(Excerpts)

Elderly

· Pharmaceutical Assistance. The Governor proposes legislation mandating enrollment in Medicare Part D for all eligible Pharmaceutical Assistance clients; currently only clients in the lowest income levels are required to enroll. It would also require use of generic drugs, where available. The Governor recommends total program funding of $2.1 million from all funds, $720,000 less than enacted, including $650,000 less from general revenues and $70,000 less from restricted receipt drug rebates.

· Elderly Security. The Governor proposes legislation to eliminate requirements for the state to provide matching grant funds for security services at elderly housing complexes. The legislation would empower the Director of Elderly Affairs to require each housing complex to submit satisfactory evidence of an ongoing security educational program and a safety and security plan. The enacted budget includes $0.2 million for a community service grant to provide these matching funds; however the FY 2009 budget only reduces funding by 50 percent.

· Senior Community Service Employment. The Governor proposes transferring the Senior Community Service Employment program to the Department of Labor and Training. The program develops and expands employment and training opportunities for persons age 55 and over who are at or below 125 percent of the federal poverty level.

· Paratransit Services. The Governor proposes to require riders for non-Medicaid trips to pay a coshare of $2.00 each way. The client co-payment results in general revenue expenditure savings within the Department’s budget of $319,076. The clients would pay the fee directly to the program manager, the Rhode Island Public Transit Authority. The fees would apply to all and are not means tested. The proposal assumes this change would not require legislation.

· Community Elder Information Specialists. The Budget eliminates the community elder information specialists funding for FY 2009. The FY 2008 enacted budget includes $300,000 for the program.

· Adult Day Care Services. The Governor proposes increased co-payments for subsidized adult day care effective February 15, 2008, which reduces general revenue expenditures by $82,451 in FY 2008 and $140,525 in FY 2009. This includes a $1.50 per day co-payment increase for clients with incomes up to $13,200, and $2.50 for clients with incomes up to $24,280.

· Home Care Services. The Governor proposes increased co-payments for subsidized home care services effective February 15, 2008, which reduces general revenue expenditures by $92,976 in FY 2008 and $280,503 in FY 2009. This includes a $1.50 per hour co-payment increase for clients with incomes up to $13,200 and $2.00 for clients with incomes up to $24,280.

· Elderly Affairs Community Service Grants. The Governor includes a $1.1 million or 50 percent reduction to funding for community service grants administered by the Department of Elderly Affairs that are awarded to senior centers, retired senior volunteer programs, multi-purpose centers, community action programs, and various meal sites.

Health and Human Services

· Ocean State Medicaid Waiver Initiative. The Governor and the Budget Office indicate major program changes to Medicaid affecting the department of Human Services, Children, Youth and Families and Mental Health, Retardation and Hospitals. Information about the changes are not included in the legislation submitted by the Governor. The changes to the state’s Medicaid program will likely require federal approval that may take up to three months to receive. At this time, the application that must be submitted to the Centers for Medicare and Medicaid Services has not yet been written.

· Geriatric Patients at Eleanor Slater Hospital. The Governor proposes transferring 28 geriatric patients with psychiatric conditions currently residing in the Virks Building at the Pastore Complex to other units of the Eleanor Slater Hospital or to community settings and assumes savings of $5.7 million, $2.7 million from general revenues and elimination of 70 positions. This savings does not include any adjustments for other placements supported by state expenditures, such as nursing homes.

· Nursing Facilities. The Governor’s budget decreases nursing home reimbursements by reducing the maximum allowable ceiling for direct labor costs from 125 percent of the state median to 110 percent for a savings of $5.0 million. This requires only a state regulatory change.

· Nursing Home COLA Delay. The Governor’s budget delays the statutorily required nursing home cost-of-living adjustment from October 1, 2008 to April 1, 2009 and assumes $4.0 million in savings. This does not require federal approval.

· Nursing Home Residents to Community Settings. The Governor proposes moving a portion of the state’s nursing homes residents back to community settings, whether it is their home or a relative’s home, and adds $7.0 million for home care and adult day services to support the elderly in their new residences. This proposal assumes net savings of $39.6 million, $18.8 million from general revenues and assumes savings beginning July 1, 2008.

· Supplemental Security Income Payments. The Governor proposes decreasing the state supplemental security income payment on January 1, 2009 by the amount equal to the scheduled federal cost-of-living adjustment, for savings of $2.7 million.

· Human Service Community Service Grants. The Governor recommends $2.7 million less for funding community service grants to 98 organizations distributed by the Department of Human Services. This is a 50 percent reduction.

· Privatization of Food and Housekeeping Services . The Governor again proposes privatizing certain food and housekeeping services eliminating 211 positions for a savings of $4.6 million, including $2.5 million from general revenues. He recommends savings of $3.9 million at Eleanor Slater Hospital and eliminates 183 positions by privatizing housekeeping and food services for FY 2009 with annualized savings of $6.1 million, $2.7 million from general revenues. Veterans Home food services would also be privatized, eliminating 28 positions for total FY 2009 savings of $0.7 million with annualized savings of $1.3 million.

· Department of Health Community Service Grants. The Governor provides $241,175 or 50 percent of the enacted funding level for 11 community service grants supporting AIDS Care Ocean State and Rhode Island Project AIDS, Rhode Island Cancer Council, Rhode Island Blood Center, Rhode Island Patient Advocacy Coalition Foundation, three community health centers, the Visiting Nurses Association and the child development center at Hasbro Children’s Hospital.