Federal Update
In February, President Bush presented his fiscal 2007
budget proposals for the period from October 2006 to
September 2007. These proposals, if enacted by Congress,
would have a severe impact on Alzheimer’s research,
care, and prevention. Programs under the president’s
proposed budget no longer to be funded included the
Alzheimer’s Brain Health Project at the Centers for
Disease Control, the Alzheimer’s Disease Demonstration
Grants to the States, the Alzheimer’s Association’s
24/7 Contact Center, and Safe Return, the nationwide
identification, support, and registration program providing
assistance in finding a person lost locally or far from
home. Most important, research funding at the National
Institutes of Health (NIH) would decline.
Immediate and widespread grassroots advocacy was
initiated by the Alzheimer’s Advocacy and Public Policy
Office in Washington, and in mid-March an amendment
to the Senate Budget Resolution to add $7 billion for
health and education passed. In mid-May $4 billion for
health and education was added to the House FY 2007
Budget Resolution. These actions, however, were only
first steps in the federal budget process, and the Advocacy
and Public Policy Office began to focus as well on the
Congressional Appropriations Committees responsible
for funding specific programs and services.
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Sen. Hillary Clinton with NYC & NYS Chapter Advocates |
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It was in this climate that the Alzheimer’s Association
18th Annual Public Policy Forum convened in Washington
in early June. Advocates from throughout the
country including chapter representatives, public policy
staff, family caregivers, and individuals with Early-Stage
dementia were in attendance. As in the past, our NYC
advocates made visits to the offices of Senators Schumer
and Clinton and NYC Congresspersons to advocate for
making Alzheimer’s disease an urgent national priority. NYC has been fortunate in the on-going support of its
representatives and their staff persons and this year was
not an exception.
A major priority was increasing funding by $60 million
for Alzheimer’s research at the National Institutes of Health
to maintain the momentum of Alzheimer’s research and
hasten discovery of effective preventions and treatments.
Program priorities were maintaining and increasing funding
for the Alzheimer’s programs for which funding was
eliminated in the president’s proposed budget.
Unfortunately, subsequent to the Public Policy Forum,
the House Appropriations Committee voted to cut
funding for Alzheimer’s research below last year’s level
by $7 million - down to $645 million. The Committee
did restore funding for the Alzheimer’s Call Center, the
CDC Brain Health Initiative, and the Alzheimer State
Matching Grants Program. The Senate Appropriations
Committee also voted to restore funding of the three
programs. The Senate bill included an $8 million increase
for research over last year’s $652 million. The Senate and
House are expected to resolve the differences between
their two bills in late fall.
State Update
In its version of the state budget released at the end of
March, the Legislature rejected the governor’s transfer of
assets and spousal refusal proposals. The governor proposed
to apply a five year look back and initiate a penalty
period for the transfer of assets to establish eligibility for
non-institutional services including Medicaid home care/
personal care; require that spousal refusal be restricted to
where the spouse is absent from the home; and change
the starting date of the penalty period for transfers of
assets so as to delay access to Medicaid long term care
coverage. The Legislature increased the federal home
equity cap to $750,000 and due to the high cost of NYC
housing allowed for use of home equity loans and reverse
mortgages in order for a person to establish eligibility for
Medicaid nursing home care. The Legislature authorized
an additional $8 to the nursing home daily rate for the
care of residents who have AD or a dementia diagnosis.
The governor did indeed exercise vetoes and the legislature
overrode his vetoes. The governor argued further
that the overrides were unconstitutional. Among the governor’s vetoes were the $8 add-on to the nursing home
daily rate for dementia care as well as the provision allowing
spouses remaining in the home to refuse to pay health
care bills for the ill spouse. The governor also restricted
the exercise of spousal refusal by the well spouse of an
institutionalized spouse except in hardship cases.
Intense advocacy by a large number of organizations
in opposition to the governor’s actions was engendered.
The Coalition of NYS Alzheimer’s Chapters and the
NYC Chapter were actively involved in these advocacy
efforts. At the last minute negotiations took place
between Governor Pataki and the Legislature in an
effort to resolve their differences before the close of the
legislative session in late June. The governor’s proposed
changes with regard to non-institutional services including
spousal refusal, transfer of assets penalty periods, and
the look back were eliminated. Also eliminated was the
governor’s proposal to restrict spousal refusal by the well
spouse of an institutionalized spouse. As such, spousal
refusal is retained for both home care and nursing home
cases. The $8 add-on to the nursing home daily rate
for dementia care was restored. The $750,000 home
equity cap for nursing home eligibility was approved,
but will also apply to all long term care services including
home care.
— Ann Berson
Vice President,
Director of Public Policy
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