Ohio Department of Aging
Site MapSite HelpContact Us Text Size:
May 17, 2007
Click the image above to download print-quality photos of Director Riley.
Chairman Carey, and members of the Senate Finance Committee, I am Barbara Riley, Director of the Ohio Department of Aging (ODA). Thank you for the opportunity to appear before you today in support of the budget for the Ohio Department of Aging.
Our mission is to provide leadership for the delivery of services and supports that improve quality of life and promote personal choice for older Ohioans, adults with disabilities, their families and their caregivers. It also is our charge to promote positive attitudes toward aging and older people, to advocate for their needs and to create the linkages necessary to assure effective service delivery. We do not do this work alone. The Ohio aging network includes ODA, other state departments, 12 Area Agencies on Aging, over 400 senior centers and county and municipal organizations, and hundreds of private providers and not-for-profit agencies, which working together serve over 500,000 individuals, or one quarter of all older Ohioans.
Part of what drew me to this position is the changing face of aging and its universal impact on all of us - regardless of economic status, race, or geography - we all are aging. Each month, 12,000 Ohioans celebrate their 60th birthdays. These are the oldest, the first wave, of the Baby Boom generation, their sheer numbers alone will tax our service systems. But, this generation also is well known for having strong opinions and preferences and their changing expectations and influence will alter how we must plan for the future. To put this into perspective, I would like to share our demographics forecast, one that may frighten us, but clearly sets the stage for the future:
This increasing need has to be addressed at the very time our state is encountering growing revenue pressures, requiring a creative but thoughtful approach for how we tackle what we are facing. Built on Governor Strickland's Turnaround Ohio initiatives, this budget proposal does exactly that by focusing on: consumer choice, independence and self-care, promoting home and community based care, reducing costs, and addressing quality.
To carry out this administration's Turnaround Ohio goals, the Department of Aging's budget includes a number of specific proposals and provisions that support our vision for enhanced and effective service delivery.
PASSPORT
Spotlighted within the budget is the expansion of PASSPORT, one of our most economical ways to support older Ohioans in the settings they prefer. With the expansion of PASSPORT, we will be able to provide an additional 5600 older individuals with choices in how their long term care needs are met in their communities. At this funding level, ODA would be able to serve the projected natural enrollment for the program. This initiative, coupled with the Governor's recent directive to clear the previously existing waiting lists, will serve all those eligible individuals we anticipate requiring PASSPORT services in the upcoming biennium.
In order to assess the success of PASSPORT in serving the 33,291 Ohioans enrolled in 2006, and at the request of the General Assembly, ODA contracted for an outside evaluation by Scripps Gerontology Center of the PASSPORT program. On May 15, 2007, we released a series of six detailed reports on the results of this thorough evaluation; a summary of the results has already been posted to our website and will be delivered to all members of the General Assembly. This will be an invaluable tool as we review the state of long term care in Ohio, and I want to share a few of the highlights with you.
Since 1993 we have been conducting an ongoing study of Medicaid long-term care utilization that revealed a long term care supply and demand trend that is crucial to understand as we work to expand consumer choice. At its beginning, 33.7 of every 1000 Ohioans age 60 and over were using either PASSPORT or were in a nursing facility, 2.9 of those 33.7 individuals were in PASSPORT, and 30.8 were in nursing facilities. By 2005, 32.7 of every 1000 were in one of the two settings, but 11.4 were in PASSPORT. There was no apparent woodwork effect.
Instead, we see many more Medicaid consumers of long term care in their own homes and communities, while nursing facilities are serving many more who need rehabilitation services, or who have a more intense level of care need. Indeed, we must be certain that we have all care settings available, as there is a place in this system for all.
Assisted Living
Also included in the budget is funding to support the federally authorized 1800 assisted living waiver slots. On July 1, 2006, ODA assumed administration of the Assisted Living Waiver Program which currently is open only to individuals residing in a nursing facility or enrolled on another home and community-based waiver program, such as PASSPORT. Unfortunately, this greatly limits the population eligible for assisted living services, and only 132 older Ohioans were enrolled as of March 19th. However, the House added the provision of S.B. 5 which passed the Senate March 13, 2007 which allows persons already in assisted living who exhaust their resources to remain in a Medicaid certified facility under the Medicaid program. We are hopeful that will resolve this impediment.
In addition, we need providers willing to participate, and we need to more effectively link eligible consumers with willing providers that will meet their service needs. Not only must individuals meet the same eligibility requirements as for the PASSPORT program, an assisted living facility must meet specific requirements and be certified to become a provider.
However, of the nearly 500 residential care facilities serving Ohio, only 279 facilities meet all the federally required criteria to qualify for the program. Of that number, at present 50 facilities are participating. Based on the experience of other states with new waivers, Ohio's slow start up experiences are not unique. Regardless, we believe it is essential for us and our state and local partners to work together with potential facilities to determine what the barriers are, and how we might circumvent them. The Area Agencies on Aging have made that a priority.
