Tag: Budget

Did You See That?!? – January 2024

Quick Note

I hope everyone had a great holiday break! I know I did!! This may just be my negative winter northeastern mind kicking in, but I might be the only person who really doesn’t enjoy “year in review” look back segments. Weather its friends posting their year in photos on Instagram, CNN covering all the horrific news events of the year that made everyone sad, or ESPN replaying every winning play in sports, I think they are all kind of pointless and a waste of time. Other than Spotify yearly wraps. I personally find it really fun and interesting because I get to see firsthand how my wife’s love for Taylor Swift is so deep, that it affects my top 5 artists of the year.

Besides that! It’s 2024, it’s time to move on to the present and the future. So rather than rehashing for the 30th time what happened in 2023, I’m going move forward and update everyone on what to expect in 2024.

*I would also like to say that all opinions raised in this piece are my own and do not represent HCA’s opinions and thoughts.*

Federal Outlook

Now We Have TWO BUDGET DEADLINES!!!

Congress loves budget season and the immense amount of press that comes with it so much, that they broke the yearly budget into two deadlines. For a small recap, (I know, the hypocrite I am) Congress previously failed to pass a full year spending package that would fully fund all 12 regular appropriations bills by the original continuing resolution (CR) November 17th deadline, newly elected House Speaker Mike Johnson crafted and passed a two-step CR, with four of 12 appropriations bills expiring January 19, and the remaining eight expiring February 2. While this buys Congress time to discuss appropriation levels, it also creates a series of funding deadlines that, if not met, will shut down parts of the government.

Now the first deadline, January 19th, is quickly approaching for Congress to pass four of 12 appropriations bills, which include budgets for the FDA, Energy and Water Development, Military Construction and Veterans Affairs, and Transportation, Housing and Urban Development. “The Hill” reported that there are four different avenues that Congress could take when it comes to dealing with the budget.

Option one: Congress passes all their funding bills by each deadline. Now this Option is looking less and less likely as days pass.  “It’s going to be very difficult to get all of the appropriations bills we have to get done in time if we don’t have the [top-line] number, and we don’t have the number right now,” Rep. Tom Cole who heads the House subcommittee that crafts the annual funding bills for the departments of Transportation (DOT) and Housing and Urban Development (HUD). “So, we’re going to have to make some tough decisions in early January.” To date, the House has passed seven GOP-crafted spending bills while the Senate has passed a so-called maxibus of three bills. But the bills passed look vastly different between chambers, which means there is still a long way to go for Senate and House leaders when it comes to an agreement on a final package.

Option Two: Congress passes another stopgap for the budgets due on January 19th. This is becoming the more likely option as discussions between lawmakers continue to stall. There have already been doubts raised by legislatures in the House and in the Senate before the Holiday break on Congresses ability to pass any budget pieces, with one saying that if a deal was not made before the break, the odds of any deal happening by the deadline were very slim. It is yet to be seen how a 3rd CR would be drafted and when the next deadline would be. It is important to note that Speaker Johnson has said he will not push through another short-term stopgap. “A CR is simply unacceptable for a year,” Senate Minority Leader Mitch McConnell (R-Ky.) said before the Senate left for their end-of-year recess. “It’s devastating, particularly for defense, and we’ve got all of these wars going on. So, we need to reach an agreement on the top line and get about getting an outcome as soon as possible.”

Option Three: Parts of the government shut down as negotiations continue through the February 2nd deadline. I personally believe that this will not happen, as it would be a major blow to Speaker Johnson reputation if he fails to pass any sort of a budget or a CR by the 19th.

Option Four: Congress passes and omnibus spending package funding all budgets at once. This is something that hardline Republicans were trying to prevent when they pushed for the two-step CR. Former Speaker Kevin McCarthy, during his fight to keep his spot, promised conservatives he wouldn’t resort to a single massive spending package, and Speaker Johnson backed that vow, telling reporters in November that they “broke the omnibus fever — we call it the ‘omni fever.’”

But with limited options on the table, I would not put it out of the realm of possibility that the Biden Administration along with Senate Democrats propose a full year omnibus package to Republicans at the last minute that entices them to support rather than a government shutdown.

