Federal Outlook
Senate Passes $95.3 Billion Foreign Aid Bill, DOA in House
The Senate passed a $95.3 billion foreign aid bill with assistance for Ukraine and Israel, setting up a showdown with the House. The foreign aid package includes billions of dollars to support Ukraine and for security assistance for Israel, as well as humanitarian assistance for civilians in Gaza, the West Bank and Ukraine, among other priorities. The Senate vote was 70 to 29 with 22 Republicans voting in favor, including Senate Minority Leader Mitch McConnell. “History settles every account,” McConnell said in a statement following the vote. “And today, on the value of American leadership and strength, history will record that the Senate did not blink.” The bill includes $60 billion to support Ukraine in its fight against Russia, $14.1 billion in security assistance for Israel, $9.2 billion in humanitarian assistance and $4.8 billion to support regional partners in the Indo-Pacific region in addition to other policy provisions, according to the Senate Appropriations Committee.
The bill passed the Senate despite Speak Mike Johnson’s, who looks like the type of person that would side with the parents that banned dancing in footloose, criticism of the legislation and former President Donald Trump signaling opposition to the bill by arguing the US should stop providing foreign aid unless it is in the form of a loan. Johnson has said that he has no plan to take up the bill currently. “Right now, we’re dealing with the appropriations process, we have immediate deadlines upon us and that’s where the attention is in the House in this moment.” Johnson also said that we, Congress, need to focus on the border first, and not on foreign aid. Johnson has said in the past that he would not support a foreign aid package unless the House’s hardline border bill is attached, which Senate leadership on both sides of the aisle have said in the past is a nonstarter. The Senate previously announced that they have agreed on a border bill that has bipartisan support, but the House and Speaker Johnson argue that it does not go far enough. But what the House did not say is that presidential candidate Donald Trump has pushed for Congressional republicans to block any border deals so that democrats cannot campaign on the border during the upcoming election cycle. President Joe Biden called on House Republicans to hold a vote on the bill in remarks from the White House, saying that a “minority of the most extreme voices in the House,” should not be permitted to block the bill.
House Impeaches Homeland Security Secretary Alejandro Mayorkas
After an embarrassing failure in January, the GOP led House succeeded in impeaching Homeland Security Secretary Alejandro Mayorkas for his handling of increased migration at the southern border, making him the first cabinet secretary since 1876 to be impeached. The vote tally was 214 to 213. Three Republicans voted with Democrats against the measure. Speaker Johnson said Homeland Security Secretary Alejandro Mayorkas needed to be impeached because he refused to do his job. “From his first day in office, Secretary Mayorkas has willfully and consistently refused to comply with federal immigration laws, fueling the worst border catastrophe in American history,” Johnson said in a statement after the impeachment vote Tuesday. Johnson accused Mayorkas of undermining the public’s trust “through multiple false statements to Congress.” He also said the homeland security secretary “obstructed lawful oversight of the Department of Homeland Security, and violated his oath of office.” Constitutional experts have said the evidence does not reach that high bar of impeachment and three Republicans voted with Democrats against the resolution.
Republican Rep. Ken Buck voted against the impeachment of Homeland Security Secretary Alejandro Mayorkas last week — and did so again tonight. Buck said he did not reconsider his vote because he does not believe that the circumstance qualifies as a high crime and misdemeanor. “You can try to put lipstick on this pig, it is still a big, and this is a terrible impeachment. It sets a terrible precedent,” Buck told CNN on Tuesday after the vote. Sen. Ken Cramer (R-N.D.), an ally of former President Trump, slammed House Republicans actions, calling it “the worst, dumbest exercise and use of time.” The impeachment now moves to the Senate where Democrats have a majority, all but killing any GOP hope of Mayorkas being fully impeached. The Senate is required to hold an impeachment trial, Senate Majority Leader Chuck Schumer’s office said House impeachment managers will present the articles of impeachment to the Senate following the state work period. Senators will be sworn in as jurors in the trial the next day. Senate President Pro Tempore Patty Murray will preside. The key part of the trial is that during an impeachment trial in the Senate, no other official business can be done till the trial is completed. It is widely expected for the Senate to push through the trial to acquit Mayorkas as quickly as possible so they can get back to budget negotiations for a full year budget.
State Outlook
It’s All About the Benjamins
In a crushing blow for Governor Healey’s budget plans, for the seventh straight month Massachusetts failed to hit projected tax revenue. This comes on the heals of Governor Healey implementing emergency 9c cuts of up to $375 million and the Healey administration significantly lowering monthly tax revenue benchmarks. State House News reported that The Department of Revenue reported collecting $3.594 billion last month (January) — $268 million or 6.9 percent less than actual collections in January 2023 and $263 million or 6.8 percent below the administration’s revised monthly benchmark of $3.858 billion. The Healey administration last month lowered the monthly benchmark for January from the $4.121 billion it projected for the month prior to the governor’s fiscal year 2024 adjustments.