PACE & CHOICES
Am. Sub. H.B. 119 funding levels support the two existing PACE sites providing services to 735 participants in Cleveland and Cincinnati. PACE is a managed care model that provides participants with all of their needed health care, medical care and ancillary services in acute, sub-acute, institutional and community settings. PACE sites receive two monthly capitated payments, one from Medicare and one from Medicaid. Each of the two PACE sites pool those resources to pay for whatever services an individual needs, including services not otherwise covered by Medicare or Medicaid. This flexibility allows them to be proactive in their care of participants.
The Choices Medicaid waiver program, available in two areas of the state (central Ohio and rural southern Ohio), allows a qualified PASSPORT participant to employ service providers in his or her home, allowing the participant to self direct his or her plan of care. In 2006, 236 individuals enrolled. CHOICES is funded as a component of PASSPORT.
Residential State Supplement (RSS)
The Residential State Supplement program provides funds to low-income adults with disabilities who do not require nursing home care. The supplement, along with the consumer's income, pays for an approved living arrangement in a certified and licensed facility. This funding request retains housing subsidies for 2000 low-income adults age 21 and over.
HB 119 also contains language that seeks to improve the quality of RSS living arrangements through certification standards to be adopted in rule by ODA and additionally sets forth a new priority for the RSS waiting list that will allow us first to serve those who receive Supplemental Security Income. These changes are in line with federal requirements for RSS programs.
Homestead Exemption
As you are aware, the budget would remove existing income limitations on the homestead exemption making property tax relief available to all senior citizens and disabled homeowners, and greatly simplifying the administration of the program. When the Homestead Exemption was established in 1980, 70 percent of our seniors qualified, but the qualifying income was not routinely indexed to inflation, and today only 29 percent of our seniors qualify. This expansion will increase the number of eligible recipients for homestead relief from the current 220,000 to 775,000, which is about one-quarter of all homeowners, and will save older home owners an average of $400 a year. By exempting the first $25,000 of home value from property taxes, the older or disabled homeowner in Gallia County, with a $50,000 home (Gallia County's median home price), will experience a 50 percent cut in their property taxes. The owner of a $500,000 home would experience only a 5 percent savings.
Kinship Care
Although not in the ODA budget, I want to support the provision in the Ohio Department of Job and Family Services budget which expands eligibility and support for our grandparents who are raising their grandchildren. In Ohio, there are an estimated 86,000 grandparents who are providing care, and the newly configured program will allow us to serve many more of those who are most financially in need of assistance.
Unified Long Term Care Budget
In order to move Ohio forward in providing consumer choice and to achieve better balance within our long term care system, H.B. 119 assigns to ODA the responsibility for establishing a process that will lead to the creation of a unified long term care budget by June 1, 2008. Other states are finding this to be an essential facet of a more rational long term care system. The Ohio Commission to Reform Medicaid and the Ohio Medicaid Administrative Study Council recommended creation of a unified budget, and this proposal moves us to the next step of "how".
Why a unified long term care budget? First, flexibility would be achieved by allocating the dollars to the individual to be expended on their care, rather than allocating dollars to a particular service category. In an ideal system, there are no waiting lists for any particular setting, be it a nursing facility, assisted living facility, or an individual's own home. Instead, for those eligible for long-term services and supports, the setting is determined by consumer choice and the necessary levels of service. Some will need the more intensive medical setting of a nursing facility; others will need assistance with the activities of daily living, which they can safely continue to receive in their own homes. The Department of Job and Family Services recently received a federal "Money Follows the Person" grant, which is an excellent example of how this principle can work.
The second rationale is transparency. As members of the General Assembly, you should not have to examine the budgets of several different state agencies to determine how much Ohio spends on long-term care services and supports.
The third, and perhaps not so well recognized, reason for a unified budget is civility. For many years the debates on long-term care funding have pitted provider against consumer, provider against provider, and consumers and providers together against state agencies. The process of creating a unified budget will require us all to work together for the common good.
However, I believe the success of a unified long-term care budget is dependent on first developing a unified long-term care strategy for Ohio, a step that has proven to be elusive over the years. The time to address these issues is now, because the status quo is unsustainable as the baby boomers age. In 2050 more than one million Ohioans will be over age 85, and we must build the system we want for them, and let's be candid, for ourselves and those we care about.
As set forth in H.B. 119, ODA is to create a workgroup of consumers, providers, advocates, and state and local policymakers who are charged with developing a budget that:
This will be a considerable task and we will have to grapple with many issues, but we know that consumers do choose wisely. We also know that we must manage our Medicaid cost and the average cost of care varies greatly, from about $1100 a month for PASSPORT to around $5000 a month for nursing facility care. Another given is that we need a full array of services, including those delivered in both home and facility-based settings. I believe success in this effort is fundamental to our effectively providing services and controlling Medicaid costs in this state.
ODA ACTIVITIES AND INITIATIVES
To better understand how all of these pieces fit together to form the patchwork quilt that serves and protects Ohioans, I want to share some highlights of ODA operations.
