Advocacy in Action

1. Advocacy in Action n4a Legislative Update Amy Gotwals Senior Director, Public Policy and Advocacy April 22, 2013

2. The Budget • Pre-BCA realities • Budget Control Act, July 2011 Debt Ceiling, Discretionary Caps, “Super Committee,” Sequester • Post-BCA • Fiscal Cliff (Taxes) • Sequester • Budget Resolutions • Cuts to Mandatory Programs?

3. 2013 Policy Priorities • Reauthorize Older Americans Act • Enhancing the Health of Older Adults • Preserving the Safety Net • FY 2014 Appropriations • Promoting Community Living & Mobility

4. Reauthorize OAA • Engaged with all key Hill leaders and staff • Timing remains unclear • LCAO Letter to Congress • Tuesday morning panel

5. Enhancing the Health of Older Adults • Medicaid Managed LTSS • Care Transitions • ADRCs • Prevention and Wellness • MIPPA

6. Preserving the Safety Net • Medicare • Protecting beneficiaries from shifted costs • Medicaid • Opposing block grants, per-capita caps, similar proposals • Social Security • Opposing chained CPI

7. FY 2014 Appropriations • End sequestration • FY 2014 OAA request sent to Hill last week (at least 5.26%, hold harmless) • III B Supportive Services, III E NFCSP, VI Native American • SHIPs, Elder Justice Act (APS), CDSMP and falls prevention  Advocacy Opportunity: Sanders DC Letter

8. Sequestration • Went into effect on March 1 • In FY 2013: roughly 5 percent across-the-board cut but some OAA programs affected differently based on formulas, so wide range between states in III B • Final sequester #s dependent on final FY 2013 appropriations ACL expects to release final figures in next week or so

9. Sequestration • BCA continues sequester through 2021 • “Out years” (FY ‘14-’21) sequester operates differently • Forces the BCA caps lower instead of an across-the-board cut • Pressure is on appropriators to decide where to cut, but pie made much smaller

10. Sequestration Quandary • Focus has rightly shifted from Advocacy  Administration • What’s best for your clients doesn’t usually make the best news story • How will we get sequester turned off if harms aren’t immediately evident? “We have good people dedicated to service who are mitigating your foolishness!”

11. Sequestration Messaging • Transparency is important (Carry-over funds, one-time options, transfer authority, etc.) • What magic did you work this year that you wouldn’t be able to next year? • Are you ready for the press calls when you close a program?

12. Sequestration & Media • Plan your message • Make clear sequestration’s role • Make clear it would be worse but for… • Make clear it will get worse if it continues • Make clear why this choice to take the hit • Keep circling back to the need in your community and what you need to meet it

13. n4a Sequestration Efforts • Continued direct advocacy with Capitol Hill • Two policy webinars since January • n4a Sequestration Central launched last week to provide resources, gather examples • Advocacy Opportunity: Please fill out the n4a sequestration survey! Deadline Friday, April 26

14. FY 2013 Continuing Resolution • Measure, passed in March, finalizes remaining 6 months of funding until FY 2014 starts on Oct. 1. • Did not turn off sequestration! • Final numbers (incl sequester) have not yet been released . Why? Complicated math: --First half of year was 0.189% higher than FY 2012 --Second half needed to be reduced to fit under the BCA caps --Plus 0.2% rescission (aka 2nd sequester)

15. FY 2013 Continuing Resolution • Cut $200 million from the $500 million Community-based Care Transitions Program (CCTP, Sec. 3026 of ACA) • 92 of 102 CCTP sites involve AAAs in leadership role • CMS has said current contracts will not be affected • n4a working with NTOCC; Letter and meeting request in to CMS

16. FY 2013 PPHF Allocations • Just last week, ACA’s Prevention and Public Health Fund (PPHF) allocations were announced by Sec. of HHS Sebelius • ACL secured $ for 3 programs, but reduced amts • CDSMP down to $7.1 mil from 10 in FY 2012 • Alzheimer’s 150k • APS $2 mil down from 6 in FY 2012

17. President’s FY 2014 Budget • Usually released 1st week February • 2013: President’s Budget was 9 weeks late • White House bargaining position on any future deficit reduction deals • Lays out FY 2014 suggested appropriations levels • Turns off sequester for remaining 9 years More from Ellen…

18. President’s FY 2014 Budget OLDER AMERICANS ACT • Core programs level funded at FY 2012 levels • This represents a “win” in 2013 • Exception: Title V SCSEP cut 15% ($68 million cut out of $448 million program)

19. President’s FY 2014 Budget ADMINISTRATION FOR COMMUNITY LIVING • 1st budget as consolidated agency • Movement: Asking for OAA Title V and SHIPs to move from DOL/CMS over to ACL • Increases: Proposes new and restored Alzheimer’s funding (some PPHF); boosts APS to $8 million (from approps)

20. President’s FY 2014 Budget ADMINISTRATION FOR COMMUNITY LIVING • PPHF requests: • $10 mil Chronic Disease Self-Mgmt Program • $10.5 Administration’s Alzheimer’s Initiative • No $ requested for falls prevention

21. What’s Next? • Debt ceiling fight is next opportunity to turn off sequester, make other deficit reduction deals • Appropriators have begun their annual work; so we must as well!

22. Timing • Spring/Summer: Sequester Realities • Late April: FY 2014 Approps Advocacy campaign begins (5.26% hold harmless) [Find tools on www.n4a.org] • Now/Summer & Beyond: Engage on Deficit Reduction, Medicare & Social Security proposals • Summer/Fall? OAA Reauthorization?

23. Call to Action • Continue to engage your Members of Congress. Let them know how the sequester will affect your community’s federally funded programs, your agency’s ability to meet the needs of your clients, and the ripple effects on the health and independence of older adults and caregivers. • Keep them informed about major changes you are forced to make.

24. Questions? n4a’s Public Policy & Advocacy Staff Amy E. Gotwals, agotwals@n4a.orgNeal Karkhanis, nkarkhanis@n4a.org www.n4a.org/advocacy www.twitter.com/n4aACTIONwww.twitter.com/amygotwals