Special Edition

FSSA’s Attempts to Hold Back CHOICE Home Care Funds is “unacceptable by any measure”

(Editor’s Comment: Because of the extraordinary situation created by state agencies attempting to withhold monies appropriated by the General Assembly for publicly funded home care services for senior citizens and persons with disabilities, United Senior Action has published this special edition of The United Senior Advocate. Please read the article that follows.)

The season of the summer solstice is generally a time of long relaxed days, family reunions, and lovely evenings. It is a season for enjoying life and Indiana at its best. Unfortunately, in 2011 the high days of summer will be a time of stress for senior citizens, persons with disabilities, and family caregivers that need publicly funded home and community based services in the Hoosier state.

In late May home care consumers began to hear stories the Indiana Family and Social Services Administration (FSSA) was pushing the area agencies on aging to accept contracts that would provide just short of $20 million for the CHOICE home care program in state fiscal year 2012. The new state fiscal year begins on July 1. On June 3 FSSA issued contracts to the area agencies that confirmed the $20 million funding level. Ever since, persons and families that depend on CHOICE funded home care services have had reactions that range from shock to intense anger. They know the new contracts represent a huge cut in the funds needed for home health and community based services.

Nancy Griffin, a long time leader and policy advocate for persons with disabilities, and a former USA board president, sharply criticized FSSA’s closed door attempt to reduce funding for CHOICE services. Nancy said: “That is unacceptable by any measure. It is inhumane, bad public policy, and a violation of the new state budget act.”

Nancy is right. Cutting CHOICE funding, putting individuals and families at great risk, driving people into nursing homes, and sticking taxpayers with the resultant higher costs of Medicaid funded nursing home care, any and all of those outcomes are unacceptable.

FSSA’s actions are also impossible to understand and they conflict with the funding provisions of the state budget law, House Enrolled Act 1001, that was signed by Governor Daniels after its passage by the General Assembly.

The General Assembly appropriated $48,765,643 per year for the CHOICE program during the two-year life of HEA 1001. Out of those funds, up to $15 million can be used for the state’s required contribution to home care services that can be provided through the federal Medicaid program. State participation in home care services provided through Medicaid is optional. Those optional services are called Medicaid waivers.

Indiana participates in several Medicaid waivers including one that funds home care services for low income persons who are aged and disabled. The $15 million in CHOICE funds that are used for Medicaid match are used for that waiver. All of the appropriated CHOICE dollars that are not used for the Medicaid aged and disabled waiver can only be used for the CHOICE program. At a minimum that means $33,765,643 dollars should be available for CHOICE services and administration, plus any of the $15 million in CHOICE funds that are not used for the state’s share of the aged and disabled waiver.

What does all this mean? When it comes to funding the CHOICE program, FSSA simply needs to follow the law. It is no more complex than that.

Since the word has gotten out regarding FSSA’s intentions, the public reaction has been highly critical. AARP appropriately criticized FSSA’s actions in a press release. USA joined the Indiana Alliance for Retired Americans, The Generations Project, SEIU, Hoosiers First and other members of the Indiana Home Care Task Force in a press conference on June 14, calling on Governor Daniels to direct FSSA to follow the law. AARP and USA addressed the state’s CHOICE Advisory Board regarding the issue on June 16. Individuals throughout the state are calling and emailing the governor, asking him to direct FSSA to fully use the CHOICE dollars for home care services as intended by the General Assembly. Legislators are also asking the governor to intervene.

Now FSSA and its Division of Aging are saying they never intended to cut funding for CHOICE services, and will amend the contracts sent to the area agencies on aging in the coming months. The amendments are suppose to happen in late July and in the fall. FSSA and the Division are saying these amendments will eventually raise the CHOICE funds that are available for services to $27 million. However, in the summer of 2010 FSSA arbitrarily took $7.3 million from the CHOICE program and that money was never restored to the program despite repeated inquiries from citizens, legislators, and advocacy organizations, including USA. FSSA was repeatedly asked to explain what it was doing with the $7.3 million dollars. On June 14, 2011 Marcus Barlow of FSSA finally said the money taken in 2010 was sent back to the state’s general fund. The reversion of those dollars back to the general fund constituted a direct violation of state law.

