24-05-2025
Jehlen giving voice to emerging elder affairs issues
BOSTON (SHNS) – Despite funding increases, the top senator on elder issues is raising a red flag about service cuts to programs that help keep seniors out of nursing homes.
With demand for services outpacing budget increases, senators 'should be open and transparent about the fact that services to individuals are being cut to try to control the budget,' Sen. Pat Jehlen of Somerville, who co-chairs the Joint Committee on Elder Affairs, said during annual budget debate.
'This is an austerity budget. It's more money. But for many people, the services are less,' said Jehlen, who is 81 and described a friend who was able to continue working because her husband was able to access services.
Jehlen filed three budget amendments to try to curb those service cuts, each of which she promoted from the Senate floor. However, she withdrew her proposals without pushing for votes.
Two amendments sought to address enrollment caps and other directives from the Healey administration to tighten eligibility and rein in costs for the Enhanced Community Options Program (ECOP), which serves frail individuals who clinically qualify for nursing homes but are able to receive intensive at-home care. The other would have stopped a 6% rate cut coming down from the Healey administration to all Adult Day Health programs, which Jehlen says will result in the highest-quality, local nonprofit programs shuttering their doors.
Earlier this year, the Healey administration began imposing a cap on the number of available ECOP slots, providers told the News Service, in an effort to 'manage intake.'
ECOP functions as a 'middle-income' home care program for older adults who do not qualify for MassHealth but struggle to afford private care on their own. Home care workers help participants with a wide range of services, including medication assistance, help showering and cleaning, Alzheimer's and dementia care, and cooking or home delivered meals. Without the care, providers say, these individuals are reliant on help from family members or neighbors, or need to be placed in more expensive nursing homes.
The new enrollment caps from the Executive Office of Aging & Independence (AGE), which outline monthly reductions for providers to reach through the end of the fiscal year, have spawned waitlists for ECOP.
Older adults can still receive basic home care, but their loved ones may need to play a bigger caregiving role to bridge service gaps, said Betsey Crimmins, executive director of Mass Aging Access, which represents the state's 27 Aging Service Access Points and Area Agencies on Aging.
'It doesn't mean people don't get nothing – it means they don't get the higher level of services while they're waiting,' Crimmins told the News Service last week. 'So I think the idea is: How do you do more with less? How do you create efficiencies, and how do you make sure that people don't completely just fall through the cracks?'
She added, 'These are really hard decisions, telling people that they can't get services that they need, and that if they had called in January, they would have.'
Crimmins said she is querying her members to find out how many adults on the ECOP waiting list had to be admitted to nursing homes. Crimmins said she is also working with AGE to navigate potential exemptions to the new guidelines, including how to handle an older adult who needs ECOP-level care sooner than a slot is available.
'People will wait longer and receive less assistance than they would have this year. That's not likely to be remedied by any future supp budget. It will just be the new normal,' Jehlen said during Tuesday's debate.
The administration has said individuals already receiving services will not get kicked off.
'Now that enrollment is capped, [those on the waitlist] may have to wait with fewer services than they need until someone else is no longer alive or goes into a nursing home,' Jehlen said.
The administration in February also tightened eligibility for the program by creating a higher spending threshold on services for older adults to qualify for ECOP.
One of Jehlen's amendments (#466) would have injected an additional $15 million into the elder home care services line item, which is $278.7 million in the Senate Ways and Means Committee budget. The other ($464) would have given a $4.5 million boost to the $110.7 million line item for elder home care case management.
Jehlen said the state 'almost always' has to add funds through supplemental budgets for the ECOP program. The line item for elder home care services is increasing by $41 million in the Senate budget, but Jehlen said demand continues to outpace what the state has budgeted.
'There will be continued increases because more people are living longer and living longer with disabilities,' she said. 'Because of those increases in utilization, we almost always have to add funds to both of those items in a supplemental budget.'
Elder home care providers for months warned they would run out money this spring without a supplemental funding infusion to fill big budget gaps amid soaring demand for services.
Healey's supplemental budget in April called for steering $60 million to elder home care services, an amount the House embraced in its spending package Wednesday. Even without that money, the state has managed to continue paying providers through other funding streams, Crimmins said.
The Healey administration also moved recently to cut rates for adult day health programs, which offer community-based daytime care for older adults and adults with cognitive, medical or behavioral health impairments. There are 140 such programs in the state.
EOHHS proposed decreasing the per day and partial per day rates to providers for the basic level of care for adult day health services from $106.32 to $99.49 and $53.16 to $49.75, respectively. The cuts will save the state $5.59 million.
The new regulations were rolled out in March, received a hearing in April, and will be effective July 1.
'The administration is not saying 'We're going to force closure of small nonprofits.' And we're not voting to close those small nonprofit places. But the administration cut will do that,' Jehlen said.
Despite her strong words, Jehlen withdrew her amendment that would have required MassHealth to maintain and pay base rates to providers of adult day health services at their current rates.
Asked about Jehlen's amendments and cutting services even as spending increases, Senate President Karen Spilka said it is a difficult budget year and can 'bring heartbreak… because we can't satisfy every need.'
'It's hard when you're taking a deep dive into the budget and every item, for children, for families, for veterans, for babies, for supporting families — there's so many needs out there,' Spilka said. 'We try to support them as much as we can, and we feel like we're spending, but there's still so many vulnerable populations out there in need. And we can't address it. We have one pot of money. We can't print money. That's all we can do.'
Since the beginning of the pandemic, 35 adult day health programs have closed.
'In 2023, just two years ago, the [Center for Health Information and Analysis] found that salaries in adult day health were $3 to $4 less than in similar jobs, and that a third of them were running deficits. Twenty-four were at serious risk of closure. So the administration raised those rates to prevent closures. Now the administration is planning to cut those rates,' Jehlen said.
MassHealth said they applied a 33% rate increase to all adult day health services in fiscal 2024.
'MassHealth remains committed to ensuring our members have access to a wide range of long-term services and supports (LTSS) programs. In the aftermath of COVID, the Commonwealth made significant investments in Adult Day Health programs to promote stability,' MassHealth spokesperson Stacey Nee said. 'As a result of these investment, the programs are in a much more stable financial position. Given the current budget climate, MassHealth is recommending reasonable adjustments to Adult Day Health rates.'
A cost report analysis from fiscal 2023 shows median profitability of adult day health programs was 7.86%, and the weighted average profitability was 14.36%, MassHealth said.
Jehlen said that about two-thirds of the centers are for-profit ventures, and are 'running significant profits.' Those are not the programs she's concerned about, she said.
'They often spend less on care, more on management fees, more on real estate,' she said. 'They will survive despite the rate cut.'
The Somerville Democrat said she's concerned about the one-third of adult day health centers that are small- and medium-sized run by local nonprofits and family businesses, which she said often provide more direct care.
'According to CHIA, they are running significant deficits, and have for years. They are the ones that are likely to close. This will be a real loss in quality overall, and it will be a real loss for the people who have received more local, more personal care,' she said.
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