Michigan Campaign For Quality Care

Newsletter

March 2007

1. Please join us at our next statewide meeting on St. Patrick’s Day, Saturday, March 17, 2007 from 10:30-2:30 at the Library of Michigan Lake Superior Room, 717 West Allegan, Lansing. And mark your calendars for our next statewide meeting on Saturday, May 5 at the same time and place. We love to welcome new members! If you plan to attend the March meeting, please RSVP to Alison Hirschel at hirschel@umich.edu or 517-324-5754 by March 14. See you on March 17...and encourage your friends to come, too!

2. Campaign members join Governor Granholm for Ceremonial signing of the Single Point of Entry legislation – Campaign chairperson Bill Mania, Southeast Michigan Chapter Chairperson Toni Wilson, and Campaign counsel Alison Hirschel joined other invited advocates and a very jovial Governor Granholm on February 1 for the ceremonial signing of the Single Point of Entry bill. The Campaign and other advocates worked hard to support this important bill which concerns the four pilot single point of entry sites across the state that provide "one stop shopping" for long term care consumers. These new entities will provide information, assessments, and person centered planning to long term care consumers and will gather data to help shape long term care spending and reform in the state in the future. Governor Granholm expressed delight in signing the bill and the hope that this bill was the first of many to bring real long term care reform to the state. After the bill signing, Bill took the opportunity to talk one-on-one with the Governor about his long term care experiences and concerns. At the invitation of Rep. Rick Shaffer, the SPE bill sponsor, Bill, Toni, and Alison also joined other advocates for a reception after the bill signing.

3. Campaign supports State’s efforts to raise new revenues to fund long term care and other essential services–Governor Granholm has announced a proposal to raise $3 billion in revenues to support essential state services and functions including long term care. The revenues would replace the nearly $2 billion that will be lost as a result of the repeal of the Single Business Tax which goes into effect at the end of the year. It will also provide additional revenue to address the state’s deficit and needs.

Years of tax cuts have left the state desperately short of funds and years of budget cuts mean there is virtually no fat left to cut in the state budget. Programs like Medicaid-- which accounts for about a quarter of the state budget-- will be utterly devastated if we do not obtain additional revenues in the state. According to state Medicaid Director Paul Reinhart, it is no exaggeration that the state will have to discharge a number of residents from nursing homes if we do not raise additional revenues. A Senate Fiscal Report projected the elimination of the MiChoice Home and Community Based waiver program without new revenues. Bob Kleine, State Treasurer, testified before the House Tax Policy committee on February 21 that the State is in jeopardy of running out of operating funds by May, "the first time in recent memory that the state coffers have dipped so low so early," if a plan to resolve the deficit is not implemented.

So far, the Governor’s plan to raise revenues, which includes a replacement for the Single Business tax and a 2% tax on many services, is the only plan on the table. While no one likes to pay additional taxes, the Campaign understands the state cannot raise substantial revenues without creating new or raising existing taxes. Michigan Senate Republicans apparently have developed a plan to address the budget crisis by cutting $850 million from the budget for this fiscal year, but have not yet released their plan or shared information about what it contains.

Long term care consumers have reason to be very nervous about the Republican proposal. It is likely that Medicaid, which is such a big part of the state budget and provides medical care for one in seven Michigan citizens (including those in nursing homes and on MiChoice), will be a big target. That means the state will have to terminate eligibility for certain Medicaid recipients, eliminate certain covered services, or reduce payments to health care providers who might then choose not to provide care to Medicaid recipients. However, Medicaid is already a very lean and efficient program. It provides health care to recipients at much lower costs than the health plans of Ford, Chrysler, General Motors or the state’s own employee health plan. In addition, reducing Medicaid funding will eliminate jobs in every county, hurt the healthcare industry which is Michigan’s largest employer, and result in the loss of more than two dollars in federal funds and health services for every dollar we cut in state Medicaid expenditures.

The Campaign is non-partisan and will be eager to look at plans from either party to solve the state’s budget crisis and ensure adequate funding for long term care. In the meantime, we need to let our voice be heard.

PLEASE do your part to protect long term care funding:

p Call your State Senator and State Representative to say you support continued and expanded funding for long term care including nursing homes, home help, and the MiChoice Home and Community Based Care program.

p Tell your State Senator and State Representative that you understand the state needs new revenues to continue to fund essential programs and that you will support a sales tax on services or other fair proposals to raise desperately needed revenues.

p Join other Campaign members when we walk the halls of the State Capitol in late March to talk to your representatives about long term care (contact Alison Hirschel for details at 517-324-5754 or hirschel@umich.edu).

p Write a letter to the editor of your local paper saying you support continued funding for long term care and will support new sales taxes or other proposals to allow the state to raise crucial revenues.

4. How do other countries assure quality in long term care?–A new issue paper by AARP’s Public Policy Institute examines how England, Germany, Japan, and Australia seek to ensure high quality long term care. England focuses on strong and aggressive enforcement of national quality standards and permits localities to impose additional quality requirements. Germany relies heavily on the enforcement of contracts between long term care providers and the heavily regulated nonprofit organizations called "sickness funds" that pay providers to care for consumers. The Australian government seeks to provide education to providers and consults with them to improve care. And Japan places more emphasis on worker training and informal mechanisms to assure quality. Japan is also experimenting with ways to supplement government regulation. The full report is available at http://assets.aarp.org/rgcenter/il/2007_05_ltc.pdf.

4. Campaign seeks to protect Medicaid recipients in nursing homes–According to state law, nursing homes that participate in Medicaid (the state and federal program for low income individuals) or Medicare (the federal health care program for seniors and some people with disabilities) are required to have their beds certified for both programs ("dually certified"). If they are, residents whose source of payment changes from Medicare to Medicaid can remain in the facility because the beds they are in can be used by both Medicare and Medicaid recipients. However, a number of facilities have been permitted by the state to have Medicare only and Medicaid only beds. As a result, residents may sometimes be involuntarily discharged from the nursing home when their source of payment changes. Campaign member and local ombudsman John Weir and local ombudsman Sally Bruce noticed that some nursing home corporations were changing a number of dually certified beds to Medicare only beds because the facilities get higher reimbursement from the Medicare program. As a result, a number of residents were facing discharge. The Campaign immediately requested that the state stop approving any additional requests to convert dually certified beds to Medicare only beds and the state agreed to do so. The Campaign will be continuing to do vigorous advocacy on this issue and will press for full implementation of the law.

Kudos to John and Sally for picking up on this disturbing trend! Please contact Alison Hirschel at 517-324-5754 or hirschel@umich.edu if you are having problems with nursing home beds that are not dually certified for Medicare and Medicaid.

5. Citizens for Better Care and the Elder Law and Disability Rights Section of the State Bar offer support to the Campaign– The Campaign gratefully recognizes the support and assistance of Citizens for Better Care (CBC). New CBC Executive Director Helen Kozlowski-Hicks has encouraged ombudsman staff to continue to participate in the Campaign and offered a variety of support. In addition, the Campaign is deeply indebted to the Elder Law and Disability Rights Section of the State Bar for providing funding for copying and mailing this issue of the Campaign newsletter and for advocacy on numerous issues of concern to long term care consumers such as expanded support for the MiChoice program.