Regardless of which option comes to fruition, we can all agree that this will be an absolute shit show. It’s unbelievable to me that Congress continues to fail to recognize that literally no one wins when they fight over the budget, and it only pisses off the vast majority of the public. The public is forced to witness stupid cat fights between media hungry, empty-suit politicians that only care about themselves and only try to show that they care about leading when it’s best for them.

It’s the same dog and pony show every year, where one side demands X and the other demands Y, they both say they wont budge even though in the end they always do. I understand why Speaker Johnson broke up the appropriation budgets into different deadlines, but in the end won’t change how they negotiate overspending. We are already hearing discussions about a single omnibus budget being negotiated which basically makes the two deadlines useless. What holds up the budget process every year, isn’t mundane budget features such as payroll or resources. It always comes down to year specific budget proposals (i.e. border crisis, Ukraine aide, Israel aide, etc.) which cause the whole budget process to hault. These politicians walk around like there are no ramifications for delaying a budget or even failing to pass a budget resulting in a government shutdown. So many businesses, non-profits, charities, non-profits rely on government funding to survive and when they fail to advance the budget, they all get hurt. I think, every time there is a CR, members of Congress should not be paid for the extended amount of time, and if there is a government shutdown, they should owe money for every day it is not open.

Presidential Election

It’s the most horrible time of the year!!! With so much despair and with everyone crying, giving you great fear!!!! It’s the most horrible time of the year!!! (single with cadence of it’s the most wonderful time of the year by Andy Williams).

Yes, sadly it’s finally here. The race to be elected president is right around the corner, haunting us all like the Babadook in the shadows, with election day this November. I’m not going to spend much time on this because, as history has shown, no one can accurately predict what will happen. Right now, it is looking like we will have to live through the worst rematch in history between Donald Trump and Joe Biden. The only outside candidate that I believe has a shot to challenge either candidate is former South Carolina Governor Nikki Haley, who is the type of person that reminded her teachers when homework wasn’t collected. She has gotten the most support out of all the challengers to Donald Trump in the Republican primary.

As the year goes on Congress will become less and less active as the election day draws closer. So, I would plan for Congress to basically stop once August recess comes around.

State Outlook

Second Session Is Here

New year, same business. January 3rd marks the beginning of the second session of the 193rd general court of the Commonwealth of Massachusetts. The second session is when the legislature is usually the most active, with it being the last time to act on a piece of legislation that were introduced during the first session. This year, legislative leadership will have their handful with trying to pass legislation on hot button issues, such as gun control, climate, housing crisis and growing health care costs. The legislature will also need to pass a budget for FY25, which will come with its own headaches as Massachusetts looks to address the migrant shelter crisis.

HCA will be very active this year as we look to advance two key pieces of legislation that we filed, H.649 – An Act to Improve Massachusetts Home Care, and H.1195/S.755 – An Act Clarifying Rate Setting Processes for Home Health and Home Care Services. The licensure bill was recently voted favorably out of committee by the Joint Committee on Elder Affairs, referring the bill to the Committee on Health Care Financing. The Licensure bill will now move to the next step of the legislative process, which involves three occasions (known as “readings”) in each branch in which a bill is considered. The first “reading” will come from the from the Joint Committee on Health Care financing. Please use this ACTION ALERT to write to members on the Joint Committee on Health Care Financing urging them to give the bill a favorable report. HCA will provide updates on the licensure bill as they unfold.

We expect that H.1195/S.755 – An Act Clarifying Rate Setting Processes for Home Health and Home Care Services, will be given the same treatment soon as the deadline for the Joint Committee on Health Care Financing to report bills out of their committee is the fourth Wednesday of February.

The Rundown – March 2023

I would apologize for not writing a February edition of “The Rundown”, but honestly there wasn’t enough to write about at the state and mainly the federal level to justify a rundown.

Federal Recap

At the federal level, over the last month and a half, Members of Congress have basically spent their time creating sounds bites for news stations and click bate twitter posts. For an example, On Presidents Day, Georgia Rep. Marjory Taylor Greene, wrote a tweet saying “We need a national divorce. We need to separate by red states and blue states and shrink the federal government. Everyone I talk to says this. From the sick and disgusting woke culture issues shoved down our throats to the Democrat’s traitorous America Last policies, we are done.” And she doubled down after on Fox news saying that a national divorce would be better than a civil war. Now as a child of divorced parents I can say from experience that while it’s great in the beginning for the child (U.S. citizens) beginning when both parents fight to show that they love their kids more by showering them with presents (tax cuts, tax relief etc.), that part ends quickly and the child is just left with a broken home (divided country) and a new bike. Have we not learned from history that, that never works. Yugoslavia in the 90s, Korea and Ireland in the early 1900s, and let us not forget……. The U.S. and the civil war. How would it even work? Where would purple states like Georgia, Arizona and Nevada, go?? What about interstate commerce. Anyway, I feel like that sums up what Members of Congress have been up to the last month and a half.

