Advocates for Missouri’s seniors will have their hands full in this year’s legislative session defending current programs, trying to secure lost funding and pushing for new protections for the elderly. They say funding has been cut for several key programs that help seniors get proper care, which has made some of them concerned about future legislation.
Organizations representing Missouri’s seniors are keeping their eyes on the “circuit breaker” tax credit, which saw debate in the legislature during the 2018 legislative session. The policy survived budget cuts last session through a Senate compromise that took money from other dedicated Medicaid funds. The tax break, called the Missouri Property Tax Credit Claim, provides low-income seniors who rent their homes with a credit of up to $750 and, for those who own their homes, up to $1,100, according to the Missouri Department of Revenue.
We checked in with some of these organizations to see what other policies they’ll be paying attention to in 2019.
A lack of sufficient funding was the major concern for many senior-focused organizations. The Missouri Association of Area Agencies on Aging, which works to help coordinate services for seniors in Missouri, expressed concerns about insufficient fundingfor many of those services.
Besides continuing to defend the circuit breaker program, Catherine Edwards, the association’s executive director, said the association’s main goal is to establish the Senior Services Growth and Development Program. Prefiled as Senate Bill 86 by Sen. Wayne Wallingford, R-Cape Girardeau, the program would fund senior services through area agencies on aging. Money would be generated by setting aside 5 percent of the insurance premium tax collected from certain companies and associations, other than the premium tax already dedicated to the education, phased in over two years.
Edwards hopes the program could supplement the legislature’s current appropriations process to help make up for funding lost in the past. But Edwards said the number of seniors needing care is increasing, as is the cost of providing services, so her association would still be struggling if the program passed.
“Even if we were to fully restore, for example, what we had received 10 years ago,” Edwards said, “we’re behind the eight ball.”
Another of the association’s goals is to expand eligibility for the Missouri Rx Plan. According to the association,MORx pays for 50 percent of the out-of-pocket prescription costs not covered by a senior’s Medicare plan. As of June 30, 2017, however, eligibility was reduced so that only seniors who qualify for both Medicare and Medicaid can receive this benefit. This change affected an estimated 64,000 Missouri residents, according to AARP Missouri.
Edwards said the removal of the dual-eligibility requirement, prefiled as Senate Bill 78 by Sen. David Sater, R-Cassville, is essential for her association’s mission of ensuring that seniors are able to be as independent as possible.
“If we are to try to keep seniors at home longer,” Edwards said, “it’s important they manage their chronic conditions. And to do that oftentimes requires faithful compliance with your prescriptions. But if you can’t afford them, obviously then that starts causing a problem.”
The Missouri Health Care Association, the largest trade association for both for-profit and nonprofit long-term care facilities in Missouri, said its biggest issue is the “significantly underfunded” Medicaid rates for care provided in skilled nursing facilities.
Since nursing home residents require constant, specialized care, their care can get quite expensive. According to the Kaiser Family Foundation, 62 percent of residents in American nursing homes are covered by Medicaid. According to MHCA, Missouri nursing homes are reimbursed, on average, $19-per-patient per day less than what it actually costs to care for them.
“We’re kind of in a crisis situation in the state right now because the level of funding doesn’t meet what the cost of care actually is,” said Nikki Strong, the association’s executive director.
Nikki Strong, the association’s executive director, said nursing homes need funding help from the state because their own funding mechanisms are limited. To stay open, Strong said some nursing homes have had to make sacrifices, such as cutting nondirect care services, such as transportation to and from medical appointments. A few have gone out of business entirely, according to Strong.
“Some folks that have other businesses (and) that own nursing homes,” Strong said, “their other businesses are having to essentially keep the nursing homes afloat because things are so bad.”
Chad Jordon, vice president of the Missouri Coalition for Quality Care, cited cuts to home-delivered meal programs, the MORx program and in-home personal care through Medicaid among the coalition’s concerns.
“We’re tired of the elderly being on the short end of the stick,” Jordon said. “They have been ignored by the legislature. And, actually, in many respects, they have been hurt by the legislature with what they’ve been doing.”
Establishing new protections
Although many of the issues facing Missouri’s senior stakeholders are monetary, organizations also spoke of efforts to pass new protections.
While appropriations bills may be the coalition’s top priority, Jordon said the organization, which works to advocate for long-term care recipients, eventually wants to see a strengthening of the licensing process for in-home care providers.
“Right now, Missourians have no idea whether an in-home care company provides good care or bad,” Jordon said, “because they’re not allowed to have access to records that reflect cases where somebody had been hurt while receiving services from personal care workers.”
VOYCE, a St. Louis-based nonprofit organization that provides advocacy services to long-term care residents in the St. Louis area and northeast Missouri as part of the state long-term care ombudsman program, will be advocating for several measures to improve care of long-term care residents.
Mary Lynn Faunda Donovan, VOYCE’s executive director, said the organization hopes to build off the passage of House Bill 1635 last year, which changed mandated reporting laws so that long-term care facility workers must report suspected sexual assaults to law enforcement in addition to the Department of Health and Senior Services.
Faunda Donovan said VOYCE is looking for a sponsor for a designated health care decision-maker bill. The idea would be to create a hierarchy of people who would be able to make health care decisions for a person in cases where they are incapacitated and haven’t already designated someone.
Additionally, VOYCE will be pushing for legislation to require nursing homes to notify residents and families when a resident who is a registered sex offender moves into the home and to screen both residents and staff against the National Sex Offender Registry. Currently, Faunda Donovan said, homes are only required to screen employees against the state’s data through the Missouri Family Care Safety Registry, and no screening is required for residents. This doesn’t mean some homes don’t already do these types of screenings, Faunda Donovan said, but this legislation would simply make it a requirement for all homes.
VOYCE’s main goal this session, however, is the passage of a long-term care facility monitoring bill. Introduced several times over the past few years, the bill would require nursing homes to allow residents and residents’ families to install surveillance cameras in their rooms.
Proponents of the bill — such as Martha Eudaley, who said her husband was a victim of neglect in a Town and Country nursing home before his death in 2010 — said the bill could help limit abuse and neglect of residents and increase accountability for nursing home staff. But the Missouri Health Care Association says giving residents or residents’ families complete control over the cameras would present privacy rights issues for other residents and hinder the “collaborative process” necessary to provide residents with proper care.
Supervising editor is Mark Horvit.