New Child Care Administration Supervisor The Department requested $0.1 million for new supervisor position for FY 2014, consistent with the revised request This includes $49,788 from

both general revenues and federal funds and assumes the position will be vacant for 10 percent of the year. The revised request assumes the position will be filled in FY 2013, though the position remained vacant as of December 7, 2012. The Governor recommended funding as requested. The Assembly did not include authorization or funding for the new position.

Child Care Administration - All Other Staffing. The Department requested $1.6 million from all funds for salary and benefit expenses for child care administration. The request includes $0.8 million from both general revenues and federal funds, and is $0.1 million more than enacted, including $3,055 less from general revenues and $83,663 more from federal funds. The request includes $85,000 for

the InRhodes contract, which is $42,721 more than enacted and $189,000 for postage and printing, which is $85,500 more than enacted. It includes the enacted level of $1.7 million for grant expenditures, $70,000 for interpreters and translators, $81,281 for other contracted management consultants and includes $3,875 for all other administrative expenses, which is $58,619 less than enacted. The Governor’s recommendation is $61,891 more from federal funds than requested, including $55,285 for audit fees and office supplies and $6,606 in statewide savings from federal sources shifted to miscellaneous operating expenses. The Assembly concurred.

SSI Supplemental Payment Administration. The Department requested $859,749 from general revenues, which is $15,234 more than enacted, for administering the state supplemental security income program for individuals whose income is too high to meet the eligibility criteria for the federal supplemental security income program. This includes $305,249 for 3.0 full-time equivalent positions, which is $35,735 more than enacted. Consistent with the revised request, increased expenditures include $5,000 for overtime, which was not included in the enacted budget, and filling a supervisory position in FY 2013. The request assumes the three positions are fully funded with benefit rates consistent with Budget Office instructions for FY 2014. The request includes $302,500 for operational expenditures, including $100,000 for the InRhodes eligibility system, which is $20,501 less than enacted, and the enacted levels of $105,500 for mail and bank processing expenses, $65,000 for office supplies, $12,000 for printing, $10,000 for legal expenses, and $10,000 for lease costs related to the field offices. The request utilizes savings in operating expenditures towards the additional staffing expenses. The Governor’s recommendation is $2,402 less than requested to reflect statewide benefits savings. The Assembly concurred.

Division of Veterans’ Affairs

Veterans’ Affairs – Staffing. The Department requested $23.9 million from all funds for salaries and benefits for 238.6 positions, including $17.4 million from general revenues and $6.5 million from federal funds. The request is $1.2 million more than enacted, including $1.4 million more from general revenues and 0.6 full-time equivalent positions less than the enacted authorization. It includes benefit rates consistent with Budget Office planning values for FY 2014 and $1.0 million for overtime expenses, which is $0.3 million less than enacted and consistent with the revised request.

Consistent with the revised request, changes to the enacted budget include filling 8.0 positions and then backfilling 10.0 temporary positions in FY 2013, which will lead to savings from reduced nursing pool costs in FY 2014 while an assistant administrator was also hired in November 2012 to be the budget person. The request assumes the 9.0 new positions and 26.0 temporary positions will be filled before the start of FY 2014; however, subsequent to the request, the Department indicated construction delays would also delay the hiring of the 35.0 new positions until the first quarter of FY 2014.

The Department inadvertently excluded holiday pay for the employees who work at the 24-hour state- run Veterans’ Home and as a result its revised request is underfunded by $0.4 million from all sources, including $0.3 million from general revenues.

