous year.

The hardest hit line item was the account that pays for all the staffing and operational costs of the 27 Aging Services Access Points (ASAPs) themselves. The governor cut $866,677 from this line item, compared to the FY 15 appropriation. This represents a cut of —2.44 percent in the care management account, which supports the work of more than 1,000 care managers on the frontlines of home care work in the community.

This account has been frozen at $35.5 million for the past 5 years, and was funded at $39.31 million in 2007. The governor’s figure for the care manager account is 12 percent lower than this account stood nine years ago.

The home care Case Management Account (9110-1633) is the companion account to 9110-1630. This line item pays for all ASAP workers–among them care managers and RNs who coordinate services provided to clients in the home care 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 percent since FY 2001. In FY 2009 the governor recommended $40.37 million for this line item, which in FY 15 stood at $35.54 million. Mass Home Care seeks three significant reforms in the FY 16 care management account:

1. Adjust ASAP staffing to accommodate 7,389 new clients in the program assuming the home care eligibility level is raised from $27,000 a year to $35,000 per year.
2. Increase ASAP personnel and related expenses to keep pace with personnel at competitive agencies
3. Broaden the ASAP clinical team to deal with complex, “super utilizer” clients by adding “Care Transitions Coaching” to work with these high cost cases.

After months of waiting, advocates were hoping for new initiatives in the governor’s budget from the Community First Trust Fund, but innovative approaches will have to come in the versions submitted by the General Court The CF Trust Fund is new money awarded to the Commonwealth under the “Balancing Incentive Payments” (BIP) program, given to states as an incentive to “rebalance” their spending on long term supports away from institutions, and into community-based care.

The governor’s budget uses $53 million in BIP funds in FY 16 to pay for what was initiated by the BIP program in FY 15. No new initiatives are funded. Roughly 80 percent of these BIP funds are targeted towards non-elderly populations — despite the fact that the worst imbalance of institutional spending is in the elder services accounts.

For example, according to state figures, only 34 percent of all long term supports funding for seniors was spent in the community, the rest on institutions. But 81 percent of all long term supports spending for those under 65 was spent on community care. The real “rebalancing” problem in Massachusetts is in elderly spending. If the goal is to shift care from institutions to the community — 80 percent of those in nursing facilities are age 65 and over. BIP funding is being use for worthwhile programs—but not to alleviate the imbalance of institutional spending.

During an afternoon phone briefing with advocates, Marylou Sudders, Secretary of the Executive Office of Health and Human Services, gave further details on the governor’s budget released earlier in the day. According to Sudders, the Elder Affairs line items overall received a 2.1 percent increase. She also said:

• There will be “minimum impact on service recipients” of MassHealth.
• MassHealth overall is increasing by 5.6 percent
• MassHealth spending will total $15.3 billion.
• MassHealth is “right-sizing” its caseload by conducting caseload redeterminations.
• Chiropractic services are being eliminated from MassHealth
• MassHealth eligibility standards for programs like Personal Care Attendant and Adult Foster Care etc. are not being changed. Advocates were very pleased with this outcome.
• $30 million is being set aside as a reserve account for Ch. 257 rates.
• There will be no MassHealth cuts to mental health providers this year.
  Courtesy of the Mass Home Care Bulletin, At Home.