CLT UPDATE
Monday, March 8, 2010
Obscene self-paying nursing home bed tax
accelerates -- as expected
Judy, 65, went to live at Sunny Acres Nursing and
Rehabilitation Center in Chelmsford in November. Bob, a retired
elementary school teacher, has been cutting deep into his
savings to keep Judy comfortable in a private room, costing $340
a day.
Until January, when the nursing-home bed tax jumped from $11.59
a day to $19.17 per day -- adding hundreds to his monthly bill.
Despite the soaring tax increase, the state slashed federal
Medicaid reimbursement to nursing homes by about $23 million
this year, leaving many elder-care facilities unable to cover
the costs of daily care and forcing some self-pay patients into
the Medicaid system....
Enacted in Massachusetts in 2002, the "nursing home user fee
program" began taking money from an estimated 8,000 nursing-home
patients who pay for their own care, and used it to help foot
the bill for all Medicare patients in the system.
The private-payer money was used to leverage federal tax dollars
to shore up the state's ailing nursing-home system, including
strengthening a largely underpaid, underdeveloped work force and
conducting major repairs on several neglected facilities....
The state assesses each nursing home $19.17 a day for each
non-Medicare patient, generating an estimated $220 million. In
the past, the state took about $145 million raised from the user
fee, doubled it and funneled it all into nursing homes
throughout the Medicaid program. Since the federal government
pays half of Medicaid expenditures, the state was reimbursed
$145 million.
On a net basis, nursing homes received an infusion of $145
million from federal taxpayers and those nursing-home patients
paying for their own care. And the state pays nothing more.
Last September, the state increased the user fee by $75 million.
But unlike the previous program, Gov. Deval Patrick's budget
failed to fully pay the fee for Medicaid residents, Plumb said.
Basically, out of the $19.17 bed tax, only $15 comes back into
the system. This means nursing homes are falling back to the
levels they were at in 2002, before the patient bed tax was
instituted.
"Our position here, is we came up with a way to improve care in
nursing homes and it worked," Plumb said. "Now it's in danger.
The fee was raised but the state decided to use a portion of it
and apply it elsewhere to solve their budget problem. Now we're
worried the result will be another decline in services and more
nursing homes closing."
The Lowell Sun
Sunday, March 7, 2010
State increase in rates leaves patients in dire straits
A newly raised nursing home user fee has
prompted facilities to switch out cheaper alternatives for
juices, use powdered eggs and cut activities for residents,
health care worker union leaders told lawmakers Tuesday.
State House News Service
Tuesday, January 12, 2010
'Bed tax' said to cut activities, diet options for nursing home
dwellers
I am writing to urge that you take swift and
favorable action on Senate Bill 305, An Act to Repeal the
Nursing Home Tax, which is currently pending before the Joint
Committee on Elder Affairs.
The nursing home tax - which was first implemented as part of
the Fiscal Year 2003 state budget - constitutes an onerous
penalty that unfairly targets those individuals who had the
foresight to plan ahead and save for their long-term health care
needs. Those who privately pay for their nursing home care and
don't have to rely on the state for assistance should not be
penalized by having to pay a tax....
Letter to the Joint Committee on Elder Affairs
Monday, March 8, 2010
from Richard R. Tisei, State Senator
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Chip Ford's CLT Commentary
In 2002, the proposed
state budget for 2003 contained a new "fee." This was part of the
largest tax increase in state history which included "temporarily
freezing" the voters' 2000 mandate to roll back the income tax to 5
percent at 5.3 percent (where it remains, eight years later).
This new "fee" was outrageous -- charging patients for being
responsible enough to pay their own cost for a nursing home stay.
This was outrageous, despicable.
Despicable because
those citizens had set aside their own money to pay for
their own care, should they need it.
Despicable because now
the state intended to penalize them for foregoing other things they
could have spent that money on over their lives.
We have been fighting
to repeal this despicable assault ever since, but incredibly this
abomination still exists. Incredibly, those who responsibly take
care of themselves and their loved ones are penalized by the state,
forced to pay for Medicaid patients who the state can't afford.
Only in Taxachusetts.
Anyone for ObamaCare
next, raise your hand, shout "Amen!"
When this
unconstitutional "fee" was imposed, it was for a daily amount of
$9.70 -- to get the camel's nose under the tent. Governor Patrick
just jacked it up by 65.4 percent -- to $19.17 every day --
$575 a month -- $6,900 each year for paying your own way!
