Cumberland County has implemented a wait list for its Aging Options program as of July 1, due to demand for senior in-home assistance programs outstripping funding provided by the state.
Aging Options, a program common among Pennsylvania’s local offices of aging, assists with in-home care for just over 380 senior citizens in Cumberland County, according to Sandy Gurreri, director of the county’s Department of Aging and Community Services.
Despite increased need for the program, funding, which mostly comes from the state lottery, has been rather static, with the existing cash pool hobbled by a hold-harmless clause and any new funding at the whim of the Legislature.
Of the state’s 52 local agencies on aging — some serve more than one county — 33 have implemented wait lists due to shortfalls, Gurreri said.
The issue dates back to a long-simmering debate about use of lottery funds. Over the past 10 years, increasing portions of lottery proceeds have gone to covering the state’s share of Medicaid payments for long-term senior care.
While this falls within the Lottery’s advertised mission of helping Pennsylvania’s seniors, critics argue that the Lottery was intended to help keep seniors in their homes, and that the state should be covering its Medicaid nursing home obligations using general fund dollars, as was done prior to 2006.
“As you divert funds away from the lottery to fund programs that were previously funded through the general fund, things become harder and harder,” Cumberland County Commissioner Jim Hertzler said.
In the 2018-19 state budget year, Cumberland County got just under $2.27 million in what the Pennsylvania Department of Aging calls “regular” block grant funding, which can be used for a variety of programs, including Aging Options.
This funding level, for all 52 local aging offices in the state, has been flat for many years. According to Troy Celesky with the Pennsylvania Department of Aging, the reason is that this block grant funding is subject to a “hold harmless” clause that mandates that an agency cannot receive less funding in a given year than it received the year before.
This is the same clause that has caused long-standing issues with state education aid to local school districts. If additional funding is given to an agency, and that agency subsequently has a decrease in enrollment or population served, the state can’t take money back, and is thus legally required to over-fund the agency indefinitely.
To avoid this, Celesky said, the state has created new budget line items for additional local aging funding. Unlike the block grant, these are not bound by hold harmless clauses.
In 2013-14, a dedicated grant item for Aging Options was added, with funding phased in over three fiscal years. Cumberland County receives $433,706 from this account, according to state Department of Aging budget documents.
“Everybody says the block grant has been flat, and it is because of the hold harmless provision, but when we have these other funding sources we can try to make that right,” Celesky said.
However, those items have been virtually unchanged since the 2015-16 budget cycle.
The latest addition is a line item for protective services funding to help seniors who may be in danger of abuse or fraud. Cumberland County received $38,000 out of a roughly $2.17 million statewide funding pool for protective services, demand for which is rising sharply, Hertzler said.
The Aging Options program pays for in-home care providers to help seniors with tasks such as meal preparation, laundry, errands and other chores.
The assistance is intended to help keep seniors in their homes rather than going into a nursing facility, although it can’t totally replace help from friends and family for those with major health or mobility issues, Gurreri said. Aging Options delivers a maximum of about eight hours per week of in-home aid.
The matter of keeping seniors in their homes is the dividing issue when it comes to the debate of how Lottery funding should be apportioned.
Hertzler isn’t the only one who has criticized the state’s use of Lottery money for Medicaid to free up general fund dollars in the state budget.
The AARP, during the Corbett administration’s interest in privatizing the lottery system, complained that the state is “using lottery funding as a crutch to address runaway costs of nursing home care in the state Medicaid program.”
The Lottery fund, for the first time, picked up $210 million in Medicaid long-term care in the 2006-07 budget. At that time, the expense was under the state Department of Aging. But with the implementation of managed care programs for Medicaid in Pennsylvania, the expense has been shifted to the Department of Human Services.
The lottery fund is scheduled to pay out $397 million in managed care payments for long-term living under the 2019-20 DHS budget.
The Lottery generates over $1 billion per year in funding for state services, according to the Pennsylvania Lottery.