LeadingAge Magazine · November/December 2013 • Volume 03 • Number 06

State Advocacy Protects Funds for Needed Services

November 08, 2013 | by Gene Mitchell

State Advocacy Protects Funds for Needed Services

While ensuring a “stable financial future” can include making fundraising efforts more robust and improving financial management, bread and butter for many not-for-profit providers is the government funding, via Medicaid and Medicare, that allows them to serve seniors. Here are a few stories of LeadingAge state partners who, with their members, have launched successful advocacy efforts to maintain or increase funding.

LeadingAge magazine is always looking for stories of successful advocacy. Please contact Editor Gene Mitchell at GMitchell@LeadingAge.org or 202-508-9424.

In Oklahoma, according to Mary Brinkley, executive director of LeadingAge Oklahoma, total adult day funding was about $2.8 million two years ago.

“We took an active role in ‘Senior Day’ at the capitol, had a booth, and educated legislators and the seniors at the event about the value of adult day services as an affordable option,” Brinkley says. (Senior Day is sponsored yearly, in February, by the state’s Department of Human Services.) Working with the chair of the House Appropriations Committee, LeadingAge Oklahoma succeeded in boosting adult day funding at that time by $552,000.

Behind the scenes, flyers were sent out to legislators, talking up the advantages of adult day programs. Several legislators were invited to visit LeadingAge members Daily Living Centers and Oklahoma Foundation for the Disabled. The Lt. Governor visited the latter.

This year, says Brinkley, there was another effort to increase funding. “We have a new director of the Department of Human Services,” she says, “and I talked to him about the role of adult day. It’s one of the best-kept secrets. There’s been a push for legislation to bring it under Medicare.” The effort succeeded again, gaining another $400,000 in new money for this year.

LeadingAge Oklahoma sees the effort to boost adult day services as a win-win for seniors and payers. “People realize they want to stay in their own home but [loved ones] have jobs to go to,” Brinkley says. “They can have their needs met, three meals a day, can have medications administered in Oklahoma, can do laundry, can be bathed. In the past people just saw it as activities for the day when really, it’s a partner in the care continuum.”

LeadingAge Iowa is another state partner pushing for increased adult day funding, an effort tied into modernizing the state’s adult day regulations.

Bill Nutty, government relations and member services director for LeadingAge Iowa, says “We have 32 adult day programs. Next door, Minnesota has four times as many. Why? Because the Medicaid reimbursement is $45 a day, abysmally low. The regs are copied from the assisted living rules. It’s not a good fit; they are too restrictive.”

The association supports the relaxation of criteria for adult day clients to permit programs to serve individuals needing more than part-time or intermittent health care. It also supports the development of a cost reporting system for adult day services based upon the county CRIS cost report form. A cost reporting system would provide valuable information related to the costs of providing adult day services and help policymakers and the Medicaid program better align reimbursement rates so that more adult day programs are available to seniors across Iowa.

Nutty says the association was successful, in the spring, in extending the survey cycle for adult day programs from two to three years.

“Our best bet,” says Nutty, “is to amend the statute through legislation in 2014. We haven’t met with friends in the legislature yet, but this should not be a difficult sell because Iowa under the State Innovations Model Grant wants to start a Medicaid managed care plan.”

by Alyse Migliaro

In 2011, Texas nursing homes endured a three percent cut in Medicaid reimbursement. While the 2013 Legislature focused on cost-containment and reducing Medicaid, LeadingAge Texas took a strong position on the immediate need for increased Medicaid reimbursement and began advocating. Members began hosting legislators at their communities and press releases were sent to local papers illustrating how dismal reimbursement rates were affecting quality nursing homes in Texas.

At LeadingAge Texas Capitol Day, members met with over 100 legislative offices. Seven Acres Jewish Senior Care Services, the largest Medicaid community in Texas, mobilized board members, residents and staff, sending the legislature over 500 letters in support of increased funding. They hosted the Lt. Governor twice and held two press conferences to educate the public on the importance of providing quality care to seniors.

Methodist Retirement Communities sent “Action Alerts” to their nine communities across Texas, urging phone calls to key legislators. Through the efforts of LeadingAge Texas members and the leadership of Public Policy Committee members, nursing homes avoided further cuts and achieved a six percent increase in 2014-2015. Although Texas remains severely underfunded, ranking 49th in the country for reimbursement rates, we were able to move the ball forward through strategic, collaborative advocacy and consistent messaging.

Texas nursing homes also faced inclusion into the state’s Medicaid managed care program, STAR+PLUS. SB 7, introduced to contain costs by reducing unnecessary care, expands STAR+PLUS to cover multiple Medicaid populations. Based on previous experience with the STAR+PLUS pilot program implemented 10 years ago, and lack of protections offered to nursing home providers under the new model, LeadingAge Texas opposed the bill.

As the bill moved through the legislative process LeadingAge Texas members pressed on and focused on cultivating relationships with freshman legislators on key committees. Members with previous experience in the STAR+PLUS pilot program led the charge and were present to voice their concern in multiple committee hearings.

Mark Lenhard, executive director of Grace Presbyterian Village, presented testimony on the missteps of the STAR+PLUS pilot program in the Senate and urged the bill’s author to add amendments to ensure reimbursement rates and the Direct Care Staff Enhancement Program remain intact, timely payments maintained, and hospitalization decisions remain with the LTC provider. Marsha Cayton, administrator of campus services at Seven Acres Jewish Senior Care Services, later testified in the House on the importance of receiving adequate funding and the risks associated with the STAR+PLUS model.

After months of debate and dozens of legislative meetings, SB 7 passed with two hours left in session. Originally filed as 35 pages, the final version grew to 96 and through the collective efforts of the membership, LeadingAge Texas was successful in adding several amendments to protect Texas nursing homes. As the implementation phase begins, we remain at the forefront of the issue. Recently, Lenhard was appointed to serve on the STAR+PLUS Quality Council, which will advise HHSC on the development of policy recommendations under SB 7.

For more detail on these efforts, see this Legislative Session Summary from LeadingAge Texas.

Alyse Migliaro is director of public policy for LeadingAge Texas.