Boy, do I ever wish CLT
had the funds to again challenge unconstitutional fees -- the
insidious stealth taxes of today and the future!
The small Republican
caucus in the Legislature is making a renewed effort to repeal this
abomination. In response to the active discussion ongoing on
the conservative blog
RedMassGroup, state Senator and Republican candidate for
Lieutenant Governor, Richard Tisei, has responded today.
For
historical information see:
The Salem Evening News
June 14, 2002
'Dear Dad: You were right about the hazards of living in Mass.'
by Barbara Anderson
The Salem Evening News
July 9, 2002
Nursing home bed tax just another Beacon Hill scam
by Barbara Anderson
The Salem News
March 7, 2003
Romney calls them 'fees,' but for most they feel like a tax
by Barbara Anderson
The Salem News
May 30, 2003
Taxpayers should beware the latest in legislative fashion
by Barbara Anderson
CLT's bills filed for the 2005- ‘06 session
November 29, 2004
3. Repeal of nursing home tax
Title: AN ACT REPEALING THE NURSING HOME TAX
Theme: It’s not a fee unless you get something extra for paying it.
Summary: The nursing home tax was passed in 2002 as part of the
biggest tax hike in state history. The law says that nursing homes
must pay a “fee” to the state for each non-Medicaid patient, to
bring in $145 million a year. But nursing homes pass it on to
patients who are self-payers, thereby forcing these non-Medicaid
patients to pay even more of their own savings. Yet they get no
services for the “fee” that the Medicaid patient in the next bed
doesn’t get, so it is not a true user fee (under the state Supreme
Judicial Court’s ruling in Emerson vs. City of Boston, 1984). The
CLT bill repeals the unconstitutional “fee.”
NEWS RELEASE
November 30, 2004
Legislation filed by and for Citizens for Limited Taxation
for the 2005-06 legislative session
CLT UPDATE
May 25, 2006
State Senate unanimously backhands taxpayers, voters
"... We thought we had a chance to repeal the despicable nursing
home tax, amendment #16, because we had bi-partisan support. So the
Senate leadership "consolidated" our amendment into a clump of other
amendments it doesn’t support, and none of them will be debated at
all, ever see the light of day either...."
SENATE, No. 378
AN ACT TO REPEAL THE NURSING HOME TAX
By Mr. Brown, a petition (accompanied by bill, Senate, No. 378) of
Scott P. Brown, Francis J. Faulkner, by Citizens for Limited
Taxation, Brian P. Lees, Richard R. Tisei and other members of the
General Court for legislation to repeal the nursing home tax. Elder
Affairs
AN ACT TO REPEAL THE NURSING HOME TAX
Be it enacted by the Senate and House of Representatives in General
Court assembled, and by the authority of the same, as follows:
SECTION 1.
Section 25 of Chapter 118G of the General Laws, as added by Section
101 of Chapter 184 of the Acts of 2002 is hereby repealed.
http://www.mass.gov/legis/bills/senate/186/st00pdf/st00312.pdf
http://www.mass.gov/legis/bills/senate/186/st00pdf/st00312.pdf
The state charges
nursing home self-payer patients now $19.17 per day (up from $9.70
when it first got it's big foot in the door, 65 percent more than just
this past January when the "fee" had crept up to $11.59 a day).
Then the state dumps
SOME of that confiscated revenue from "the most vulnerable among us"
back onto nursing homes to keep them afloat, even doubles that
amount temporarily from state's general fund, expecting to be
reimbursed.
Then, thanks to federal
Medicare and Medicaid reimbursements, that doubled state expenditure
-- minus the state's vig on the fee ($75 million last year that went
into the general fund,
according to the Lowell Sun report). Medicaid reimburses the state for HALF of its (on
paper) total expenditure.
$75 million from that
alleged "fee" went into the state's general fund -- an
unconstitutional fee by definition.
That total state
expenditure is padded by the self-payer tax -- it is NOT a
fee, for there are no specific additional services provided
in exchange for the cost. [See:
Emerson
vs. Boston, 1984]
How much longer can
this rip-off go on?
Had enough yet?
Your time is coming
too!
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Chip Ford |
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The Lowell Sun
Sunday, March 7, 2010
State increase in rates leaves patients in dire straits
By Rita Savard
Judy DiPalma of Wilmington, a resident at Sunny Acres Nursing and
Rehabilitation Center in Chelmsford, says a bed tax imposed by the
state will mean she can no longer afford a private room. SUN/Tory
Germann
It's the first thing she sees when she opens her eyes in the
morning. Her best memory.
