Pennsylvania legislators are currently considering Governor
Wolf’s proposal to merge four Pennsylvania human service agencies. The Governor
would like to consolidate the current Departments of Aging (PDA), Drug and
Alcohol Programs (DDAP), Health (DOH), and Human Services (DHS) into a unified
Department of Health and Human Services (DHHS).
In recent weeks legislators have heard testimony from Wolf Administration
officials offering support for consolidation, and from groups and individuals
who expressed various degrees of opposition. Many of the concerns relate to the
impact of the merger on the Department of Aging.
The Pennsylvania Department of Aging (PDA) has a 40 year
history in Pennsylvania. In 1973 an amendment to the federal Older American’s
Act required states to establish Area Agencies on Aging (AAAs) to provide programs
and services for older adults. In response Pennsylvania established a network
of county or non-profit based local agencies. In 1978 the Legislature established
the PDA as a cabinet level position.
The PDA currently has 117 employees. The agency coordinates and
funds a broad range of programs and services that benefit older (age 60 and
over) Pennsylvanians and their families and caregivers. Most of these services
are made available through the 52 local AAAs. About 2/3rds of the PDA funding
to local AAAs comes from the Pennsylvania lottery.
The Wolf Administration states that consolidation of PDA with
other human services agencies makes sense “in order to promote more effective
collaboration and service delivery, enhance program effectiveness, and
eliminate duplicative processes.” Seniors could benefit from having a single
agency as their point of contact for state provided health and human services. The
hope is that consolidation will reduce complexity and confusion for seniors and
individuals with disabilities by providing one door to needed services instead
of several. Consolidation has the potential to reduce red tape for providers. And
it should result in modest, but ongoing cost savings. For more on the
Administration’s rationales, see the Governor’s press release here. And the Administration has posted updated information on its "unification" proposal here.
Many organizations across the state have expressed reservations
about the merger of the PDA into the new DHHS super-agency. Organizations testifying
about concerns with this aspect of the proposal have included the PA Association of Area Agencies on Aging (P4A),
the Center for the Advocacy for the Rights and
Interests of the Elderly (CARIE), the Southwestern
Pennsylvania Partnership for Aging (SWPPA). The Pennsylvania Association of Elder Law Attorneys,
of which I am a past President, has come out against including the PDA in the consolidation.
A number of legislators have also expressed reservations.
Here are some of the concerns being raised:
Loss of a cabinet level
voice advocating for
seniors. Since 1978 Pennsylvania seniors have had cabinet level representation.
As expressed by House Aging and Older Adult Services Chairman Tim Hennessey at
a House Appropriations Committee meeting: “What position do you think would be
the most effective advocate for the elderly: a cabinet secretary sitting beside
other cabinet secretaries with the governor; or a deputy secretary three levels
down from the governor, as the consolidation plan proposes?”
Buried in Bureaucracy. Aging may get lost in the large DHS dominated super-agency bureaucracy. It could get “buried in bureaucracy” according to
Representative Gene DiGirolamo, chair of the Human Services Committee. Aging
has only 117 employees compared with the 17,000 total projected employees of DHHS.
Potential reduction in
lottery funding. As
we often see noted in its advertising, proceeds from the Pennsylvania lottery go
to support programs benefiting older residents. The PDA and AAAs use lottery
funds for senior centers and meals, low cost prescription assistance (PACE and PACEnet),
transportation, property tax and rent rebates, home and community based
services and other care related services. They fund education and outreach
activities, ombudsman services, protective services, family caregiver supports,
the nursing home transition program and the OPTIONS program.
Approximately 78 percent of PDA funding comes from the
Pennsylvania Lottery with the other 22 percent being derived from federal
funds. The lottery funds are used by the PDA and AAAs to benefit older
adults who are not on Medicaid. As described by Rebecca May-Cole, Executive
Director of P4A, “the typical senior receiving services through an AAA is a
79-year-old widowed female living just above the poverty level; she is not eligible
for Medicaid, but also has a very limited income.”
But lottery funds can also be distributed to the Department
of Human Services and used to fund the state’s share of the cost of Medicaid long
term care services. In other words, the lottery funds can be used to replace
General Funds. The fear is that after consolidation lottery funding will be
diverted from the PDA and AAAs to DHS and used reduce state General Fund
outlays for Medicaid.
“If it ain’t broke,
don’t fix it.” As
noted by Chairman Hennessey there is no need to include the PDA in the DHHS
merger because PDA already functions smoothly. DHS, on the other hand, has a
recent record of failure with its assumption of handling enrollment in the Aging Waiver
program. In 2016 the enrollment functions of the PDA Waiver program were
removed from AAAs and outsourced by DHS to a private company. The transition
was poorly implement and the failure has delayed critically needed services for
untold numbers of seniors. This recent misadventure casts doubt on the ability
of a DHS controlled super-agency to oversee PDA functions.
Conflicts of Interest: There are potential conflicts of
interest in having one super-agency (DHHS) handling federally funded programs
which require separation of function. For example, is it appropriate to have the
Long-Term
Care Ombudsman Program (currently a PDA function) housed with the same
agency charged with nursing home licensing and enforcement? Would this violate the
federally mandated independence of the Ombudsman?
Lack of Stakeholder
Input: The
consolidation proposal was developed without meaningful external stakeholder
input.
Lack of adequate study: There has been no study to determine
if the consolidation makes sense. More study should be required before moving forward with its implementation.
For all of these reasons legislative approval of the proposed
consolidation seems to be in doubt. We may learn its fate in the next few
months. If you want to provide your legislators with your opinion on the merger
you can find their names and contact information here.
A video of the
April 17, 2017 Joint House Aging and Older Adult Services, Health, and Human
Services Committees hearing on the consolidation is
available here.