The Governor recommended $0.2 million more than requested, including $0.1 million more from general revenues. This includes $1.2 million more for overtime, for a total of $2.2 million for overtime costs and he added $0.4 million for holiday pay. The remaining reduction reflects $1.2 million from increasing turnover and $0.2 million from statewide benefit savings. The Assembly included additional general revenue turnover savings of $175,000.

revenues, $26,536 from federal funds and $0.8 million from restricted receipts. The request is $0.3 million more than enacted, including $0.3 million more from general revenues and $0.1 million less from restricted receipts. The request includes $0.5 million for pharmaceuticals, $0.5 million for medical services, $0.9 million for contracts for doctors, dentists and nurses and $65,000 for laboratory testing. The request also contains $0.9 million for food and food service contracts, $0.5 million for janitorial contracts and supplies, $0.2 million for maintenance and repairs of the buildings and equipment, $0.2 million for laundry services, $0.2 million for centralized state services and utility expenses, $0.1 million for information technology expenditures, and $0.8 million for all other expenses related to operations at the Veterans’ Home, including $60,000 for a new handicap van. The Governor recommended $0.4 million less than requested, including $0.2 million less from both general revenues and restricted receipts and $49,979 more from federal funds. The recommendation includes $0.3 million more from contracted nurses and reductions of $0.2 million for medical supplies and pharmaceuticals, $0.1 million for linen and laundry services, $0.1 million for building maintenance, $0.1 million for computer supplies and equipment and $0.3 million for other supplies and operating expenses. The Assembly concurred.

New Veterans’ Home Design. The Department requested $1.4 million from all sources, including $0.4 million from federal funds and $0.9 million from restricted receipts for architectural and engineering expenses related to a new Veterans’ Home. This is $1.1 million more than enacted and $0.6 million more than the capital budget request and changes the funding source from Rhode Island Capital Plan funds to federal and restricted sources. The enacted budget does not include any funding for planning or construction of a new Veterans’ Home. The Governor did not recommend any pay-go sources of funding in the Department’s operating budget for the new Home, but did include expenditures from general obligation bond proceeds for the new Home, beginning with $8.0 million in FY 2014. The Assembly concurred.

Veterans’ Cemetery. The Department requested $470,607 from all funds, including $385,607 from federal funds and $85,000 from restricted receipts for the Veterans’ Cemetery in Exeter. The request is $414,393 less than enacted from federal funds, reflecting delayed expenditures related to the federal National Cemetery Administration grant award for the repair and restoration of burial fields. The grant totals $1.3 million and the Department originally planned to spread the award equally over three years, beginning in FY 2012, though no funds have been spent through December 2012; the work will be done in conjunction with regular operations. The request also includes the enacted level of $85,000 for the purchase of four lawn mowers and two utility vehicles for maintenance services at the Cemetery through the Memorial Fund.

Subsequent to submitting the request, the Department indicated that there had been additional delays related to the National Cemetery Administration award. It indicated that only part of the $800,000 award allocated for FY 2013 would be spent in FY 2013 and the remainder would be spent in FY 2014, in addition to the FY 2014 allocation of $0.4 million; however, the amount was not yet known. The Governor recommended funding as requested. The Assembly concurred.

completion in FY 2013, but experienced delays. All projects are described in the Capital Budget Section of this publication.

The Governor’s recommendation is $0.7 million more than requested and includes $445,000 from federal funds for the columbarium and $0.3 million from restricted receipts for renovations at the Home that have been delayed from FY 2013 but will be completed in FY 2014. The Assembly concurred.

Division of Elderly Affairs

Pharmaceutical Assistance to the Elderly. The Department requested $390,647 from restricted receipts for the pharmaceutical assistance program for FY 2014, which is $46,256 less than enacted. The request includes $200,000 for rebates, which is $149,000 less than enacted, $100,000 for the contract to process point-of-sale discounts for program members that was not included in the enacted budget and $90,647 for salaries and benefits, which is $3,228 more than enacted. The request includes no funding for operating expenditures, eliminating the enacted level of $484 for these expenses.

For FY 2012 and FY 2013, the Department used the surplus restricted receipt rebate funds in lieu of general revenues; however, there is not sufficient funding in the restricted account for FY 2014 also, thus the current services estimate from the Budget Office includes restoring $264,298 from general revenues. The request does not include sufficient funding to operate the program, plus there are not sufficient restricted receipts available to cover the requested expenses in FY 2014. The request does not include general revenues in FY 2014 for this program; the general revenues included for the current services adjustment were used elsewhere in the request.

