The Boston Globe
Sunday, January 26, 2003
User fee targets nursing home residents
By Bruce Mohl
Globe Staff
Ruth Kern makes an inviting target for the bean counters on
Beacon Hill.
Kern is 82 and suffers from dementia. Her stepson and legal
guardian says she smiles when she sees him but doesn't know his name. "She's totally helpless,"
he said.
Yet Kern still has a measure of financial independence.
Between her own assets, built up over a lifetime, and her monthly Social Security check, Kern is
managing to pay $238 a day for her own care at St. Joseph's Manor, a nursing
home in Brockton.
Now the nursing home is asking Kern and others like her to
pay even more, about $9.60 a day or $3,504 a year, as part of a revenue-raising scheme to
boost Medicaid funding for the state's 450 struggling nursing homes.
In effect, the state is playing a sort of Robin Hood, taking
money from the estimated 8,000 nursing home patients in Massachusetts who pay for their
own care and using it to leverage federal tax dollars to shore up the state's
ailing nursing home system.
The state's so-called nursing home user fee (federal
regulators don't use such euphemisms; they call it a tax) was enacted as part of this year's state budget,
included in the same section that created the $1.30 prescription tax.
The nursing home fee was a House initiative crafted at the
behest of the state's nursing home industry. Nursing home executives say the fee isn't an ideal
solution to their financial problems, but they say it was the best they could
come up with under the circumstances, which are dire.
Nursing homes have been losing money and closing at a rapid
pace over the last three years. They've also been plagued by high staff turnover. The cause of
these problems has been a state Medicaid reimbursement rate for nursing
home care that is about $20 a day less than the actual cost of such care.
Medicaid, the state-administered health insurance program for the poor and
disabled, covers 72 percent, or 36,000, of the state's nursing home patients.
Ernie Corrigan, a spokesman for the Massachusetts Extended
Care Federation, said nursing homes desperately needed to increase their Medicaid revenues
but had to find a way to do that without increasing the financial burden on the
cash-strapped state.
What they came up with was the nursing home user fee.
Patterned after similar charges in nearly 20 other states, where the fee is nicknamed the
"granny tax" or the "bed tax," the nursing home fee manages to pump more
money into the state's Medicaid program without increasing the state's
expenses.
Here's how it works. The state assesses each nursing home
$9.60 a day for each non-Medicare patient, generating an estimated $145 million. The state
will take about $130 million of that money (the balance will go to other state
programs), double it, and plow it all into nursing homes through the Medicaid
program. Since the federal government pays half of Medicaid expenditures, the
state gets reimbursed $130 million.
On a net basis, nursing homes get an infusion of $130
million paid for by federal taxpayers and those nursing home patients paying for their own care. And the
state pays nothing more.
The federal government hasn't approved the Massachusetts
nursing home fee yet, but state officials aren't expecting any problem. Many nursing homes are
already collecting the fee from their patients.
Representative Charles A. Murphy, a Democrat from Burlington
who led an unsuccessful bid to block the fee when it came up during budget deliberations,
has filed new legislation to repeal it. "There's a misconception out there that the
people who are paying this fee are rich," he said. "That's just not true."
Opponents say the fee unfairly penalizes those individuals
who have refused to hide their assets and planned for an extended nursing home stay by buying
long-term care insurance or simply socking away their money.
"They are taxing the people who have scrimped and saved,"
said Maryellen Anastasia of Plymouth, who has power of attorney for a nursing home resident.
Steve Graham of Woburn, who is paying for his wife's stay in
a Lexington nursing home, warns that the new fee will deplete patient assets even faster,
accelerating the number of people on Medicaid. "It's absolutely ridiculous," he
said.
State officials and Corrigan acknowledge the fee imposes an
additional financial burden on so-called private pay nursing home patients, but they say most of
those patients will see a benefit as their nursing homes are able to pay staff
more and remain in business. (The exception is those private-pay patients at
the handful of nursing homes that don't take Medicaid patients; they won't see
any benefit from paying the new fee.)
"Private-pay residents by definition have the ability to
pay," Corrigan said. "It isn't necessarily fair, but when you're talking about a system where 80 percent
of the system is publicly financed by Medicaid and Medicare, how are we going
to fund the system?"
Guy Kern, whose stepmother is at St. Joseph's Manor, answers
that question by saying the state should cut elsewhere. He is refusing to pay the nursing
home user fee and considering moving his stepmother out of state if she is
evicted.
Kern is convinced the state is exploiting a voiceless
population. "Who represents the elderly and infirm who don't vote anymore?" he asks. "It's just
an unconscionable thing."