Since fiscal year 2024 started in July, DOR has collected $21.460 billion, 1.2 percent less than what the Healey administration projected last month that it would have hauled in by this point in the calendar. The administration last month slashed the year-end revenue estimate by $1 billion after it was reported in December that tax revenue was running $769 million behind projections. Reducing the revenue estimate by $1 billion was meant to address the existing $769 million shortfall while also providing some breathing room for the second half of the budget year, when Administration and Finance Secretary Matthew Gorzkowicz said he expected additional months of below-benchmark collections. The administration also said it thought its January actions would be enough to avoid further 9C cuts this year. Now, after the governor cut $375 million in spending and newly tapped $625 million in non-tax revenues to account for the $1 billion revenue downgrade, the state still finds itself in a hole. Gorzkowicz told reporters that the administration does not have any plan to implement any additional 9c cuts to account for lowering tax revenue.
Lagging tax revenue is a major problem for Governor Healey, who has lofty goals for 2025, and the legislature as they try to craft a FY’25 budget. In late January, Governor Healey released her proposed $58.15 billion budget for FY2025, an over $2 billion or 3.7% increase when compared to the final FY2024 budget she signed back in August. The proposed budget suggests that she and her budget team expect a growth in revenue compared to last year. The bill does not propose any new tax increases to generate additional revenue, nor does it recommend tapping into the state’s more than $8 billion “rainy day” savings account. Further details on her proposed budget can be found below.
With lagging tax revenue and Governor Healey laying out an ambitious budget proposal in January, the legislature is left to be the bad guy. Governor Healey said in her State of the Commonwealth address that she wants to continue to pay for the migrant crisis, increase spending on infrastructure, such as the T, address the housing crisis and expand access to free community college for Massachusetts residents. All these things will cost an exuberant amount of money to be done properly. Want to know how much? So much so that I had to check a thesaurus to find a better word for a “crap ton”. But in all seriousness, they will all cost billions of dollars. It has been reported that to properly address the migrant crisis it could cost over $2 billion a year. That’s more than what the state spends on free school lunches, free community college, and energy and environmental affairs combined. It’s going to be tough for the legislature to look at current revenue trends and propose a budget that could further exacerbate the ever-growing revenue dilemma and result in an unbalanced budget half-way through the fiscal year.
This concerns me especially because we have already seen the health care sector be cut by Governor Healey when she implemented her 9c cuts to balance the budget. The largest cut proposed by Governor Healey was a $294 million cut to MassHealth fee for service. The explanation that was given for why they can afford to cut $294 million was due to “members using fewer services than we had originally budgeted.” This leads me to worry that the legislature will look to make cuts to the health sector and home care specifically to offset additional spending for Governor Healey initiatives. HCA is closely tracking the legislature’s budget process and has already spoken with the House about the importance of properly and sufficiently funding home care line items in the FY25 budget. HCA plans to continue outreach to the Senate side as the budget process moves along.
Now, like a weatherman, my prediction could be completely wrong. We have seen in the past many times that governments can basically create money out of nowhere and make a budget shortfall go away while also increasing spending, look at Congress every year. But HCA won’t take that chance that they will continue their trend of higher spending till proven otherwise and will continue to fight for funding for home care.
State Recap
HCA Holds State House Advocacy Day
HCA along with members of the Enough Pay to Stay Coalition (EPTS), held a highly attended State House Advocacy Day at the Massachusetts State House. Over 18 people from 8 agencies attended the State House Event. The day started with remarks from Jake Krilovich, Julie Watt Faqir, ED, Home Care Aide Council, and Betsy Cummings, ED, Mass Home Care, followed about remarks from some of our biggest legislative champions, Senator Patricia Jehlen, Representative Thomas Stanley & Representative Carmin Gentile.
Over a full day a meetings HCA members met with over 12 legislative offices, where we discussed the struggles agencies face on a day-to-day basis due to a workforce shortage and how passing H.1195/S.755 – An Act Clarifying Rate Setting Processes for Home Health and Home Care Services would help increase transparency of the rate setting process, as well as, update the rate setting methodology to account for all the costs of that go into providing these services, which will help to create a more adequate rate that will allow agencies to properly compete for workers. We also discussed the crucial need to pass H.649 – An Act to Improve Massachusetts Home Care, which would establish a licensure system for non-medical home care services that would establish baseline standards for agencies, to ensure a quality network of providers for consumers and keeping services affordable for those who rely on them. HCA would like to give a special shoutout to all the members that attended, their valuable insight into the importance of Home Care and what we need to do to grow the sector will go a long way to help pass these two key pieces of legislation. If you would like to read more about the event, check out State House News coverage of the event HERE.