As part of its constrained request, the Department proposed eliminating the program, for restricted receipt savings of $300,000. The Department indicated that federal health care reform has superseded the program and its revenue source as they currently exist and the program has diminished significantly in recent years. This change would require repealing a section of general law and personnel assigned to this program will be reassigned to other activities in the division.

The Governor recommended $86,163 less than the unconstrained request, including $174,484 more from general revenues and $260,647 less from restricted receipts. He shifted funding used to pay rebates to program participants from restricted receipts to general revenues, added $30,000 more for the contract for making the point-of-sale discounts and reduced salary and benefit expenses by $90,647. The Assembly concurred.

Home and Community Care Medicaid Waiver Services. The Department requested $11.1 million from all sources, including $5.5 million from general revenues for the provision of subsidized home and community care to low income elders through the home and community based waiver program. This is $0.8 million more than enacted, including $0.5 million more from general revenues and $0.3 million from federal funds to reflect an anticipated increase in utilization of home and community care services.

This program funds eligible individuals who are either in an assisted living facility or receiving home care services, though the individuals continue to need a nursing home level of care. The Department indicated that the program has grown by about ten percent annually since FY 2009 as a result of the Global Waiver, specifically the initiative to move individuals from long term care facilities to assisted

As part of its constrained request, the Department requested a cap on services, which creates a waiting list and a 15 percent provider rate reduction for savings of $0.2 million, including $40,000 from general revenues. This is consistent with the corrective action plan proposed for the revised request, though it was determined the corrective action plan was not necessary; however, it appears the federal fund savings is an error that overstates the anticipated savings. The Governor’s recommendation includes $31,349 less from federal funds to adjust for the Medicaid match rate and does not include the reduction in the constrained request. He subsequently requested an amendment to transfer these services to the Office of Health and Human Services to maintain all Medicaid funded assisted living and home care expenditures in the budget of the Office. The Assembly concurred.

Home Care Services. The Department requested $3.1 million from all sources, including $1.5 million from general revenues for the home care services program. This is $0.2 million more than enacted, including $0.1 million from both general revenues and federal funds to reflect a 7.8 percent increase in program utilization.

The co-payment rate schedule for home care services is based on the program recipient’s income level. Level 1 covers those earning less than 125 percent of federal poverty or less than $13,963 for individuals and $18,913 for couples per year. Level 2 covers individuals and couples earning at or below 200 percent of federal poverty or less than $22,340 and $30,260 per year. The home care rate is $4.50 per hour for income level 1 and $7.50 per hour for income level 2. This program serves low- income elders who pay a portion of the hourly cost of home care services, including bathing, dressing, household chores, and ambulatory needs.

As part of its constrained request, the Department proposed to increase the client portion of the co-pay and limiting program growth to 10 percent of the FY 2012 service utilization, for estimated savings of $0.2 million from all funds, including $0.1 million from general revenues. The client co-pay would increase from $4.50 to $5.00 for level 1 clients and from $7.50 to $8.00 for level 2 clients.

The Governor’s recommendation is $0.9 million less than requested from all sources, including $0.5 million less from general revenues by assuming that 60 percent of the individuals currently receiving services will be eligible for 100 percent federally funded Medicaid, beginning January 1, 2014. The recommendation does not assume co-pay increases. He subsequently requested an amendment to restore funding since the Medicaid savings will not be achieved; the restoration includes $0.9 million from all sources, representing a 10.2 percent increase to the FY 2013 enacted level, consistent with the Department’s request for these services. The Assembly concurred.

Adult Day Care Services. The Department’s request includes $2.6 million from all sources, including $1.3 million from both general revenues and federal funds for the adult day care services program. This is $0.2 million or 7.8 percent more than the enacted level, including $117,420 more from general revenues.