It takes her back home.
Judy, and her husband, Bob DiPalma, never believed this would happen
to them. But when an illness began taking control of Judy's body,
Bob was no longer able to give his wife the 24/7 medical care she
required. The couple faced a hard choice.
"It was an awful decision," Bob said. "One we never imagined we'd
have to make."
Judy, 65, went to live at Sunny Acres Nursing and Rehabilitation
Center in Chelmsford in November. Bob, a retired elementary school
teacher, has been cutting deep into his savings to keep Judy
comfortable in a private room, costing $340 a day.
Until January, when the nursing-home bed tax jumped from $11.59 a
day to $19.17 per day -- adding hundreds to his monthly bill.
Despite the soaring tax increase, the state slashed federal Medicaid
reimbursement to nursing homes by about $23 million this year,
leaving many elder-care facilities unable to cover the costs of
daily care and forcing some self-pay patients into the Medicaid
system.
Bob said his limited savings would not have kept Judy in the private
pay system for the rest of her life, but the increased bed tax
leaves the couple no choice but to place Judy into the Medicaid
rolls sooner, and into a smaller room where she'll have one or more
roommates.
"I'm paying for my wife's care and by doing that, I'm saving the
state a lot of money," Bob said. "In return, the state has penalized
me for doing that by taking my money for my wife's care and putting
it in a place that doesn't benefit my wife at all."
About 80 percent of the nursing home system is publicly financed by
Medicaid and Medicare. The "nursing home user fee," or patient bed
tax, was implemented by the state to save millions in annual
Medicaid costs.
Enacted in Massachusetts in 2002, the "nursing home user fee
program" began taking money from an estimated 8,000 nursing-home
patients who pay for their own care, and used it to help foot the
bill for all Medicare patients in the system.
The private-payer money was used to leverage federal tax dollars to
shore up the state's ailing nursing-home system, including
strengthening a largely underpaid, underdeveloped work force and
conducting major repairs on several neglected facilities. Before the
tax, an average of 20 to 30 nursing homes were closing annually from
1998 to 2002, according to Scott Plumb, senior vice president of the
Massachusetts Senior Care Association.
The fee, Plumb said, wasn't an ideal solution to the problem, but it
helped turn around a nursing home system that was in "dire straits."
Here's how it works:
The state assesses each nursing home $19.17 a day for each
non-Medicare patient, generating an estimated $220 million. In the
past, the state took about $145 million raised from the user fee,
doubled it and funneled it all into nursing homes throughout the
Medicaid program. Since the federal government pays half of Medicaid
expenditures, the state was reimbursed $145 million.
On a net basis, nursing homes received an infusion of $145 million
from federal taxpayers and those nursing-home patients paying for
their own care. And the state pays nothing more.
Last September, the state increased the user fee by $75 million. But
unlike the previous program, Gov. Deval Patrick's budget failed to
fully pay the fee for Medicaid residents, Plumb said.
Basically, out of the $19.17 bed tax, only $15 comes back into the
system. This means nursing homes are falling back to the levels they
were at in 2002, before the patient bed tax was instituted.
"Our position here, is we came up with a way to improve care in
nursing homes and it worked," Plumb said. "Now it's in danger. The
fee was raised but the state decided to use a portion of it and
apply it elsewhere to solve their budget problem. Now we're worried
the result will be another decline in services and more nursing
homes closing."
The state's Department of Health and Human Services, which was
contacted Monday, was unable to supply the information requested on
the nursing-home user fee before deadline. Spokeswoman Cayenne
Isaksen said the information request was taking longer than usual to
compile. Calls to the governor's office were also not returned
Friday.
State Sen. Susan Fargo, D-Lincoln, who voted against the user fee in
2002, said she was "horrified" to hear the fee increased by nearly
$8 in the wake of less Medicaid reimbursement.
"The real story is that everyone gets the money back except those
people who pay their own way without relying on government
programs," Fargo said. "By adopting this policy, it made our budget
better but it's hurting the people who were singled out to bear the
brunt of this tax."
Fargo said she also wrote legislation to have the user fee studied
to measure long-term effects on the state's nursing-home system. But
former acting Gov. Jane Swift vetoed it, Fargo said.
By the end of the summer, DiPalma anticipates his retirement fund
will be virtually depleted due to Judy's health-care costs. He
worries about how she'll fare in a smaller room, bunking with a
stranger, away from the comforts of home after 44 years of marriage.
Judy doesn't worry as much.
