TESTIMONY of CATHERINE EDWARDS, Phd - EXECUTIVE DIRECTOR

TESTIMONY OF CATHERINE EDWARDS, PhD - EXECUTIVE DIRECTOR MISSOURI ASSOCIATION OF AREA AGENCIES ON AGING JANUARY 10, 2012 ______

Mister Chairman, members of the Committee and guests - good morning.

My name is Catherine Edwards. I serve as the Executive Director of the Missouri Association of Area Agencies on Aging. Collectively, we represent the 10 Area Agencies on Aging that exist throughout Missouri.

On behalf of ma4 thank you for the opportunity to speak with you today.

Our public face is best known by the Senior Centers that we maintain throughout this state. And I have included a map in your background materials illustrating their location. But, our responsibility, as established by the Older Americans Act goes much deeper.

The Area Agencies represent the front line in providing vital services, programs and information to Missouri seniors and their caregivers, including home-delivered meals, disease prevention, transportation, public benefits counseling (like Medicare), and in- home services.

But today I want to focus once again on the nutrition program. We are very efficient in the way we administer our funds. But, because we are so efficient in making every dollar count – every dollar lost has a magnified impact.

A year ago, I testified before you on the impact of the $1.4 million cut in meals funding the AAA’s experienced in 2010. Because of your efforts the General Assembly appropriated $941,620 for the program. However, in June of this year the Governor withheld these appropriated funds. Then as you know, in August the Governor restored $470,810.

We were encouraged by the partial restoration. The release of these funds helped to prevent cuts to the meals programs for thousands of older adults across the state and provided approximately 80,000 meals to seniors statewide. We continue to urge full restoration of the funds authorized by the legislature so no senior in Missouri goes hungry and we ask for your continued support. The graph I have provided in your materials demonstrates this funding. State Funding for Home Delivered Meals Program 2008-2012

ONGOING STATE FUNDING 2008 $12,466,573 2009 $12,096,784 2010 $9,335,053 2011 $9,041,042 2012 $9,555,884

 The increase in SFY 2012 funding is due to partial restoration of funds

 In 2011 ma4 had requested $1.4 million to partially restore previous cuts in funding

 The General Assembly appropriated $941,620  In June the Governor withheld the appropriated funds  In August the Governor restored $470,810 of the $941,620

2  The balance of the FY 2012 withhold of $470,810 is reflected in the DHSS FY2013 budget as a core reduction (netting to $456,686 after application of the Governor’s Reserve) As you can see from the funding trend chart in your materials, in general, funding for the AAA’s has been trending downwards for the past five years. Federal funding is fairly flat, with the exception of the infusion of ARRA funds in 2010 on a temporary basis. State funding has been steadily decreasing through budget cuts in the General Assembly and through Governor withholdings.

Missouri Funding Trend Chart 2008-2012

ONGOING ONGOING TOTAL FEDERAL STATE TEMPORARY FUNDING FUNDING FUNDING FUNDING 2008 $39,482,230 $27,015,657 $12,466,573 $0 2009 $40,389,158 $27,928,107 $12,096,784 $364,267 2010 $39,068,898 $27,744,977 $9,335,053 $1,988,868

3 2011 $36,825,485 $27,751,941 $9,041,042 $32,502 2012 $37,172,904 $27,617,020 $9,555,884 $0

What is the impact of this funding trend? Earlier this year, when I testified I provided examples from the 10 Area Agencies on Aging regarding impact on their meals programs. And I have included this information in your background materials.

However, we examined the data gathered by the state’s NAPIS system and we are seeing a downward trend there too in the number of people served in the home delivered meals program, which is tracking the downward funding trends. Between 2007 and 2011 the number of people served has declined from 34,241 to 31,595. (This represents unduplicated clients receiving home-delivered meals).

FY2007 FY2008 FY2009 FY2010 FY2011 34241 35530 33716 32373 31595

In the interest of time, I will not go over the following background materials. They are here for your reference. But let me say that this downward funding spiral is eroding the program for seniors we are working to serve currently. And, it is threatening the program’s ability to serve the emergent senior population who will need this service. We know from the latest census, for example, that the fastest growing age group within the senior population are those 80 and above and those 90 and above, in other words those who tend to be more vulnerable.

We thank you for your confidence in our programs over the years and we ask again for your support now when it is really needed.

BACKGROUND ON FUNDING

In FY 2010 the Missouri General Assembly cut the home delivered meals program by $1,421,354. Policymakers stated at the time that although it was a core cut, it was their intention to restore the cut in the next fiscal year. (A core cut is a permanent cut to the budget versus a one-time cut). When this cut occurred, ARRA funds were used to “back- fill” this GR loss for FY10, but still resulted in a net loss of approximately $200,000.