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The Worcester Telegram & Gazette
Thursday, January 23, 2003
SPENCER -- The closed-door meetings held by Lt. Gov. Kerry
Murphy Healey with local officials in recent days about looming local aid cuts are private, and
the public and the press are not welcome.
A spokeswoman for Ms. Healey yesterday defended the practice
as important for an "open and frank discussion."
Nicole St. Peter, deputy press secretary for the governor's
office, said yesterday, "That has been our policy. So the lieutenant governor can listen to
the ideas of public officials in a free-flowing manner, we have requested that
they be private."
While the predicted flood of red ink in state and local
budgets is a priority topic for officials waiting for budget axes to fall, solutions being offered by local
officials are occurring in the private sessions.
One such meeting was held Friday in Spencer, raising a
question as to whether that session may have violated the state Open Meeting Law.
A Spencer resident and a reporter were told they would not
be allowed access to that afternoon meeting, which was attended by numerous area town officials
and a majority of the Spencer Board of Selectmen.
The Telegram & Gazette this week filed a complaint with the
Worcester district attorney seeking a ruling on whether the session violated the Open Meeting
Law.
The law requires all meetings of governmental bodies be open
to the public. The exemptions to the law that allow executive sessions did not appear to
apply in this case; no exemption was cited by Spencer officials, and no vote was
taken to hold a closed-door session, according to at least one area town
official who attended.
A Spencer resident also has filed a complaint charging the
meeting violated the Open Meeting Law. Timothy A. Leahy, president of the
Spencer Taxpayers Association, said yesterday that Spencer Town Administrator Carter Terenzini
told him he would be barred from the meeting.
"Carter told me he would have me physically removed from
town property if I were anywhere near town property," Mr. Leahy said.
As a result of the warning, Mr. Leahy said, he did not
attempt to enter Town Hall. Had anyone tried to get inside the locked building, they would have
encountered uniformed police at a side door.
"There has been no effort to go around any public meeting
law. That is not the point. The point is to have a frank, open discussion," Ms. St. Peter said.
At a time when important public issues are being discussed
by town and state officials about the state's fiscal health, Mr. Leahy said, the meeting should have
been open to the public.
So far, Ms. Healey has met with officials of about 50
communities in small meetings, many of them described by Ms. St. Peter as "one-on-one" meetings.
In most of the meetings, Ms. Healey has met with a small group of town
officials, usually a mayor or town manager, "an occasional school superintendent or a police chief," Ms. St. Peter said.
"Spencer was not typical of the meetings she has had," Ms.
St. Peter said.
According to Ms. St. Peter, Mr. Terenzini told Ms. Healey's
staff "there would be just three people at the meeting; himself, one selectperson and the finance
chair."
She added, "So that is all we were expecting when we
arrived. She (Ms. Healey) knew there were selectpeople there and she did not realize there was a
quorum. She had no way of knowing there was a quorum there."
Ms. St. Peter said Ms. Healey had no intention of participating in a meeting that
could violate the law. "She knows the rules of the public meeting law. She
respects that," Ms. St. Peter said.
However, she noted, Ms. Healey was happy to meet with as
many local officials as possible to get ideas about how to deal with the state's financial problems.
Many of the ideas Ms. Healey is hearing from local officials
may well play a role in a legislative package, scheduled to be released Monday, on ways to help
cities and towns cope with the loss of millions of dollars in state aid.
Mr. Terenzini this week asserted the session did not violate
the Open Meeting Law, despite the quorum of Spencer Board of Selectmen present.
He has characterized the session as "his meeting" and as a
"staff meeting," and that he can invite anyone he wishes to his meetings.
He denied the session violated the Open Meeting Law.
Nearly 30 local and state officials attended the Spencer
meeting, according to a list of attendees released by Mr. Terenzini.
Spencer selectmen who attended the session were Peter J.
Adams, chairman, Gary P. Herl, John T. Gagnon and Gerald Robertson. The session was opened
by Mr. Adams, who told the group, "The town of Spencer will offer preliminary
recommendations to the lieutenant governor, which we believe will help
municipalities lessen the impact of aid reductions."
He added, "We stand ready to foster this meaningful dialogue
on both a local and regional basis."
Mr. Terenzini also told Ms. Healey about the financial
challenge the state and towns will face in dealing with budget cuts. He suggested taking a look at
Proposition 2½ to determine whether changes are in order to help the state
and communities deal with "this extraordinary fiscal crisis."
An eight-page list of "General Comments," "Actions for FY
2004" and "Longer-Term Actions" was detailed for Ms. Healey. In the documents,
numerous and specific references are made to Spencer's financial issues and
Spencer's requests for relief from state mandates.
For example; Spencer's recent increase in Chapter 70 aid was
offset by reductions in Chapter 80 distribution; a request to relieve the town of its
obligation to expend $25,000 on library books this year; permission to be
relieved of obligations to spend $271,000 on school professional development,
and relief from new DEP mandates that could increase Spencer's costs.