"Bob's the greatest," she said. "I've just been so lucky to have
married my best friend. He takes really good care of me."
Bob visits Judy daily and on Sundays, he takes her home.
"I hate bringing her back to the nursing home, even though the staff
is wonderful here," Bob said. "It really tears me up. I wish she
could stay with me."
Bob said a Senate bill under consideration that could change the
course of the user fee, but if it ever does pass, it will be too
late for Judy. Still, he vows to continue making calls and writing
his legislators. There will be other couples, he said, that will
find themselves someday standing at the same crossroads.
Wherever Judy ends up at the end of the summer, when she joins the
legions of seniors on Medicare, she'll still wake up to a
black-and-white photo of her and Bob smiling on their wedding day.
And she said she'll find home.
State House News Service
Tuesday, January 12, 2010
'Bed tax' said to cut activities, diet options for nursing home
dwellers
A newly raised nursing home user fee has prompted facilities to
switch out cheaper alternatives for juices, use powdered eggs and
cut activities for residents, health care worker union leaders told
lawmakers Tuesday.
The average nursing home had to find about $100,000 to pay the tax,
prompting cutbacks, missed payroll payments, and rate hikes, said
SEIU 1199 vice president Enid Eckstein.
Eckstein recalled taking Elder Affairs Committee co-chair Sen.
Patricia Jehlen on a tour of one nursing home. "She asked me why so
many people were sitting waiting for activities. It's because
they've seen cuts in activity aides," Eckstein said.
Pushing lawmakers to create a special commission on nursing homes (S
306), she said the new $75 million levy, part of a slew of
budget-balancing revenue measures, has forced nursing home
administrators into a corner of bad decisions.
"I wouldn't want to be in their shoes," she said of nursing home
administrators, adding, "We believe the nursing home user fee has
created a crisis for nursing homes."
SEIU 1199 wants next year's fiscal budget to boost MassHealth
reimbursement rates and said the money from the elevated "bed tax"
should be used to increase a pay-for-performance programs at nursing
homes.
Rep. James Miceli, a Democrat on the Elder Affairs Committee, used
the occasion to take a swing at the University of Massachusetts,
citing the school's effort to expand by adding a law school and the
Bayside Exposition Center as a misuse of state funds.
"We've got an out of control president at UMass," Miceli said,
equating the shortfalls at nursing homes to the prospective use of
state funds for the school's expansion. An administration official
said Patrick's long-term care financing advisory committee would
issue a report in the spring making recommendations for improved
financing mechanisms.
The following is the text of Senator
Tisei's
letter:
March 8, 2010
The Honorable Patricia D. Jehlen, Senate Chair
The Honorable Alice K. Wolf, House Chair
Joint Committee on Elder Affairs
State House, Room 167
Boston, MA 02133
Dear Chairwoman Jehlen & Chairwoman Wolf:
I am writing to urge that you take swift and favorable action on
Senate Bill 305, An Act to Repeal the Nursing Home Tax, which is
currently pending before the Joint Committee on Elder Affairs.
The nursing home tax - which was first implemented as part of the
Fiscal Year 2003 state budget - constitutes an onerous penalty that
unfairly targets those individuals who had the foresight to plan
ahead and save for their long-term health care needs. Those who
privately pay for their nursing home care and don't have to rely on
the state for assistance should not be penalized by having to pay a
tax.
When the nursing home tax was first introduced, non-Medicare
patients were being assessed $9.60 a day. Now they are being charged
$19.17 a day, nearly double the original assessment. To charge
private-pay patients an additional $575 a month is not only unfair,
but counterproductive, and places an unnecessary financial burden on
our seniors and their families.
The Lowell Sun recently reported that only $15 of the $19.17
collected actually finds its way back into the system. The rest is
being used by the Patrick Administration to help balance the state
budget, and not for its original purpose of helping nursing homes
remain financially solvent.
I have opposed the nursing home tax as bad public policy since its
inception, and have been actively working for its repeal ever since.
The Senate Republican Caucus has offered a series of repeal bills
and budget amendments in each of the last four legislative sessions,
and is prepared to raise this issue again during the upcoming budget
debate if the committee fails to act in a timely manner.
As a member of the Elder Affairs Committee, I am urging you to
expedite the bill's release from the committee with a favorable
report. Doing so will allow the House and Senate to begin the
process of repealing this misguided tax once and for all.
Sincerely,
Richard R. Tisei
STATE SENATOR
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Citizens for Limited Taxation ▪
PO Box 1147 ▪ Marblehead, MA 01945
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