Look Ahead

Having to think about what lies ahead at the federal level honestly scares me The Republican will continue to use their majority in the House to hold hearing after hearing on topics that would make the Biden administration and Democrats look bad in the run up to the next presidential election. Democrats will continue to get nothing passed in the Senate where they hold a slim majority, and we will probably continue to hear rumors about more people entering the field for the Republican presidential race. Which all means more hearings and sounds bites from members such the human equivalent of a rat with hair gel, Rep. Matt Gaetz, and the growing example for why we need mandatory cognitive test for senior members, Sen. Dianne Feinstein.

I would recommend that people stay away from the news for a couple of months and just enjoy that both the Celtics and the Bruins are the best teams in their sports. As for me, as a born and raised New Yorker I can’t enjoy Mass sports teams so I will keep track of the non-sense and will keep you all updated if anything is noteworthy. I will be using the federal section over the next couple of months to vent my frustrating that we actually pay these people 100,000s of dollars to do nothing but be on fox news and MSNBC. So keep that in mind and maybe just skip to the State section of these rundowns

State Recap

Finally, to the state level where for the first time this year things are actually happening. For a brief recap before we get to the Governor’s budget and tax relief packages, the legislature finalized leadership and committee position in the Senate and the House. It took the legislature almost a full 2 months to finalize the positions, which means that the legislature could finally get down to business and start voting on bills that could have a real impact and not just legislation that names a bridge.

The House passed its first significant bill of the session, voting 153-0 to pass a House Ways and Means redraft of Governor Healey’s FY2023 supplemental budget, includes elements of her $1 billion “immediate needs” bond bill. The $353 million billon, which also includes $585 million worth of bond authorizations, temporarily extends pandemic-era programs such as enhanced food assistance and free school meals. It also gives $44 million to the emergency shelter system to help offset medical costs for migrant families. The Bond authorizations include $400 million for the MassWorks grant program and $104 million for the Clean Water Trust, among other initiatives. 27 amendments were filed but quietly disregarded behind closed doors, which included $50 million in bond authorization for the Massachusetts Technology Park Corporation.

Governor Healey Tax Relief Package

Governor Healey jumped into the game as well in the end of February when she released an aggressive $859 million tax relief proposal, restarting a heated debate on Beacon Hill on tax relief. The plans main focus is to help keep people in the state by relieving the growing cost of living in Massachusetts and boost the state’s economic competitiveness. Healey included in her package a couple of proposals that were previously recommended by former Republican Governor Charlie Baker, including lowering the short-term capital gains tax from 12% to 5% and creating a new estate tax credit of up to $182,000, which would effectively eliminate the estate tax for all estates valued up to $3 million, higher than the current level of $1 million.

The largest share of the proposed relief, about $458 million, would come in the form of a new child and family tax credit, which would create a $600 refundable credit for each qualifying dependent, including children younger than 13 years old, adults who are disabled, and seniors. To help with rising rent and housing cost in Massachusetts, Healey is reviving a proposal to boost the maximum rental deduction from $3,000 to $4,000, which would affect 880,000 renters, and to double the maximum allowable credit for the senior circuit breaker credit, assisting 100,000 households. The package also includes a number of smaller proposals including increasing the apprenticeship tax credit to $5 million, including an exemption for employer assistance with student loan repayment, expanding the dairy tax credit from $6 to $8 million, expanded commuter transit benefits, and more.

Healey’s office said the tax package would carry a total cost in fiscal year 2024 of $859 million. It said the measure has a net cost of $742 million because the $117 million in affected short-term capital gains tax revenue by law would need to be placed into reserves and could not be spent as part of the annual budget. Healey also said that the relief package will be factored into her recently released budget proposal for FY24. It is now up to the legislature to decide if they want to increase or decrease the Governor’s tax proposal. The legislator previously shut down their own tax relief bill last year after they realized that Massachusetts owed nearly $3 billion in excess tax revenues back to taxpayers under a voter-approved law known as Chapter 62F. Since then, the legislature has shown little interest to re-address a tax relief package.

