Saving CCP: Budget reforms preserve benefits for elderly residents in need
Gov. Bruce Rauner’s recent actions highlight the need for change in the Illinois Department of Aging’s largest program.
Gov. Bruce Rauner is working to hold the line on state government spending. When he delivered his budget proposal to the Illinois General Assembly earlier this year, he proposed keeping the budget at just under $32 billion from general revenue funds – or about $62 billion when all funds are considered.
The total tax burden per man, woman and child in Illinois to support the governor’s proposed budget is about $2,500 in general revenue funds or more than $4,800 for all funds. For a family of four, that is nearly $10,000 in general revenue funds and more than $19,250 for all funds.
Despite this, legislative leaders want to spend another $4 billion in general revenue funds above and beyond what the state is expected to rake in from existing taxes. Thus far, they’ve failed to send Rauner a balanced budget and have set the stage for a government shutdown as early as July.
On June 2, the governor provided a list of executive actions he is taking to help Illinois live within its means in the face of this uncertainly. On that list are two action items to help bring down the cost of the Community Care Program, or CCP, in the Department of Aging. Higher-income seniors, as well as those with less need for care, would be asked to forgo services.
Both are reasonable reforms that ensure assistance is targeted to the elderly Illinoisans who need it most.
What is the Community Care Program?
The Community Care Program is a well-intentioned program that helps seniors needing various levels of care stay in their homes instead of entering nursing homes, which are more expensive.
Totaling nearly $1 billion, CCP is the most expensive program in the Department of Aging. The program takes up 93 percent of the department’s general revenue budget and 85 percent of its overall budget, according to the department. This program’s budget has nearly quadrupled over the past 10 years.
CCP serves about 76,000 seniors each month and provides adult day services, emergency home response services and in-home services.
First reform: Means test
In order to qualify for CCP, one has to be at least 60 years old, a U.S. resident or legal alien, and a resident of Illinois. Surprisingly, there is currently no income test to qualify for the program. This is one of the action items the governor is pursuing.
While a person cannot have assets in excess of $17,500, there is a list of exemptions that are not counted as assets. These include the homestead property, clothing and personal effects, household furnishings, business and farming equipment, motor vehicles other than recreational vehicles, and certain financial and assistance payments.
Most welfare assistance programs have income tests, and adding an income test to CCP will bring the program in line with those other programs and help ensure the benefits are going to the people who need them most.
Second reform: Needs assessment
To qualify for the Community Care Program, a senior has to be assessed to determine whether he or she truly needs assistance with daily living activities. This assessment evaluates a person’s ability to perform activities of daily living – such as eating, bathing, dressing – and instrumental activities of daily living – such as preparing meals, telephoning and managing money. The higher the score, the greater the need.
The governor’s second action item is to raise the required determination-of-need score to qualify for the program. This change will help ensure that the program is targeting those seniors who need the most help in daily activities of living.
What else can be done
Both establishing an income eligibility test and raising the required determination-of-need score appear to be common-sense steps that will help Illinois live within its means.
However, more work can be done to save the program for those who need it the most. One way for lawmakers to lower costs would be to expand eligibility requirements to include consideration of the ability of family members to care for their elderly loved ones. Also, the General Assembly may consider enacting incentives for persons to purchase insurance policies to cover long-term care needs that ultimately will reduce program demand. Further, both the Rauner administration and the General Assembly should explore ways to have the services more efficiently delivered.
The Department of Aging should also erect additional safeguards against waste in the program. A 2015 report from the Illinois Auditor General found the department paid over $320,000 for CCP services rendered to deceased individuals and nearly $40,000 for services to incarcerated individuals in fiscal year 2014.
Finally, provider unit costs and client fees ought to be reviewed. For example, clients with income above the poverty level now pay a fee based on a formula in the Administrative Code. This formula can be adjusted so that better-off clients pay for a greater share of their living-assistance costs than they do now.
Inaction comes with consequences
The disruption caused by these last-minute changes would have been entirely preventable had House Speaker Mike Madigan and Senate President John Cullerton done their jobs properly in managing the state budget during their 80 combined years in the General Assembly. The impact of Rauner’s budgetary mitigation lies at their feet.