The town provided a copy of the comments and report to the
newspaper after the meeting, and Ms. Healey made herself available after the meeting to talk to
a Telegram & Gazette reporter.
Meanwhile, Ms. Healey's meetings continued yesterday in
Shrewsbury and Yarmouth.
In the Shrewsbury meeting, Town Manager Daniel Morgado
attended, along with Thomas Fiore, chairman of the Board of Selectmen, and School
Superintendent Anthony Bent. Westboro Town Coordinator Henry Danis also
attended with two of that town's five selectmen. The session also was private,
the officials said.
Ms. Healey is scheduled to attend a session today in
Bridgewater, Seekonk and Plymouth. A meeting slated to be held in Paxton tomorrow has been postponed
until 1 p.m Jan. 31.
Return to top
The MetroWest Daily News
Sunday, January 26, 2003
State wants a piece of your tax-savings
By Tom Moroney
Now here's an optimistic public servant for you: "I believe
the citizens of Massachusetts are honest people."
The line belongs to Alan LeBovidge, head of the state
Department of Revenue. He's a man with a plan that seems -- how does one say this? -- utterly
ridiculous.
LeBovidge unveils a brand new line in this year's state
income tax form. It is line 33, and it asks you, the taxpayer, to cough up a "use tax" on all those items
you purchased out of state.
Remember those caffeine-powered runs up to the malls of New
Hampshire for the big-screen TV, the DVD player, the assorted back-to-school clothes?
Remember how it felt so good when the clerk was ringing them
up and you smiled because there was no sales tax? And you said to yourself: At last, I come
out on top. Me! After all those years of losing, I win one!
In fact, that's why you went to stupid New Hampshire in the
first place. It certainly wasn't for the culture or scenery, unless your idea of a classy roadside
attraction is a field full of cows and eight or nine rusty barrels.
Well, Mr. LeBovidge and crew want a piece of the action. He
wants you and me to total up all those items we bought in New Hampshire, over the Internet and
on that trip overseas, charge ourselves the 5 percent and then declare that
unpaid amount on line 33.
The man has a better chance of seeing me doing a bungee jump
off the Pru.
He does have history on his side. This state passed its
sales tax in 1967. And in order to prevent droves of consumers from making their purchases out of
state, thereby saving themselves the surcharge here, the law also called for the
"use tax."
No one has drawn all that much attention to it, until now.
As the commissioner points out, we could use the extra money
in these difficult times.
Another point: Corporations have been quite dutiful in
paying their use taxes, placing as much as $10 million into the state coffers in any given year.
Why is that? I asked.
"Because we audit them," said the commish.
My point exactly. As long as we, the individual taxpayers,
are free to be dishonest, guess what?
But it's more than dishonesty that drives us. There is a
genuine thrill in running up to New Hampshire to beat the 5 percent.
To use the vernacular of those psycho-babble kooks you see
on daytime television, it empowers us. It gives us one small corner of our tax-happy world
that does not demand more, more and more.
"I'm not trying to bring in zillions of dollars," the
commish was trying to tell me. "I simply want to educate people."
If only I could believe that. The truth is, this new line in
our tax forms looks to be only the beginning of our troubles.
For the first time, as you prepare your taxes in the next
weeks and months, the Department of Revenue is also using lists that have been made up by U.S.
Customs, showing which Massachusetts residents bought which items overseas, when they
bought them, and how much they paid.
"For example, if you go to London and buy your wife a nice
piece of jewelry, you should pay a use tax on that," he said.
Starting now, people who buy any item overseas for a value
of $5,000 or more and do not voluntarily pay the use tax will get a letter from Mr. LeBovidge's
crew.
There's more. A consortium of businesses that trades on the
Web has approached our revenue department. The group has volunteered to provide
the department with lists of Massachusetts people who have purchased products in cyberspace
and have failed to pay the use tax.
A record of that Dell computer you bought for the family
this Christmas, over the Internet, the one you never paid a sales tax on, could be heading straight
for those vampires at the main office as we speak.
Doesn't it just make you feel warm all over?
It reminds me of the legendary story told about Massachusetts years ago when
the bureaucrats here decided to clamp down on the Massachusetts citizens who
drove to New Hampshire to do their shopping.
Massachusetts was planning to post state troopers at the
border and in parking lots of stores up there in order to find people who were trying to avoid the use
tax.
In response, the cranky New Hampshire Gov. Meldrim Thompson,
who has since passed away, rose to the occasion with unusual clarity.
He said if those Massachusetts troopers wandered north to
spy on shoppers, he'd have them arrested.
Beautiful.