Governor Healey FY24 Budget Proposal

To kick off the month of March with some flare, Governor Healey released her first state budget proposal. Healey’s administration described the proposal as a “downpayment” on its goals of making Massachusetts a more affordable place to live, tackling climate change, and preparing students for careers in an evolving economy. The $55.5 billion budget proposal would increase spending by 4.1% over the current year (FY23) budget, which would account for the expected the growth rate in state revenues in FY2024 when accounting for $1 billion from the state’s new millionaire income surtax. Healey plans to use the $1 billion from the new surtax to increase funding for education ($510 million), including $100 million in childcare grants to providers, and transportation ($490 million), which includes $181 million in MBTA capital investments. The budget would also pump new money towards energy and environment initiatives, human service provider rates, housing programs and much more.

The proposal also includes a $3 billion increase for funding for EOHHS, compared to what former Governor Charlie Baker proposed in his budget proposal last year. Though MassHealth, would be funded in Healey’s budget at $19.8 billion, which would have a net cost to the state of $7.9 billion. That’s a decrease of $1.9 billion on a gross basis or $254 million after reimbursements compared to fiscal year 2023 spending projections. The decrease is driven, the administration said, by “caseload decline and intentional distribution of funds across fiscal years to mitigate a revenue cliff due to the end of the federal COVID Public Health Emergency.” As expected, Healey’s proposal did not include funding for the Enough Pay to Stay rate add-on. The Enough Pay to Stay rate add-on has never been included in a Governor’s proposal, if it were to be included, it would be added in later by the legislature.

Look Ahead

The release of Governor Healey’s budget recommendations marks the beginning of a long budget cycle that will see a lot of Healey’s proposed budget items be either changed or taken out. The House generally puts out, debates, and passes its own budget proposal in April, followed by the Senate in May. Those two budgets then typically spend much of June in a conference committee before lawmakers agree to a compromise version. Fiscal year 2024 begins July 1, but Massachusetts lawmakers seldom have the budget done in time for it to be in place for the start of the fiscal year, which could result in supplemental budgets being passed till they pass a full budget for FY24.

It is also now up to the legislature to decide if they want to increase or decrease the Governor’s tax proposal. The legislator previously shut down their own tax relief bill last year after they realized that Massachusetts owed nearly $3 billion in excess tax revenues back to taxpayers under a voter-approved law known as Chapter 62F. Since then, the legislature has shown little interest to re-address a tax relief package. We will have to wait and see what happens next.

No Time to Waste! Urge Your Member of Congress to Delay CMS’s 2023 Home Health Rate Cuts

On October 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released a final rule that will reduce Medicare payments for home health services by $635 million in 2023 and approximately $18 billion over the next decade. It was mandated by Congress in 2018 that CMS develop a payment model that would be “budget neutral”, not one that would reduce funding for home health care by over $18 billion.

Following the release of the final rule, HCA along with the National Association for Home Care and Hospice (NAHC) re-engaged with the sponsoring offices of The Preserving Access to Home Health Act (S. 4605/H.R. 8581) on refining the legislation to delay CMS from implementing their 2023 home health payment cut for one year, as well as strengthen transparency of the Centers for Medicare & Medicaid Services (CMS) in their rate-setting. Our champions on Capitol Hill are working to substitute this amended language in the negotiations for the year-end package. 

With time running out in the 117th Congress, lawmakers are inching closer to passing a final spending bill to keep the government funded. Home health advocates are pushing hard for a yearlong delay of the 2023 home health payment cut, which would otherwise take effect on January 1, 2023. However, NAHC has informed us that there is significant opposition to delaying these cuts.

We need your help once again and there is no time to spare! 

HCA members sent over 200 emails to members of the Massachusetts delegation urging their support of The Preserving Access to Home Health Act. Your continuous outreach resulted in Massachusetts Rep. Jim McGovern and helped to persuade CMS from backing off their initially proposed 7% rate cut. We must continue our aggressive outreach in order to persuade Congress to include the revised language in the year-end budget!

Please use the action alert below to write to your member of Congress urging them to support a year-long delay (2023) of CMS’s proposed home health rate cut and call for added transparency in CMS rate-setting practices.

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