Given its history, can FSSA be believed when the agency says it will raise CHOICE funding to $27 million for the for the state fiscal year that begins on July 1, 2011? More importantly, millions of CHOICE dollars remain missing in the latest rationalizations the agency has presented to the public. If $33,765,643 are available for services through the CHOICE program why is FSSA only agreeing to use $27 million for that purpose? The difference between the two numbers equates to nearly 1,600 people who will not receive home care services. The number will be larger if the CHOICE dollars allocated for Medicaid match are not fully utilize for that purpose.

Denny Lanane, USA’s current president, sums up the situation as follows: “Over 6,000 Hoosiers are on waiting lists for CHOICE services. That’s 6,000 people who are at-risk of death, or forced placement in nursing homes, because they cannot get the home care services they need. There is no excuse for not using the dollars that have been appropriated by the General Assembly for the CHOICE program. FSSA must follow the law and use all the dollars for the CHOICE program. As Nancy said, anything less than that is unacceptable.”

What USA Members Can Do to SAVE the CHOICE Program

Here is what you can do to stop the Indiana Family and Social Services Administration’s (FSSA) plans for taking money from the CHOICE home care program.

Call or write Governor Daniels . As the elected head of the state’s executive branch of government, Governor Daniels can direct FSSA and its Division of Aging to STOP withholding from the CHOICE home care program the dollars that were appropriated for that purpose by the General Assembly. (1)Tell Governor Daniels to order FSSA to fully fund CHOICE home care services as authorized in the 2011 state budget act by the General Assembly. (2) Also ask Governor Daniels to use his authority to recover the $7.3 million that was taken from the CHOICE program in 2010.

You can reach Governor Daniels by calling 317.232.4567 or by writing Governor Daniels, Office of the Governor, State House, 200 West Washington Street, Indianapolis, IN 46204.

Ask your State Senator and State Representative to talk to Governor Daniels. Ask you State Senator and State Representative to tell Governor Daniels the CHOICE program should be fully funded with all the dollars appropriated for that purpose by the 2011 Indiana General Assembly.

Ask your family, friends, neighborhoods, and the organizations to which you belong to contact Governor Daniels about fully funding CHOICE services as intended by the General Assembly.

Contribute to USA’s advocacy campaign to protect the CHOICE. Representatives of United Senior Action will be traveling the state organizing individuals and groups to protect the CHOICE program. Any contribution that you can make to USA for that effort is important. Simply indicate that your contribution is for the USA Protect CHOICE Services Campaign.

Whatever you do, please act as soon as you can. Your calls, letters, emails, and contributions are all very important.

2011 Action Auction: An Important Success for USA

The 2011 USA Action Auction was an important success for United Senior Action. The Auction raised $8,500 in bids and sponsorships, and will continue to raise more as part of USA’s Protect CHOICE Services Campaign. Seventy people took part in the auction, which was held at Primo’s. The event featured a Sock Hop theme and included a Hula Hoop contest that was led by USA Board President Denny Lanane, Dennis Frick, Dan Skinner, Garth Norris and Darlene Webster. These “Oh My Olympians” can be seen on the USA website.

The Action Auction sponsors included Rock-n-Roll class sponsors The Law Office of Claire E. Lewis and SEIU Health Care ; Bonafide sponsors AARP , Severns and Stinson P.C ., SICIL , and the Indiana Alliance for Retired Americans ; Peachy-Keen sponsors were Carolyn Cunningham , National Bank of Indianapolis , and the Friends of CICOA ; and the Neat-O sponsor was Citizens Action Coalition Education Fund.

Don Young was a marvelous auctioneer, and Michelle Robertson of the USA staff coordinated the event. Auction solicitors included Michelle Roberson, John Cardwell, June Holt, Ada Shaum, Carlyn Johnson, Jim Wallihan, Denny Lanane, Ann Latscha, and Nancy Griffin. The emcees were John Cardwell, Denny Lanane and Nancy Griffin.