As part of its constrained request, the Department proposed to increase the client portion of the co-pay and limiting program growth to 10 percent of the FY 2012 service utilization, for estimated savings of $0.4 million from all funds, including $0.2 million from general revenues. The client co-pay would increase from $7.00 to $7.50 for level 1 clients and from $11.50 to $13.00 for level 2 clients.

The Governor’s recommendation is $0.8 million less than requested, including $0.4 million less from general revenues by assuming that 60 percent of the individuals currently receiving services will be eligible for 100 percent federally funded Medicaid, beginning January 1, 2014. The recommendation does not assume co-pay increases. He subsequently requested an amendment to restore funding since the Medicaid savings will not be achieved; the restoration includes $0.8 million from all sources, representing a 10.2 percent increase to the FY 2013 enacted level, consistent with the Department’s request for these services. The Assembly concurred.

Case Management Services. The Department’s request includes $0.9 million from all sources, including $0.4 million from general revenues for elder case management. This is $64,562 more than enacted from all sources, including $40,434 from general revenues, representing a 7.8 percent increase. These services were previously funded only from state funds; however, the Department is now able to leverage Medicaid through the Rhode Island Consumer Choice Global Waiver. Case management programs assist older Rhode Islanders who wish to remain at home as long as possible. As part of its constrained request, the Department proposed to cap case management activities at 10 percent below the FY 2013 levels for savings of $47,283, including $23,453 from general revenues. This would impact eligible clients and other case management programs at both the state and local levels.

The Governor’s recommendation is $153,996 less than requested, including $75,859 less from general revenues. This includes reductions of $152,918 from all sources by assuming that 60 percent of the individuals receiving services will be eligible for 100 percent federally funded Medicaid, beginning January 1, 2014. The recommendation also includes $1,079 less from federal funds to adjust for the Medicaid match rate. He subsequently requested an amendment to restore funding since the Medicaid savings will not be achieved; the restoration includes $0.2 million from all sources, representing a 10.2 percent increase to the FY 2013 enacted level, consistent with the Department’s request for these services. The Assembly concurred.

Volunteer Guardianship Program. The Department requested the enacted level of $81,512 from general revenues for the volunteer guardianship program which is a legal arrangement through which the guardian is authorized to make certain decisions, such as health care, residence and relationship decisions, for the client after being appointed as a Good Samaritan Guardian by a Probate Court Judge. Cornerstone Adult Services manages the program and trains volunteers to help cognitively impaired elders while volunteer lawyers handle the Probate Court papers and hearings needed to appoint volunteer guardians. This program began in 2001.

As part of its constrained request, the Department requested eliminating this program for general revenue savings of $81,512. The Governor recommended the enacted level of $81,512 and did not recommend elimination of this program. The Assembly concurred.

Medicare Outreach and Enrollment Assistance Grants. Consistent with the revised request, the Department’s request eliminates the enacted level of $158,965 from federal funds for Medicare

Providers Act and the purpose was to provide targeted outreach to clients who may be eligible for the Medicare Savings Program and the “Extra Help” program and who are not yet enrolled. These programs were for people with limited income and resources that pay some monthly premiums, annual deductibles, and prescription co-payments related to a Medicare prescription drug plan. The Governor recommended funding as requested. The Assembly concurred.

Aging and Disability Resource Center. The Department requested $86,823 from federal funds, which is $0.3 million less than enacted, for the Aging and Disability Resource Center, locally known as the Point. The Point’s goal is to provide information about and referral to a statewide network of programs for seniors, adults with disabilities, and caregivers. The federal government no longer funds one of the two grants and reduced the second grant; the Department’s request includes all available funding for the center for FY 2014. The Governor’s recommendation added $109,608 from federal Money Follows the Person grant funds received by the Department for a project that will end in FY 2014. The Assembly concurred.

Title III B Older Americans Act Grants. The Department requested $2.0 million from federal funds