In 2010 the General Assembly did not restore the funding for FY11. Therefore, the lower appropriation level was used to determine the DHSS “core budget” for FY11. For FY11, there were no ARRA funds resulting in a GR decrease of approximately $1.4 million for the home-delivered meal program with no amelioration. For FY 2012, budget proposals suggested funding at the FY11 level reflecting the $1.4 million cut, in essence, making the earlier temporary cut a permanent cut.

In FY 2010 federal stimulus dollars filled the gap. Moreover, the area agencies took several measures to protect the meals for seniors programs -- they cut staff, cut other services such as transportation or legal services, increased local fundraising -- all to protect this core program.

4 IMPACT OF CUTS

Still, the cuts were felt and had a significant impact on Missouri’s seniors and communities. Some examples----

 In Northwest Missouri, $90,000 was cut from the home delivered meals program alone, which translated into 16,500 meals.

 In Southwest Missouri one center (Crane) was forced to close completely, removing that resource to about 50 seniors; the number of meals per week available to some clients had to be cut back. The area agency cut supportive service programs (transportation, legal referrals, etc.) by 5% to have additional meal dollars. Despite these additional cost-saving measures, the southwest area served 26,036 fewer meals in FY 10 than in 09.

 In Region X (the Joplin area) the area agency lost funding resulted in the closing of the senior center in downtown Joplin and the loss of 4 employees.

 The Mid- East AAA was forced to close a center in Gerald, Missouri -- and another in St. Ann. That area agency has seen a decrease in numbers of 14,563 in FY 2009 and 52,587 in FY 2010.

 St. Louis City was forced to cut 6 meal delivery days out of the calendar for all clients, developed a six month backlog of people needing home delivered meal services; and reduced services in all other programs to save food dollars.

 In Northeast Missouri because of reduced funding the number of meals available decreased (some contractors went from serving meals 6 days a week to 5 and one contractor is delivering meals 3 days a week instead of 5). Also in FY 10 funding cuts contributed to the closing of a satellite site in Jonesburg.

 In Southeast Missouri, the area agency has been forced to deny requests from 5 town leaders for funding to start/operate Senior Centers. Additionally, the agency is unable to allow 2 meals/day to be served to an individual, even if an individual’s health/situation dictates that vital need.

 In mid Missouri, Columbia and the state capitol, total meals served were down by 100,000 during 2010.

 In the Kansas City region, this program year, MARC has phased out the MARC- Direct operated senior centers and solicited community sponsors. No sponsor emerged for the program in Gladstone Mo. and that program will close effective

5 12/31/11. Community sponsors were found for the programs in Belton and Buckner.

INCREASED COST OF MEALS On top of all of this, over the past five years, the area agencies have experienced a steady increase in the cost of meals on average. The impact of meals funding cuts will be magnified as the cost of meals continues to increase.

All of this falls hard on seniors and aggravates their existing health conditions.

If only 90 seniors (less than one person per county) enter a nursing home because of the loss of the home-delivered meal service, the state will spend MORE in MO HealthNet general revenue match for their nursing home care than the state would have spent if it provided the full $1.4 million in general revenue for the home-delivered meals.*

ABOUT THE HOME DELIVERED MEALS PROGRAM

The home delivered meals program is designed to deliver a nutritionally balanced meal that represents one-third of a typical adult’s Recommended Daily Allowance of nutrients to homebound individuals. Participants must be 60 years of age or older and physically or mentally unable to leave their homes. Priority is given to people who have no immediate family members available to assist in meal preparation or delivery; individuals in greatest economic and social need; and people who are in the protective services program of the Missouri Division of Senior and Disability Services.

A high percentage of these meals are delivered by local volunteer drivers. State funding for this program is combined with federal funds, client contributions and other private and public donations to expand the reach of the program.

During 2010, the 10 Area Agencies on Aging delivered more than 5.2 million meals to Missouri seniors in their homes.

When the Older Americans Act established the nutrition (meals) program, it was because America’s seniors were living in poverty and going hungry. Over the past five decades the program has helped turn that situation around -- but we must remain watchful and not slip back. Despite our advances, 9% of Missouri’s seniors continue to live in poverty with a median income of about $27,000. The meals programs help people live independently for as long as they can by keeping them strong – and that goal becomes more difficult every time we ratchet back on our ability to serve them.

A complete position paper regarding the Home Delivered Meals Program is available from MA4 at the following link: http://www.ma4web.org/wp- content/uploads/2011/02/Seniormealspaper-v-2.pdf

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6 *Average MO HealthNet cost for a nursing home bed is $132.00 per day. Medicaid participation rates are variable – MA4 assumed a 40% state match rate for this calculation.