February 3, 2015
President Obama’s annual budget request once again presents a mixed bag for seniors.
It is unlikely to receive support from a Republican Congress, but the Administration’s preferences will be important when a final fiscal year 2016 (FY16) budget is crafted at year’s end.
The positive news is that the budget invests in a number of core aging services programs and omits cuts proposed in past years for key community programs. It also calls for eliminating the sequester, the automatic across-the-board cuts to discretionary programs that are slated to take effect again this year.
However, it is disappointing that the request once again includes Medicare proposals that negatively affect beneficiaries.
Administration for Community Living (ACL)
The FY16 request proposes significant new funding for Older Americans Act Title III programs, including:
- $38.5 million more for Supportive Services and Senior Centers
- $19.9 million more for Congregate Nutrition
- $20 million more for Home-Delivered Nutrition
- $20 million for a new nutrition modernization demonstration program which “would support competitive grants to translate research into evidence-based models states can use to implement more efficient and effective home-delivered and congregate nutrition programs”
- $5 million more for the National Family Caregiver Support Program
- $15 million for a new Family Support Initiative, for the “development and expansion of promising and evidence-based state and local approaches to supporting the largest provider of our nation’s long-term care: families”
There are also increases for supportive services, nutrition and caregiver support programs for Native Americans, and additional caregiver support with more than double funding for Lifetime Respite.
The Administration continues its commitment to national funding for elder justice, with another $21 million requested for Adult Protective Services (APS). And after mandatory funding to maintain the investment in Aging and Disability Resource Centers (ADRCs) didn’t materialize last year, the Administration is now proposing to restore those resources at $20 million, entirely from discretionary funding.
Falls prevention, Chronic Disease Self-Management Education, Alzheimer’s Disease demonstrations and outreach, and State Health Insurance Programs (SHIPs), are level-funded in the President’s budget request for ACL.
Centers for Disease Control (CDC)
Falls prevention activities at the CDC National Center for Injury Control and Prevention are level-funded at $2.05 million in the FY16 request. These interventions also continue to be a focus in a number of states under the Core Violence and Injury Prevention Program (Core VIPP), particularly in Colorado, New York, and Oregon.
The budget includes net Medicare savings of $423 billion over 10 years.
NCOA is disappointed in five proposals that would increase Medicare beneficiary out-of-pocket costs for new beneficiaries by about $84 billion over 10 years and significantly more in the following 10 years.
The biggest cost shift ($66.4 billion over 10 years) would further increase Medicare Parts B and D premiums based on income, which could eventually impact beneficiaries with incomes of about $50,000.
NCOA is particularly disappointed in proposals that would increase out-of-pocket health costs in a manner that would harm sicker, lower-income seniors:
- Starting in 2019, a new $100 Medicare home health copayment, which would primarily affect lower-income women with functional impairments
- Starting in 2017, doubling brand-name prescription drug copayments and reducing generic copays for beneficiaries with incomes below 150% of poverty, which could be particularly troublesome for sicker seniors who need more medications
- Starting in 2017, gradually increasing Medicare Part B deductibles by $75, which would make it more expensive for beneficiaries to see their doctors
- Imposing a 15% premium penalty for seniors with first dollar Medigap supplemental insurance policies, including the most popular plans F and C, which would increase annual out-of-pocket costs by about $250 on average
Beneficiaries with incomes between 100-200% of poverty are not protected against these costs and already spend an estimated 26% of their income out-of-pocket on health care – more than any other demographic group.
NCOA also is disappointed that the Administration did not propose to make the Medicare low-income protection Qualified Individual (QI) program permanent, but would only extend it from March 31, 2015 to December 31, 2016.
However, the budget does include proposals to accelerate by three years the closure of the prescription drug coverage gap and improve Medicare appeals.
Medicaid Home and Community Based Services (HCBS)
The President’s budget proposes several Medicaid HCBS improvements:
- A new pilot program for “comprehensive” Medicaid long-term services and supports would authorize up to five states over eight years to design programs that remove the institutional bias and streamline existing programs.
- Additional state flexibility on eligibility for the Community First Choice Option would allow states to extend eligibility to certain individuals who qualify for nursing facility services (individuals with incomes up to 300% of SSI) in more administratively efficient ways.
- Two proposals to provide additional state flexibility in the 1915(i) Home and Community-Based Services State Plan Option would remove administrative burdens to permit states to expand eligibility to certain individuals who meet needs-based criteria and allow states to provide full Medicaid to individuals accessing 1915(i) services.
- A non-legislative proposal would allow the Secretary to implement a streamlined appeals process for dually eligible individuals being served in programs that integrate Medicaid and Medicare.
Other Department of Health & Human Services (HHS)
The FY16 request includes level-funding of $1.7 billion for the Social Services Block Grant (SSBG) and $3.390 billion for the Low-Income Home Energy Assistance Program (LIHEAP). Unlike recent years, no cuts are proposed for the Community Services Block Grant (CSBG).
Department of Labor (DOL)
In a reversal from recent year’s budget requests, the FY16 request does not propose any cuts in the Senior Community Service Employment Program (SCSEP), nor does it call for transferring it from the Labor Department to the Administration for Community Living.
A number of policy changes are outlined, including increasing participant eligibility from 125% of poverty to 133%, directing more program dollars toward skills training, and expanding resources for demonstration programs to support on the job training (OJT) innovations. Details continue to emerge, but it is clear that all these changes would require legislative action.
Department of Agriculture (USDA)
Two notable proposals related to older adults are contained in the Agriculture Department’s FY16 budget.
Recognizing that participation rates for low-income elderly individuals eligible for the Supplemental Nutrition Assistance Program (SNAP) continue to be much lower than average, $9 million is requested to enable states to streamline and simplify SNAP applications for these food insecure seniors.
Also, with the addition of seven new states to the Commodity Supplemental Food Program (CSFP), an additional $10 million is proposed to help address the increased demand. Over 90% of food insecure individuals turning to CSFP for nutritious food baskets are older adults, and the program will transition to seniors-only in the coming years.
Department of Housing & Urban Development (HUD)
Similar to last year, the Administration is requesting $60 million for Housing Counseling, a $13 million increase over current funding, which includes resources for mandatory reverse mortgage counseling. An increase of $25 million is also proposed for the Section 202 Housing for the Elderly program.
Corporation for National & Community Service (CNCS)
In another reversal from the FY15 budget request, no cuts or consolidations are proposed in any of the Senior Corps programs.