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

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

3. California Commission on Aging
Established in 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.

4. 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

5. 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

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

7. State Budget Highlights

8. 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)

9. 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)

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

11. 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

13. 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

14. 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

15. 64% of CA’s medicaid spending is federal share

16. 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

17. 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

18. 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

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

20. CCoA Advocacy Positions on Federal Legislation
Oppose HR 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.

21. Long-Term services and supports: AN update

22. LTSS Update: LTSS Scorecard

23. AB (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.

24. 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

25. 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.

26. AGE … RIGHT …. CALIFORNIA
California Commission on Aging Paul Downey, Chair
AGE … RIGHT …. CALIFORNIA