I
have to give credit to the Bush Administration for executing such a well
thought out and perfect plan that as of now appears to be on schedule. The
plan is not new and it has been moving slowly to its final conclusion
projected to take place in 2006. To the surprise of many, I am not
referring to the Modernization of the Medicare plan, but to the merging of
elders and disabled adults into one huge category.
In
times of budget crisis, whether created on purpose by removing a trillion
dollars from the government coffers or not, the public tends to bypass the
analysis of the fine print of new government initiatives.The agencies tend to project what are going to be the unintended
consequences of government actions to the missions of their respective
organizations. In times of crisis we pull together to survive. This is
such a time.
Let
me start by saying that for years the service providers and the Area
Agency on Aging have followed the funding regardless whether or not the
new available funding compliments the objectives of the agency or the core
service competencies the agency possesses.The administration knows very well that the best way to dismantle
the existing powerful aging network is to do it one piece at a time with
new funding initiatives that will move the agency from focusing
exclusively on elders to other client populations. The plan is to
introduce new funding which involves providing services to more than just
elders. The plan is to begin to merge several populations at the time they
need information, at the time that they are in serious need of help.
If
an agency is forced to consider other options in order to financially
survive, the not for profit agency and its Board of Directors will vote to
add the new group to the mission of the agency. Adding a new group
detracts from the focus on elders, but because the eyes of the agency is
on the funding, this change in focus will not be noticed. All this will be
done without a fight.It can
be said that if confronted with this master plan to dismantle the aging
service providers’ network the administration would simply say that
those agencies applied for the “new money” and it was up to those
agencies to choose serving other groups and not just elders. The
implementation of this portion of the plan began last year when agencies
were given funding to implement a one stop information and referral center
for individuals with disabilities and elders. The plan will continue this
year with an additional 9 million dollars to be given to twelve
(12)additional states to expand the institutionalization of the central
point of access for elders and disabled adults.
The
above is an effective mechanism to take away the emphasis and support to
our generation of heroes. To make sure the dismantling of the aging
network is effective and fast the administration is implementing other
strategies.The 10 Billion
dollars in temporary Federal Assistance Program expired
6/30/04
.At this time States are in
desperate need to address this issue and will be willing to accept any
variation to the program.This
is the time to introduce the “Modernization of the Medicaid plan”.This modernization will be headed by the Governors’ Association,
so it will give the impression it is a bi partisan proposal. To prepare
for the event that is already in the works, states like
Florida
, who will play a leadership role in all of this, have introduced
legislation to accommodate the transfer of Medicaid dollars to one lump
sum category.
Medicaid
Block grants to the States is another way to dismantle the aging service
network.By lumping together
all the Medicaid waiver programs in one huge block grant and by leaving on
a temporary basis the Older Americans Act money separate, the network will
have no choice but to reinvent itself in the process. The “new” huge
block grant will first provide the appearance that there is more money
coming in to the individuals in need of services because each group will
look at the final budget figures when in reality they should look at their
disappearing dollars.They
should track how this “huge” budget category intends to serve the many
groups it now covers.The
individual sum coming from each budget category is in this case not
greater than its individual parts. But few people will know that behind
the “huge” block grant there are serious budget cuts to their
individual programs. Few people will also discover that if we continue to
be a Medicaid provider now by default we need focus on frailty levels and
not age. Maybe this is a good idea, but if this is the case the well
accepted concept that each cohort has different values, experiences and
needs should also be revised or eliminated altogether.
In
addition to the “initiative” and “huge” block grants, the
administration’s plan is to introduce new titles to existing Act or
modify their wording. Adding a new title or changing a few words to an
existing congressionally mandated program is not going to raise a lot of
attention, but it provides a foothold for further changes. One case in
point is the fact that in the Modernization of the Medicare program the
eyes of the world are in the Prescription Drug coverage, but this is not
the most troublesome part of the act. The most troublesome part of the
Medicare Modernization Act is in title 8 that capitates further
expenditures if the cost of the Medicare program goes above a certain
level.This minor detail not
mentioned by any one media outlet or observer would take away the peace of
mind and security of future retirees unless they are Donald Trump or Bill
Gates. It establishes a foothold for health care rationing and by the time
people begin to react the foothold has now been executed to the detriment
of the baby boom generation.
Such
a foothold also exists in the Family Caregivers Program. A program that
has been hijacked by the administration and converted to something
different that shifts the focus from helping families to emphasizing
family responsibilities to do more for their loved ones. The Family
Caregivers program eliminates the age requirement and concentrates on the
family, not the individual elder or the frail person in need of help. This
is another minor adjustment that takes the focus away from the elder. It
is very possible that the Family Caregivers Initiative will be the only
Act in the Older Americans Act Program to receive funding, and as such,
more and more agencies will modify their mission and their programs to
follow those dollars.
If
the next White House Conference on Aging takes place under a Republican
administration, it is very possible that the process of dismantling the
aging service providers’ network will be accelerated. There is nothing
outside the Older Americans Act that requires the existence of the Area
Agencies on Aging. Nothing outside the Older Americans Act that mandates
each state to have a State Unit on Aging therefore, with the Medicaid
money leaving to be administered by Medicaid state agencies and the
Medicare money going to support more HMOs and HMOs willing to integrate
the acute and long term care systems to save money and streamline the
service delivery systems for elders what would be the role of the AAAs?
The
plan is there and all the pieces are falling in place, from AARP
supporting the Medicare reform to the fragmentation of voices in the
Leadership Council on Aging organizations. What is next?
To be continued
e
plan to dismantle the Aging Network has begun