By Gema G. Hernández

I have to give credit to the Bush Administration for executing such a well thought out and perfect plan that as of now appears to be on schedule. The plan is not new and it has been moving slowly to its final conclusion projected to take place in 2006. To the surprise of many, I am not referring to the Modernization of the Medicare plan, but to the merging of elders and disabled adults into one huge category.

In times of budget crisis, whether created on purpose by removing a trillion dollars from the government's coffers or not, the public tends to bypass the analysis of the fine print of new government initiatives. The agencies tend to project what are going to be the unintended consequences of government actions to the missions of their respective organizations. In times of crisis we pull together to survive. This is such a time.

Let me start by saying that for years the service providers and the Area Agency on Aging have followed the funding regardless whether or not the new available funding compliments the objectives of the agency or the core service competencies the agency possesses. The administration knows very well that the best way to dismantle the existing powerful aging network is to do it one piece at a time with new funding initiatives that will move the agency from focusing exclusively on elders to other client populations. The plan is to introduce new funding which involves providing services to more than just elders. The plan is to begin to merge several populations at the time they need information, at the time that they are in serious need of help.

If an agency is forced to consider other options in order to financially survive, the not for profit agency and its Board of Directors will vote to add the new group to the mission of the agency. Adding a new group detracts from the focus on elders, but because the eyes of the agency is on the funding, this change in focus will not be noticed. All this will be done without a fight. It can be said that if confronted with this master plan to dismantle the aging service providers' network the administration would simply say that those agencies applied for the "new money" and it was up to those agencies to choose serving other groups and not just elders.

The implementation of this portion of the plan began last year when agencies were given funding to implement a one stop information and referral center for individuals with disabilities and elders. The plan will continue this year with an additional nine (9) million dollars to be given to nine additional states to expand the institutionalization of the central point of access for elders and disabled adults.

The above is an effective mechanism to take away the emphasis and support to our generation of heroes. To make sure the dismantling of the aging network is effective and fast the administration is implementing other strategies. The 10 Billion dollars in temporary Federal Assistance Program expired 6/30/04. At this time States are in desperate need to address this issue and will be willing to accept any variation to the program. This is the time to introduce the "Modernization of the Medicaid plan." This modernization will be headed by the Governors' Association, so it will give the impression it is a bipartisan proposal. To prepare for the event that is already in the works, states like Florida, who will play a leadership role in all of this, have introduced legislation to accommodate the transfer of Medicaid dollars to one lump sum category.

Medicaid Block grants to the states is another way to dismantle the aging service network. By lumping together all the Medicaid waiver programs in one huge block grant and by leaving on a temporary basis the Older Americans Act money separate, the network will have no choice but to reinvent itself in the process. The "new" huge block grant will first provide the appearance that there is more money coming in to the individuals in need of services because each group will look at the final budget figures when in reality they should look at their disappearing dollars.

They should track how this "huge" budget category intends to serve the many groups it now covers. The individual sum coming from each budget category is in this case not greater than its individual parts. But few people will know that behind the "huge" block grant there are serious budget cuts to their individual programs. Few people will also discover that if we continue to be a Medicaid provider now by default we need focus on frailty levels and not age. Maybe this is a good idea, but if this is the case the well accepted concept that each cohort has different values, experiences and needs should also be revised or eliminated altogether.

In addition to the "initiative" and "huge" block grants, the administration's plan is to introduce new titles to existing Act or modify their wording. Adding a new title or changing a few words to an existing congressionally mandated program is not going to raise a lot of attention, but it provides a foothold for further changes.

One case in point is the fact that in the Modernization of the Medicare program the eyes of the world are in the Prescription Drug coverage, but this is not the most troublesome part of the act. The most troublesome part of the Medicare Modernization Act is in title 8 that capitates further expenditures if the cost of the Medicare program goes above a certain level. This minor detail not mentioned by any one media outlet or observer would take away the peace of mind and security of future retirees unless they are Donald Trump or Bill Gates. It establishes a foothold for health care rationing and by the time people begin to react the foothold has now been executed to the detriment of the baby boom generation.

Such a foothold also exists in the Family Caregivers Program. A program that has been hijacked by the administration and converted to something different that shifts the focus from helping families to emphasizing family responsibilities to do more for their loved ones. The Family Caregivers program eliminates the age requirement and concentrates on the family, not the individual elder or the frail person in need of help. This is another minor adjustment that takes the focus away from the elder. It is very possible that the Family Caregivers Initiative will be the only Act in the Older Americans Act Program to receive funding, and as such, more and more agencies will modify their mission and their programs to follow those dollars.

If the next White House Conference on Aging takes place under a Republican administration, it is very possible that the process of dismantling the aging service providers' network will be accelerated. There is nothing outside the Older Americans Act that requires the existence of the Area Agencies on Aging. Nothing outside the Older Americans Act that mandates each state to have a State Unit on Aging therefore, with the Medicaid money leaving to be administered by Medicaid state agencies and the Medicare money going to support more HMOs and HMOs willing to integrate the acute and long term care systems to save money and streamline the service delivery systems for elders what would be the role of the AAAs?

The plan is there and all the pieces are falling in place, from AARP supporting the Medicare reform to the fragmentation of voices in the Leadership Council on Aging organizations. What is next? To learn more about the plan check this site in the coming weeks.