State Revenue Shortfall Hits Adult Foster Care Program

The state’s “soft revenues” have resulted in hard cuts to programs in Massachusetts that help the elderly and disabled living at home.

Governor Charlie Baker released cuts amounting to $98 million from the state budget to bring it into balance on Dec. 7. Some of the largest cuts came from MassHealth program. A total of $52.2 million was cut from the Executive Office of Health and Human Services, including $5.6 million from the Adult Foster Care program, one of the Commonwealth’s signature programs for keeping people out of nursing homes.

Advocates are pushing back against 9C cuts targeting Adult Foster Care, a program that supports family caregivers. COURTESY PHOTO

Somerville-Cambridge Elder Services provides Adult Foster Care for much of the Greater Boston Area through the Adult Family Care program.

Five days after the cuts were announced, a coalition of groups sent a letter to House leaders urging them to restore the lost funding, which in FY 2018 will annualize to $22.6 million in lost funding. Total appropriations this year for the AFC program in FY 16 are around $240 million. Here are excerpts from the letter sent to House Speaker Robert DeLeo (D-Winthrop) and House Ways and Means Chairman Brian Dempsey (D-Haverhill):

“We are writing to urge the House to restore funding caused by recent 9C cuts made to the Adult Care (AFC)  program, one of the state’s premier “community first” programs. We share the position of the General Court that these cuts are untimely with respect to the overall status of the Commonwealth’s fiscal condition.  We also wish to share with you our concern that the cuts targeted within Mass Health, which reduce $5.6 million for the Adult Foster Care program in FY 16, and $22.6 million annualized in FY 17, are unwise and likely to cause instability and quality erosion within a program that has saved the Commonwealth millions of dollars in savings that otherwise would have resulted in nursing home placements or other out-of-home placements.

As you know, the Adult Foster Care program is an innovative and highly effective cost alternative to out- of-home placements that currently supports more than 10,000 elders and people with disabilities to live in their own homes or the homes of individual caregivers at a tremendous cost savings to the overall budget of Mass Health and the Commonwealth.  Between the years 2000 and 2015, nursing facility patient days paid for by Mass Health have fallen -37%, in part because of community-based alternatives like AFC. It gives elders and people with disabilities an inclusive opportunity to continue to live in a home setting and be part of a family.  It is a program beloved by the participants and the wonderful caregivers who open their homes and hearts to others. AFC is one of the few 24/7 residential support programs that uses volunteer caregivers on a stipend, and keeps members living in the least restrictive setting, which is the mission of Mass Health.

We have spoken with and met with the leaders of Mass Health and continue to share our concerns with them.  They believe that a reduction in requirements on provider agencies to employ nurses and care managers to conduct home visits justifies a 10% rate reduction to agencies. We believe that a substantial and unprecedented rate reduction for this program will:

  • Undermine the ability of quality agencies to provide the level of clinical and social support that lay caregivers need to take on caregiving responsibilities for individuals with complex health and behavioral conditions.
  • Negatively impact the ability of provider agencies to recruit individual caregivers willing to share their homes and the capacity of those agencies to train and provide quality assurance to individual caregivers.
  • Erode the confidence of families to take on around-the-clock commitment to caregiving at home and thereby the utilization of more costly alternatives.
  • Place some provider programs into a fiscal deficit for the current year and going forward, having built programs, staffing, training and administration based upon their contract assurance of funding with the Commonwealth, the needs of Mass Health members and the Commonwealth’s current regulatory requirements.

We will continue to meet with Mass Health leaders to convince them this rate reduction is untimely and unwarranted. We believe that these cutbacks will result in program damage and negative impact upon the lives of people served within the AFC program.

If the General Court chooses to reverse the AFC 9C reductions, we request that there be inserted into line item language for  4000-0600 a proviso that requires Mass Health to maintain the rate for Adult Foster Care in force at the level it was at  as of July 1, 2016.”

SOURCE: Mass Home Care.