John Cardwell, USA executive director, had the following statement regarding the auction: “Michelle Robertson did a wonderful job with the total coordination of the event, the volunteer team put together by Michelle and June Holt was on its game, Primo’s did a great job, and people had a good time. We are already talking about having a far bigger event next year and even more fun. To the seventy people that attended this year’s Action Auction, USA says thanks and please come back next year.”

USA Caregiver and Advocacy programs taking off!

United Senior Action has invested considerable effort in the first half of 2011 in revitalizing its caregiver support and advocacy programs. “These programs are designed to do three important things,” according to John Cardwell, USA executive director. “Honor and fulfill the mission of the Older Americans Act to empower and serve senior citizens, give Indiana’s seniors and other citizens the skills and knowledge they need to be full and effective participants in civic affairs, and help individuals and family caregivers address any and all aspects of their long term care needs.” June Holt, USA’s assistant director, added: “We have developed and are distributing new literature designed to meet the caregiver and advocacy needs of seniors and all Hoosiers in the Indianapolis metropolitan region, and throughout the state. We are updating USA’s innovative caregiver CD, which was originally developed by Robyn Grant, and are making many changes to the USA website so it will be simple and easy to use. John, myself, and a growing list of trained USA volunteers will be rapidly expanding these services and our presentations across the state.”

Presently, USA caregiver and advocacy programs include working with seniors at low income neighborhood centers in Indianapolis, faith based organizations, union retiree chapters, the member organizations of the Indiana Home Care Task Force, disability groups, and long term care professionals. Eventually, USA will be working intensely throughout the metro Indianapolis region and the state.

One program, the New Leadership School, has been delayed for a few weeks due to the necessity of responding to the CHOICE funding crisis. The new Leadership School will be re-scheduled for late July and early August.

John Cardwell concluded: “We have the privilege of building on the great service and advocacy traditions that were developed by Paul Severance, Hubert Clodfelter, Scott Severns, Ruth Sears, Michelle Niemier, and many other fantastic people that made United Senior Action an innovative and essential organization in the lives of older Hoosiers. We are working to enhance that heritage by serving the current and growing needs of senior citizens and their family caregivers.”

Contacting United Senior Action

 Persons interested in USA’s caregiver services, literature and CDs, education and presentation services, and advocacy education services, are urged to call 317.634.0872 or go to the USA website at www.usaindiana.org , or write to United Senior Action, P.O. Box 2922, Indianapolis, Indiana 46206.

The USA board officers are: Denny Lanane, President; Tom Marvin, Vice President; Dennis Frick, Secretary; Ada Shaum, Treasurer; Jim Wallihan, Immediate Past USAI President; and Nancy Griffin, Immediate Past USAF President.

USA staff members are: John Cardwell, Executive Director; June Holt, Assistant Director; Michelle Robertson, Member Services and Special Projects Coordinator; and Al Freije, Membership Outreach Officer.

The following letter was delivered to Governor Daniel's office by members of the Indiana Home Care Task Force:

Indiana Home Care Task Force

One North Capitol Avenue, Suite 1025

Indianapolis, IN 46204

June 13, 2011

Dear Governor Daniels:

We write you with grave concerns regarding the availability of affordable and quality home and community based services (HCBS) through the CHOICE program. These are services that are necessary to keep persons with meager resources from being forced into nursing homes. The failure to provide these services directly leads to the forced placement of persons into nursing homes at a significant increase in cost to taxpayers through the Medicaid program.

For all these reasons, it is deeply troubling the Indiana Family and Social Services Administration has presented to the area agencies on aging contracts for SFY 2012 that reduce dollars available for CHOICE services to $20,000,000. This action will harm thousands of persons who are currently receiving CHOICE services and will harm thousands more who will not be able to enroll in CHOICE services. This action, if sustained, will greatly harm the viability of the CHOICE program going forward.