ODA programs are designed to assist older Ohioans at every stage of aging to help mature adults live active, healthy and independent lives. For that older Ohioan, the key to maintaining good health is to remain active, both physically and mentally - to be their best in body, mind and spirit. ODA and the aging network provide many opportunities to work, learn, volunteer, contribute to our communities, and generally enjoy life. Volunteer programs, like the Long-Term Care Ombudsman program, RSVP, Foster Grandparents and others, keep interested older Ohioans engaged in meaningful activities. Approximately 400 senior centers throughout the state also engage the older members of their communities. We work with employers, Ohio's workforce systems and the Department of Labor's Senior Community Services Employment Program to help older Ohioans contribute to the prosperity of their communities through employment and independence.
GOLDEN BUCKEYE
Perhaps our best known and most popular program is the Golden Buckeye Card which is in the pockets of approximately 2 million Ohioans and is honored at more than 20,000 businesses statewide. Golden Buckeye cardholders have saved an estimated $2 billion since 1976 through voluntary discounts at participating merchants. We are constantly seeking new ways to partner with business leaders to not only increase the value of the Golden Buckeye Card, but also to help businesses take full advantage of the benefits of courting older Ohioans as consumers and employees.
As a result of HB 468, on July 1, 2007, the Ohio Best Rx and Golden Buckeye Prescription Drug Savings Program will merge under the auspices of ODA, and we will be able to offer Ohioans the best of both worlds. While the Golden Buckeye program gives seniors a discount at many participating businesses, Best Rx offers a better prescription deal than the Golden Buckeye Prescription Drug Savings program, thereby allowing the state to serve more people with a more valuable benefit.
State Ombudsman Program
Ohio can be particularly proud of our Long Term Care Ombudsman program. This service is available to all long term care consumers, regardless of income or payment source, who need to resolve complaints they might have related to nursing facilities, physician services, Medicare and Medicaid eligibility, guardianship, and other consumer rights. In an average year we receive over 10,000 such complaints. There are 88 paid ombudsmen, who along with 255 volunteers, field these complaints and work for resolution. In addition we provide extensive public education and information about the choices available in long term care, publish an on-line consumer guide, conduct resident and family satisfaction surveys, provide legal assistance, elder abuse protection, and as mandated by the federal Older Americans Act, advocate for older Ohioans.
Aging Network
The aging network provides an array of home and community supports to enable older Ohioans to remain in their homes. Through such programs and services as Meals on Wheels, transportation services, home repair, adult day care, respite programs, and support services for caregivers, older Ohioans and their caregivers receive the support they need to maintain their health and independence in their own homes and communities.
Many of these services fall under our administration of the Older Americans Act in Ohio, ultimately serving 500,000 individuals. Funding for these services, which are not supported by Medicaid, include $49 million in federal funds, $16 million in state funds and $57 million in local general revenue and levy funds. Federal Title XX funds also support some of these services as detailed in each county's Title XX plan.
As I previously stated, we cannot carry out these responsibilities alone. Regionally, Ohio has 12 Area Agencies on Aging, which make up the backbone of aging services delivery in Ohio. Each area agency serves a unique geographic area and coordinates with local human and social service networks, including service providers, to plan and deliver aging services. Similarly, 12 Regional Long-term Care Ombudsman Programs work within their communities to safeguard consumers of care services, advocating for quality care, investigating complaints and giving them a voice.
County and local offices on aging throughout the state extend the reach of the aging network, tailor services to their specific communities and have their own offices on aging to support and enhance the efforts of the state and regional offices. County and Municipal Senior Centers offer people age 60 and older a place to go for nutritious meals, social activities, volunteer opportunities, health screenings, health and consumer education, creative arts, exercise and more.
Local law enforcement, colleges and universities, non-profit charities, fraternal and benevolent organizations, chambers of commerce and other community resources are also part of the virtually endless aging network.
Services to those under 65
Something that is less well known, but important, is that ODA also serves younger adults through many of our programs. I previously mentioned the merger of Ohio Best Rx and the Golden Buckeye Prescription Drug Program, which will target all uninsured Ohioans up to 300 percent of poverty. Other ODA programs that serve Ohioans under the age of 60 include the new assisted living Medicaid waiver, the Residential State Supplement program, PACE, the Senior Community Services Employment program, the long-term care ombudsman program, our family caregiver support program, the Golden Buckeye Card program, and the "PASS" (preadmission screening) part of our PASSPORT program.
Before I conclude, I want to bring to your attention two areas of concern in the House passed version of the ODA budget. The administration supports the 3 percent PASSPORT provider increase, but in Am. Sub. H.B. 119 the funding for the second 3 percent increase for SFY 2009 was inadvertently omitted. In order to fully fund the subsequent SFY '09 increase it will require an additional $12 million, $4.9 million state share. In addition, although the House retained the language authorizing ODA to convene the Unified Long Term Care Budget work group, it eliminated the authority necessary to implement that unified budget. I believe that after several years of effort, with prior work groups determining that this is a necessary move, it is now time to bring this to fruition. I am hopeful that the administration can work with you to find a means to achieve implementation of a unified long term care budget.
Mr. Chairman, members of the committee, I am proud of our ability, with only 102 qualified and competent staff, to facilitate services for so many of our most vulnerable Ohioans, and look forward to working with you to build a more strategic and effective system in the future. I would be happy to answer any questions you might have.
Ohio Department of Aging