April 4, 2013- Health and Human Services

Elder Services and Dually Eligible Members

The Appropriations Committee, in conjunction with the Committee on Health and Human Services, heard testimony regarding the Governor’s budget proposals for elder services and dually eligible members.   The hearing focused on:

  • Independent Housing with Service           Dually Eligible: Reimbursement to LCSWs Only,
  • Low-Cost Drugs to the Elderly                  Office of Elder Services – Adult Protective,
  • The Medicare Savings Program              Office Of Elder Services – Central Office,
  • The Maine RX Plus Program                   Nursing Facilities,
  • MR/Elderly PNMI Room & Board            MAP: Elimination of ineligible spouse disregard,
  • Elimination of therapeutic leave days
  • Limitation of reimbursement for certain services provided in Boarding Homes

Major Issues

Low Cost Drugs to the Elderly (DEL).   The Governor’s proposal eliminates funding for the Low-cost Drugs to the Elderly Program, which is funded exclusively with General Fund money.   This program provides a discount on generic drugs for everyone who is enrolled and on brand name drugs for people with certain serious health conditions like diabetes, heart disease, chronic lung disease and Multiple Sclerosis.  It also makes certain drugs more affordable for some low-income Medicare beneficiaries

  • The Budget provides, however, $10.4 million each year in the Fund For A Healthy Maine [FHM] to fund the Low-cost Drugs to the Elderly Program, which creates great confusion with respect to the Governor’s intent.
  • Who will be affected: Approximately 80,000 low-income seniors over the age of 62 and people with disabilities will lose the help they need to afford their prescription drugs.  Most of the people impacted have income at or below 175% of the federal poverty level ($19,548/yr. for a single person).

Medicare Savings Program.   The Governor’s budget rolls-back this program to minimum federal standards to save roughly $16 million.   The standards are rolled back from:

140% of the FPL to 100% of the FPL for Qualified Medicare Beneficiaries,

160% of the FPL to 120% of the FPL for specified Low-income Medicare Beneficiaries, and

175% of the FPL to 125% of the FPL for Qualifying individuals.

  • Proposal: This program helps to pay for Medicare premiums, co-payments and deductibles, prescription drug costs, and coverage through the so-called “donut hole”. The Governor’s budget proposes to limit this program to people with incomes at or below 135% of the federal poverty level ($15,080 for a single person; $20,425 for a couple).   This program currently serves those with incomes up to 175% of the poverty level ($19,548 for a single person).
  • Who will be affected:    Nearly 40,000 low-income seniors and people with disabilities (those with income between 135% and 175% of the poverty level) will lose the help they
  • currently get through the MSP.   According to DHHS, 25,498 members will be affected by this change.

Loss of MaineCare for Certain Elderly and Disabled Individuals

  • Proposal:    This proposal would eliminate the “ineligible spouse disregard” in the MaineCare program. This deduction of spousal income provides the DHHS with some flexibility when determining MaineCare eligibility so that disabled and elderly individuals who are married can qualify for coverage when they have serious medical needs.
  • Who will be affected: This change in policy will leave some elderly and/or disabled individuals (who live with their spouse) without healthcare coverage.

Nursing Facilities.   The Governor’s budget provides an additional $5.6 million over the biennium to replace federal funds that are lost as a result of the reduction in the federal funds matching rate.   A total of  $147,000 in federal and General Fund monies are cut as a result of eliminating the “Ineligible Spouse Disregard.”

Elder Services – Central Office.   The Governor provides funding for two additional limited-period positions that will terminate in June 2015.   The budget also provides funding for the Long-term Care Ombudsman Program.   The Center for Medicare and Medicaid Services has required the State to no longer fund this program with  federal funds.

Reimbursement for Services Provided By Therapists.   The Governor’s Budget prohibits reimbursement for services provided by licensed clinical professional counselors [LCPCs] and licensed Marriage and family therapists [LMFTs] to dually eligible persons.     Dual eligibles are persons who qualify, in some way, for both Medicare and Medicaid coverage.   Medicare covers their acute care services, while Medicaid covers Medicare premiums and cost sharing, and—for those below certain income and asset thresholds—long-term care services and, until 2006, prescription drugs, among other services.

  • The Governor proposes to limit reimbursement for services to this population to licensed social workers to save $6.6 million in General Fund money, but at the loss of $10.58 million in federal Expenditure funds.   The governor proposed this same measure in his FY 2013 Supplemental budget, and it was rejected.
  • Testimony indicated that there are not enough licensed social workers to provide the services needed.   In addition, many eligible Maine residents, who are eligible and disabled, would have to travel long distances to find a licensed social worker, who has no history of the clients and no knowledge of the issues challenging the clients.

Therapeutic Leave Days.   These are days that enable a nursing home person or a PNMI resident to stay with family for a few days and return to their assisted living or nursing home without losing their bed.   The Governor proposes to eliminate this benefit, which means that once the person leaves the facility, the person could lose their place – and may have nowhere else to go.

Health and Human Services

Budget documents for the HHS committee may be here.

Commissioner Mayhew joined both the HHS and AFA committees to present testimony.

Committee members requested more information regarding therapeutic leave days, the Governor’s proposal to prohibit reimbursement for services provided by licensed clinical professional counselors [LCPCs] and licensed Marriage and family therapists [LMFTs] to dually eligible persons.  Other members asked for information about programs in other states similar to Maine’s DEL program.

Members of the public testified in opposition to the Governor’s renewed proposal to eliminate the Medicare Savings Program (MSP) and DEL program, the elimination of therapeutic and hospital leave days, the prohibition of reimbursement for services provided by licensed clinical professional counselors [LCPCs] and licensed Marriage and family therapists [LMFTs] to dually eligible persons and the elimination of the eligible spouse disregard and coverage for the medically needy spend down.

Public Testimony Part 1- April 4, 2013

Public Testimony Part 2- April 4, 2013

Public Testimony Part 3- April 4, 2013

Public Testimony Part 4- April 4, 2013

Public Testimony Part 5- April 4, 2013

Public Testimony Part 6- April 4, 2013

Schedule

Tomorrow, Friday, April 5 Public Hearings on the Governor’s proposed Biennial budget draw to a close when Appropriations is joined by the Health and Human Services committee for a public hearing on issues related to:

  • Social Services
  • Children’s and Children’s Mental Health
  • Developmental Disabilities
  • Brain Injury
  • Hospitals

The full schedule may be found here.

Report backs

Policy Committees will now hold budget work sessions in preparation for reporting recommendations to AFA.  The schedule for report backs is below.

Audio and more

Please feel free to join the committee as they do their work. You may also listen online using the following link: http://www.maine.gov/legis/ofpr/appropriations_committee/audio/index.htm

You also may watch broadcasts of these and other committee hearings on the Maine Capitol Connection pilot channel through Maine Public Broadcasting.  You may watch over the air or through your cable provider as well as online here: http://www.mpbn.net/News/MaineCapitolConnection.aspx

Thank you and please let me know if you have questions.

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