Senior Advocates Coalition Muskegon, Ottawa & Oceana Counties MEMORANDUM. Save the Date

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1 Senior Advocates Coalition Muskegon, Ottawa & Oceana Counties To: Senior Advocates Coalition From: Pam Curtis, Facilitator Date: August 24, 2017 Re: September 11, 2017 Senior Advocates Meeting MEMORANDUM Save the Date The next meeting of the Senior Advocates Coalition for Muskegon, Ottawa, and Oceana counties will be held: Monday, September 11, :30 3:00 p.m. Senior Resources at Tanglewood Park 560 Seminole Road Muskegon Board/Training Room We will be meeting with our State Legislators 1) Introductions/Announcements AGENDA 2) Federal Updates and Discussion Items- A. Keep Up Appropriations Advocacy During Recess! The House and the Senate will consider their respective bills to fund the Departments of Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) shortly after they return to Washington, DC after Labor Day. This is a critical time for local advocates to drive home messages about the importance of protecting funding for important Older Americans Act (OAA) and other aging programs! We expect that FY 2018 will be a very challenging fiscal year for federally funded domestic programs, including OAA and other important aging programs. Not only did the Administration release a federal budget request that proposed deep cuts to many domestic programs, but House leaders have also proposed funding for many federal agencies at levels even lower than current budget caps. House appropriators took the first steps toward hashing out funding levels for OAA and other aging programs in late July when the House Appropriations Committee passed a Labor-HHS bill for FY 2018.

2 Despite high-level cuts that lawmakers proposed for the bill, House appropriators approved level funding for most core OAA programs. Although stagnant funding for programs that serve a growing population, meet a growing need and cost more each year often translates to a cut for local agencies sparing most OAA programs from House-proposed cuts in this incredibly challenging environment is an advocacy win! Unfortunately, House lawmakers did propose deep cuts to a few key programs that support older adults. The Labor-HHS funding bill that passed the House Appropriations committee would eliminate funding for the State Health Insurance Assistance Programs (SHIPs) which is the Medicare/Medicaid Assistance Program (MMAP) in Michigan, and cut funding for Elder Justice by 14 percent. Please refer to the next agenda item for more information on MMAP. Elder Justice funds efforts to (1) prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation; and (2) protect elders with diminished capacity while maximizing their autonomy. After Labor Day in the House, lawmakers are planning to bring a bill to the floor for a vote that would roll eight of the 12 annual appropriations bills into one. This bill, known as an omnibus, would include the Labor-HHS proposal that passed the full House Appropriations Committee last month. Because of both controversial policy riders that are expected to be included in the bill and cuts to non-defense discretionary programs below current budget caps, the omnibus is not expected to receive any Democratic support. Assuming it has enough Republican votes to pass, the House could be done with their appropriations work by mid-september well ahead of the late-september deadline. However, whatever the House passes will likely be unpalatable to Senate Democrats. Because at least eight minority members in the Senate need to support final funding proposals to advance them through the upper chamber, a FY 2018 funding bill from the House will probably be a non-starter in the Senate. Ultimately, both the House and the Senate will have to pass identical funding bills for all federal programs. We have not yet seen the Senate Labor-HHS funding bill. However, we do know that Senate leaders have allocated more money overall for the Labor-HHS spending bill than their House counterparts did. We don t yet know what this will mean for the many programs funded through the Labor-HHS bill, but the Senate version provides a better starting point for these spending discussions than House appropriators had. It is possible that lawmakers on both sides of Capitol Hill may be unable to agree on final funding levels; and that House and Senate leadership may resort to passing a continuing resolution, or CR, that simply extends current funding levels into next year. As it stands, spending bills are still subject to the reduced budget caps for FY 2018, which trigger an across-the-board sequester if Congress exceeds those caps. However, we are hearing that lawmakers want to avoid the threat of sequester, and they could come to some agreement to raise top-line budget caps. Whether the President would sign any funding bill that increases budget caps is unknown, so there could be a government shutdown showdown later this fall. Now is the time for advocacy! The endgame for FY 2018 funding is unclear. However, our best chance to fix the House-proposed elimination of SHIP and deep cuts to Elder Justice programs is to ensure the Senate fully funds these programs! Advocates can CONTACT our SENATORS to tell them they support a REJECTION of cuts to aging programs proposed in the House and ask them to contact Committee leaders regarding support or SHIP and Elder Justice. Reach out to Congressman Huizenga in the House, and ask him to support any effort to increase SHIP and Elder Justice funding in a final House bill.