CHOICE only averages about $4,000 per year per person. No other program remotely comes close to the low cost, efficiency and effectiveness of CHOICE. CHOICE also serves people who are poor. These are the facts as presented by the Division of Aging. They demonstrate that CHOICE is by far the lowest cost long term care program in our state no matter how it has been represented to the public by FSSA officials.

The General Assembly passed HEA 1001 on April 29. Shortly thereafter you signed the budget act. When HEA 1001 passed there was a consensus among Republican and Democrat lawmakers on the following points regarding the CHOICE program.

(1) CHOICE had extensive public support throughout the state.

(2) Indiana’s long term care system was badly out of balance and in the future needed to invest more dollars in lower cost home and community based services, such as CHOICE and Medicaid waivers, and fewer dollars in high cost Medicaid funded nursing home care, in order to stay affordable.

(3) The compromises on CHOICE in the budget act, developed after extensive debate and review, represented the will of the legislature as enacted into law. $48,765,643 was appropriated for CHOICE in each year of the biennium, using CHOICE dollars for Medicaid aged and disabled waiver match up to a cap of $15,000,000 in year one, but only if needed, and up to $18,000,000 in year two, but only if needed. All of the dollars not used for waiver match were dollars appropriated for the CHOICE program.

(4) CHOICE funded services were clearly needed given the huge waiting lists and the overwhelming public support for the program.

Given these facts, we are asking you to take the following actions.

One, order FSSA to immediately obligate all of the CHOICE funds that are in the new budget beyond the $15,000,000 for match, to the area agencies on aging for the provision of services through the CHOICE program. We understand the dollars for CHOICE may include two or three million for related administrative costs.

Two, if contracts with the area agencies on aging are to be amended later in the biennium such actions should be taken to transfer unused CHOICE dollars that were intended to be used for Medicaid match back to the CHOICE program so the area agencies on aging can use those dollars for CHOICE clients, including providing services to persons on the waiting lists.

Three, order FSSA and the State Budget Agency to account for the $7,300,000 that was arbitrarily taken from the CHOICE program in the current fiscal year, SFY 2011, in direct violation of the 2009 state budget act. Given the huge waiting lists for CHOICE services those dollars should be available now for the provisions of those services.

Four, order executive personnel within FSSA and the Division of Aging to fully implement the provisions of both the 2009 and 2011 state budget acts regarding CHOICE, to implement the letter and the spirit of the CHOICE law, including properly informing and supporting CHOICE board members so they can properly fulfill their obligations under state law. Persons within these agencies who are unwilling to follow the provisions of the CHOICE law and state budget acts should be asked to move on.

Governor, we do appreciate your time and willingness to consider our concerns.

With you we share a belief that concepts like service, hard work, and caring for loved ones are not mere words. These personal beacons guide the behavior of millions of Hoosiers every day.

These beacons of commitment are at their strongest, but are also most tested, whenever anyone must get up in the middle of the night to care for a loved one who needs help with the most basic of life functions. These beacons of resolve and love are stressed at such times. Persons with impairments and disabilities of all ages, even those with dedicated caregivers, and family caregivers and breadwinners, have their resolve, endurance and finances tested daily in the provision of home care services. Of course, those persons in need of home care services that do not have caregivers, or who receive too few hours of care, have more than their resolve at risk. Their very lives can be jeopardized if publicly financed home care is not available.

With the help of the CHOICE program, thousands of people struggling with their most basic human needs are able to keep their personal beacons lit and the precious bonds of humanity whole. So please work with us to achieve these most basic and best ends. Direct the agencies at your command to release the dollars that are intended for the CHOICE program. Help the countless people that are dedicated to service, hard work and the caring for loved ones in order to give their families and Indiana a long term care system worthy of its citizens. Take these actions for the freedom and dignity of all Hoosiers.

Sincerely yours,

John Cardwell, Chairperson IHCTF

Denny Lanane, President United Senior Action

Elmer Blankenship,President Indiana Alliance for for Retired Americans

CC: Members of the Indiana General Assembly and the Indiana Home Care Task Force.

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