Making Sense of Uncertainty Sandi Fitzpatrick, MA Executive Director California Commission on Aging July 2017

Overview California Commission on Aging State Budget Clouds of Uncertainty Federal Budget LTSS

California Commission on Aging Established in 1974 - under authority of the Older Americans Act. Statutory Responsibilities: Principal state advocacy body for older adults. Advise Governor and Legislature. Prepare, publish and disseminate information. Participate in State Plan on Aging. Meet around the state to engage in discussion Sponsor Initiatives that look at issues in depth.

18 Commissioners Appointed by Governor, Senate, and Assembly 3-year term X 2 Meet 5 times/year Committees: Legislative Advocacy Federal Policy Elder Justice Operational Procedures Commissioners at Salida Library 3/17

Policy Area Priorities Poverty Food Security, SSI, Gender Inequalities Health Care Medicare/MediCal/Denti-Cal, Behavioral Health, Long-Term Care Community Living Housing, Transportation, Caregiving, Livable Communities, Senior Centers Elder Protections Victim compensation, Adult Protective Services, LTC Ombudsman Program

FOCUS Priorities Preserve/Expand the Services Continuum Support Caregivers Work in partnership Recommend policy & legislative changes Promote positive portrayal of aging

State Budget Highlights

State Budget Highlights – what was included Restoration of Denti-Cal adult benefits Reauthorizes the Coordinated Care Initiative Increase patient staff ratio in skilled nursing facilities Augments funding for the LTC ombudsman program (on-going) Augments funding for courts (equal access fund)

State Budget – what didn’t make it $12.5 million for senior nutrition $2 million for medically-tailored meals for Medi-Cal beneficiaries COLA’s for SSI/SSP recipients $10 million to provide housing-related assistance to avoid homelessness (HomeSafe Pilot Project)

Clouds of Uncertainty in Washington D.C. Federal Issues of Significance

Federal Issues: AHCA Increase the number of uninsured by 24 million Make it harder for pre-Medicare older adults to find affordable health insurance – up to 5X more costly Weakens Medicare Trust Fund Repeals preventive and home care programs Information from National Council on Aging

Better Care Reconciliation Act of 2017 Ever-changing dialogue 22 million denied service Vote now expected, week of 7/17 Medicaid becomes a per capita cap program beginning in Fiscal Year 2020 Makes deeper cuts to Medicaid that previous version Denies essential Health Benefits

Medicaid Cuts from repeal/replace ACA CA will lose $45 billion under AHCA 62 % of nursing home residents are on Medicaid Destroys “safety net” of basic heath care and in home services for older adults, adults with disabilities and special need children Negative impact on caregivers and won’t keep pace with increased need Drastic cuts to IHSS Proposes moving “savings” to “tax cuts” CDC Falls Prevention Information from Family Caregiver Alliance

64% of CA’s medicaid spending is federal share

Federal Issue: FY 17-18 Budget How the Administration’s Budget would impact Older Americans Medicaid: Cut by $627 billion (on top of ACA replacement) Supplemental Nutrition Assistance Program (SNAP): Cut by $194 billion Chronic Disease Self-Management Education (CDSME): Cut by $3 million Older Americans Act (OAA) and Elder Justice Act (EJA): Increases reversed

Federal Issue: FY 17-18 Budget (continued) Programs slated for elimination in Administration’s Budget: Senior Community Service Employment Program (SCSEP) Medicare State Health Insurance Assistance Program (SHIP) Low-Income Home Energy Assistance Program (LIHEAP) Block Grants (SSBG, CSBG, CDBG) CDC Falls Prevention

Federal Issue: Food Assistance (SNAP) known as CalFresh in California SNAP helps struggling families put food on the table. SNAP benefits are roughly $1.50/person/meal in Calif. In Nevada County region between 4-8 % of households received CalFresh in 2015. President’s proposal would shift ¼ of cost to the states, allow state to cut costs, and would tighten eligibility. Information from California Budget Project

Federal Issue: Older Americans Act Funds critical services to help older adults stay healthy and independent. Enacted 1965; last reauthorized 2016 Appropriations

CCoA Advocacy Positions on Federal Legislation Oppose HR 1628 - American Health Care Act Support HR 2639 – Reauthorization of the Elder Justice Act Support S.870 – Chronic Care Act – implements Medicare payment policies to improve management of chronic disease via telehealth.

Long-Term services and supports: AN update

LTSS Update: LTSS Scorecard

AB 1200 (Cervantes) Establish Aging and Disability Resource Connection (ADRC) program Establish the ADRC Advisory Committee. Authorize CDA to designate/approve ADRC programs. Require ADRC programs to submit data to CDA on an annual basis. Require Administration to explore reimbursement for qualified administrative activities performed pursuant to these provisions.

LTC System Change Workgroup 10 organizations met in response to a request from Assembly Member Ridley Thomas “California’s Economic and Moral Imperative: Meeting the Long-Term Care Needs of our Population” System Change Platform

PLATFORM PILLARS Infrastructure and Capacity: Years of budget cuts and flat funding at both the state and federal levels have eroded the service delivery system. ACTIONS: develop new funding to support infrastructure & capacity including workforce development, transpiration and housing. Service Delivery: Fragmentation in service delivery creates significant system-wide challenges. ACTION: establish a Legislative Blue Ribbon Commission on LTC. LTC Financing: We face an unprecedented crisis related to LTC financing. ACTIONS: stabilize and strengthen the LTC financing market, including a “public” financing option and amending regulatory barriers.

AGE … RIGHT …. CALIFORNIA California Commission on Aging Paul Downey, Chair www.ccoa.ca.gov 916 419 7591 AGE … RIGHT …. CALIFORNIA