3 B. The Medicare/Medicaid Assistance Program (MMAP) is the State Health Insurance Assistance Program (SHIP) in Michigan and is a free insurance counseling service provided by the Administration on Community Living and in partnership with the Centers for Medicare & Medicaid Services and state aging agencies to help Medicare beneficiaries and their caregivers with Medicare information. Every state has a SHIP program, but it may be called a different name. SHIPs answer questions about Medicare, Medicare Supplement Insurance, Medicare Advantage Plans (such as health maintenance organization (HMO), preferred provider organization (PPO), private feefor-service (PFFS), etc.), and Medicare Part D, long-term care financing options, other prescription coverage, and low-income assistance. SHIP/MMAP in Michigan provides a network of free, unbiased, reliable, and personalized health benefits information. In Michigan, SHIP/MMAP helps Medicare beneficiaries make choices among a vast array of options that include an average of more than 25 prescription drug plans, 29 Medicare Advantage plans, as well as 142 Medigap supplemental insurance policies. In Michigan, SHIP/MMAP also provides help with Medicare fraud and abuse issues, billing problems, appeal rights, and enrollment in low-income assistance programs. They inform consumers of their rights as a Medicare beneficiary or health insurance policyholder and help consumers file claims and appeal Medicare decisions. In Michigan, client contacts have increased by 189% in the last five years. In 2016, the Michigan SHIP/MMAP had 125,524 contacts with Medicare beneficiaries. SHIP/MMAP in Michigan provides community educational efforts and enrollment events. In Michigan, SHIP/MMAP hosted 239 enrollment events and 2,499 outreach events to assist and educate Medicare beneficiaries and their families in MMAP has referred clients to appropriate agencies for help with their other needs. MMAP had helped clients find assistance with payment for their prescriptions through Medicare Part D plans, drug manufacturers patient assistance programs, and retail discounts. SHIP/MMAP in Michigan provided assistance to beneficiaries in greatest need, including those with disabilities and those facing language and cultural barriers. In Michigan, 47% of SHIP/MMAP contacts served beneficiaries with incomes below 150% of the federal poverty level. In Michigan, 23% of SHIP/MMAP contacts served beneficiaries with disabilities. In Michigan, over 6% of SHIP/MMAP contacts served beneficiaries that speak English as a second language. SHIP/MMAP provides critical resources and expertise to federal partners. The Social Security Administration, CMS, Medicare, Medicare Advantage plans, Medicare Part D prescription drug plans, local and state agencies and Congressional representatives and staff refer beneficiaries to SHIP/MMAP. They include MMAP in their websites, publications, and correspondence to beneficiaries as the source of help when individuals need one-on-one counseling. In Michigan, 42% of the SHIP/MMAP client contacts were referred from federal partners, including the Social Security Administration, Center for Medicaid and Medicare Services (CMS), local and state agencies, Medicare, Medicare Advantage plans, Medicare Part D prescription drug plans, and Congressional representatives and staff. The SHIP/MMAP program is in serious jeopardy! Legislation has been introduced in Congress to completely defund the program!

4 Please contact Congressman Huizenga and encourage him to oppose any effort to defund the SHIP/MMAP program! 3) State Legislative Updates A. FY2018 Budget Kudos to our state legislators for passing a balanced FY18 budget. B. Two bills of interest have recently been introduced in the House. HBs 4885 and 4886 (Rep. Peter Lucido R-36th District -- Shelby Township) would increase the penalties and sentencing guidelines for financial crimes against vulnerable adults. The bills have been referred to the House Families, Children, and Seniors Committee. C. Another initiative that is just starting up is a statewide conversation on affordable, accessible housing for seniors. It was prompted by some constituent calls to Rep. Ronnie Peterson (D-Ypsilanti). At least one facility in his district is no longer obligated to offer subsidized housing and is choosing to go to market rates, which the current elderly residents cannot afford. In doing some research, Rep. Peterson discovered that the problem is more widespread than he thought so he is trying to convene some community conversations around the state to examine all the issues concerning housing for seniors, brainstorm solutions, and gather bipartisan support for legislation, if needed, to implement the solutions. Affordable housing is a big issue in our region and we will be keeping an eye on this and may want to consider inviting Representative Peterson to our area. D. The Nursing Facility Transition Initiative (NFTI) is part of the MI Choice Medicaid Waiver program. It gained national attention for successfully transitioning people in nursing homes who would prefer to live independently but who face obstacles such as the lack of an accessible home or the need for supports and services. Although the program has functioned relatively well, it will not be funded by the Federal government after February With the change in the funding stream for the NFTI program and the resulting transition to total State administration, a decision was made to completely assess the program s strengths and weaknesses to identify areas for improvement. To this end, the Michigan Department of Health and Human Services (MDHHS) and a number of interested organizations formed the NFT Design Team to gather information and recommendations from the field to develop a more streamlined, person-centered, and seamless transition process for persons leaving nursing facilities and transitioning back to their communities. The Team has drafted the following 18 re-design values to guide the development of the new transition process. Specifically, the transition program must: 1. Be based on providing a continually better customer experience for people who are transitioning. 2. Be built on a person-centered foundation that promotes maximum personal choice. 3. Design a process such that participants communicate with only one person to eliminate confusion. 4. Respect the person s right to take risks. 5. Include flexible timelines each person needs his or her own individual timeline to transition. 6. Respect participants need to try multiple times to transition successfully. 7. Include additional support for the person so he or she can be successful in the transition through such efforts as a mentoring program and others. 8. Include well-trained and qualified staff at all levels using a reimbursable training system for aides, caregivers and Transition Navigators. 9. Respect and trust providers to make good and responsible decisions. 10. Include clear, concise, and consistent two-way communication. 11. Ensure collaboration over competition. 12. Include consensus on operational definitions for terms, data, metrics and measurements. 13. Include a continual, two-way feedback loop into the system. 14. Include purposeful reporting. 15. Be cost-effective and cost-saving overall with an eye to low administrative costs. 16. Build continual quality improvement into the system. 17. Promote rebalancing of funding from institutional to community-based living. 18. Create a future where it is as easy to get out of a nursing home as it is to get into one.

5 MDHHS has been holding meetings around the state to solicit stakeholders reactions to and suggestions concerning these design elements. As the Design Team has received comments from the stakeholders, it has reviewed each one to determine if it has already been adopted or addressed in the re-design concept, it addresses an issue that will no longer exist in the re-design project, it will need to be addressed as the re-design project rolls out, or it is out of scope for the project, e.g. helping a person move to another state. Once the Design Team has finished gathering stakeholder comments, it will produce a white paper on the NFTI re-design. 4) Updates from our State Legislators (Committee updates, bills they are working on, areas of interest, 2017 accomplishments, items of interest in 2018, etc.) 5) Other Updates from the Group (as time allows) Our next regular meeting will be Monday, November 13, 2017 with our Federal Legislative Aides