Governor Healey Proposes Increasing FY25 Budget by Over $2.1 Billion
Governor Healey is proposing a $58.15 billion budget for FY2025, an over $2 billion or 3.7% increase when compared to the final FY2024 budget she signed back in August. The proposed budget suggests that she and her budget team expect a growth in revenue compared to last year. State House News reported that Healey’s team balanced their plan by trimming $450 million from various line items, proposing to prevent about half a billion dollars in other spending growth, and deploying $1.25 billion other available state resources. The bill does not propose any new tax increases to generate additional revenue, nor does it recommend tapping into the state’s more than $8 billion “rainy day” savings account. Cost controls include closure of the MCI-Concord medium security prison and changes at MassHealth, which typically reflects the largest share of the budget. The budget will propose “flat spending” for MassHealth’s personal care attendant (PCA) program.
Governor Healey proposed several increases in funding as compared to FY24, to line items that affect home care services. Including but not limited to:
- 1599-6903 – Chapter 257 and Human Service Reserve – $173,000,000 to $390,000,000.
- 9110-1630 – Home Care Services Provided Through ASAPs – $215,556,634 to $236,582,945.
- 4000-0700 – MassHealth Fee for Service Payments – $3,601,016,357 to $4,232,605,645.
In addition, unlike the FY2024 final budget, Governor Healey’s proposed budget did not include language for a pass-through requirement for Chapter 257 rates under line item 1599-6903. The pass-through requirement included in the FY24 budget amended the Chapter 257 Rate Reserve line item 1599-6903 as follows, by inserting after the words “any human service provider receiving revenue under said Chapter 257” the following: “, and any home care agency subcontracting with such human service providers to provide home care services,”. This language specifically requires home care providers under chapter 257 to comply with a 75% pass-through requirement that is stipulated in line item 1599-6903. We would like to note that this pass-through requirement is much broader than a pass-through amendment that SEIU tried to pass during the House budget debate, that HCA along with the Home Care Aide Council successfully blocked. Next, Governor Healey’s budget will be taken into consideration by the House and the Senate. The legislature is not required to include anything that is proposed by the Governor in her budget proposal. HCA will work with our legislative champions at the state house to make sure that no pass-through language is included in either of the proposed budgets from the House and the Senate.
Joint Rule 10 Deadline Extended for Select Committees
On Monday, The State House of Representatives voted to extend the Joint Rule 10 deadline, which is the deadline for committees to report on bills (favorable, non-favorable, or further study), was extended to May for select committees including the Committee on Advanced Information Technology, the Internet and Cybersecurity; the Committee on Agriculture; the Committee on Children, Families and Persons with Disabilities; the Committee on the Judiciary; and the Committee on Transportation. This does not affect the two bills (H.649 – An Act to Improve Massachusetts Home Care & H1195/S755- An Act Clarifying Rate Setting Processes for Home Health and Home Care Services) that were introduced by HCA along with the Enough Pay to Stay Coalition (EPTS Coalition). Both these bills are currently before the Joint Committee on Health Care Financing, whose deadline to report out bills is March 27th. HCA will continue to provide updates as both bills move through the legislative process.
Infectious Disease Bill Sent For Study
The Joint Committee on Elder Affairs announced yesterday that it is recommending that H.640/S.397 – An Act to improve infection control in Massachusetts home, which would establish a mandatory infection control training program for personal home care attendants, be given a study order. A study order authorizes the Committee to sit during recess and study this measure and similar ones and file a narrative report of its findings. However, for the vast majority of bills sent to a study order, no further Committee activity takes place, it is mainly seen as a quiet way to kill a bill.
HCA does not support the bill. We raised our concerns about a bill during a hearing on a bill in June of 2023. HCA provided testimony in person that raised amongst other concerns that home care agencies under contract with Aging Service Access Points already have infection control requirements as part of their contracts in the home care program. These require training during employee onboarding and on an annual basis as part of their in-service requirements. In addition, federally certified home health agencies also have infection control requirements as part of the Federal CMS Conditions of Participation. We proposed adding an amendment that would exclude home care agencies contracting with ASAP entities and exclude home health agencies as defined in the Massachusetts general laws section 51K.
Think Home Care Blog 