WICS Live: Around the States

California: Federal Court of Appeals Ruling Blocks State from Implementing Medi-Cal Provider Cuts: The U.S. Court of Appeals July 8th upheld a lower court ruling, preventing the state from reducing Medicaid provider reimbursements by 10% that was to take effect in July 2008. The appeals court ruled that the state violated federal Medicaid law by failing to consider how the across-the-board provider rate cuts would affect quality and access to care. The court said a state budget crisis could not be used as a justification for illegal cuts in the Medicaid program. California can appeal the ruling or ask for an en banc ruling. However, the ruling could cost the state $56 million in retroactive payments; it could be more if providers are entitled to interest. This ruling now jeopardizes a second-round of rate cuts that took effect March 1st and are also before the 9th Circuit. As part of its budget compromise, the state is implmenting a rate freeze, beginning August 1st. Read more!

State Budget Updates

Following the passage of the Indiana state budget, Family and Social Service Agency Secretary Anne Murphy has assured Indiana provider association, INARF, that there would not be a 5% reduction in Medicaid rates, although no written language was included in the budget. Other senior officials indicated the ability to continue aggressively taking people off the waiting list.

Colorado ended their 2008/2009 legislative session with no reduction to community services for individuals with developmental disabilities.

Both Indiana and Colorado note that their budgets would not have been preserved with out the temporary increase in FMAP from the Recovery Act. Indiana received $2.4 billion in Recovery Act funding. The total stimulus revenue available for the state budget is $2.4 billion, $1.4 billion for Medicaid and one billion dollars for fiscal stabilization.

ANCOR staff would like to thank State Association Executives Jim Hammond with INARF from Indiana and Chris Collins with Alliance from Colorado for these updates.

Read more!

CMS Issues ICF/MR Clarifying Memo on “Client Right to Manage Financial Affairs and Money Management Training”

CMS issued the letter on July 10th. ANCOR offered comments prior to the letter publication and many suggestions were incorporated. The letter puts the assessment and determination for the need for formal money management programs in the hands of the interdisciplinary team (IDT). Providers who are cited will want to have this letter handy – as long as their IDTs review the comprehensive functional assessment (CFA) and discuss the need for a formal program for each client (who is the chronological age to utilize money) and document their reasoning when there is no formal objective. If the surveyors find that the CFA and the individual’s skills (and age) support the need for a formal program, and there is not one, they can cite a deficiency during the survey process.

ANCOR suggestions incorporated into the letter:
· Added the use of the “formal objective” vs. just saying money management program
· Changed several “must be” to “is” to show that the standard regarding use of CFA continues and is not new
· Softened what must be included in the assessment from dictating - “Assessment findings should include at a minimum:” and changed it to “Assessment findings to be considered by the team include skills that can be cross-utilized in training programs such as:”
· Took out the use of the work “transferable” but changed it to “cross-utilized”.
· Added that the CFA must be reviewed at least annually, but did leave in that the annual review “should always include an update to the CFA and take into consideration any changes in the individual’s circumstances since the last IDT.”

Read more!

FY 2010 Appropriations Likely to Take Center Stage on House and Senate Floors in July

With three months remaining in FY 2009, Congress has yet to pass all twelve FY 2010 appropriations before the October 1st start of the fiscal year. The House has passed four of its bills, the Senate none. The House is scheduled to vote on four more this week while the Senate hopes to complete action on two. The House Appropriations Labor-HHS-Education Subcommittee approved by voice vote today a FY 2010 spending bill that would provide $160.7 billion in discretionary spending, about $5 billion more than the 2009 enacted level and $52 million below what the president requested. Housing and Urban Development has not yet been considered. Labor-HHS-Education and T-HUD are tentatively scheduled for action on the House floor before the summer recess. Read more!

Administration Releases Grants to States and Calls on Nation to Prepare for Fall Flu and H1N1 Virus

HHS July 7th sent out a press release asking the public to prepare for the fall flu season and ongoing H1N1 flu outbreak. Secretary Sebelius asks the “American people to become actively engaged with their own preparation and prevention. It’s a responsibility we all share.” HHS launched a new website www.flu.gov to help centralize communications about the H1N1 flu as well as a Public Service Announcement campaign to encourage the public to become more involved.

UPDATE July 10, 2009: States Now Eligible to Receive $350 Million for H1N1, Seasonal Flu Preparedness Efforts--Grants Will Support Work to Protect Public Health, Prepare for H1N1 and Seasonal Flu

Secretary Sebelius today announced the availability of $350 million in grants to help states and territories prepare for the H1N1 flu virus and the fall flu season. The grants were funded by the recent supplemental appropriations bill that was passed by Congress and signed into law by the President on June 24, 2009.


Read more!

Send State Budget and Medicaid Updates to ANCOR

Don’t forget! ANCOR wants to hear from you on state specific news related to Medicaid, budgets, or other issues of importance to providers. Sharing this information with ANCOR gives you the opportunity to inform ANCOR membership about what is happening in your state—your news will be published in WICs Live! Send updates to ANCOR staff, Mary Pauline Jones at mpjones@ancor.org.
Read more!

States Continue to Face Short Falls as FY 2010 Budgets Wrap Up—Watch for ANCOR Survey

At least 48 states addressed or are facing shortfalls in their budgets for the upcoming year totaling $166 billion or 24 percent of state budgets. The Center on Budget and Policy Priorities reports that a majority of states expect shortfalls in 2011 as well. Most states start their fiscal year July 1st and have either adopted budgets for fiscal year 2010 or will do so shortly. Combining those new shortfalls with the fiscal year 2010 gaps already addressed, and those faced by states that have not yet completed their budgets, the total amount for fiscal year 2010 is at least $166 billion.

Watch for a survey late next week from ANCOR that asks members about the effect of their states’ budgets on providers. Read more!

Judge Decertifies Class Seeking Rights of Illinois Institutional Residents to LIve in the Community

On July 7, a federal district court issued an order decertifying an Illinois class in Elias v. Maram, a lawsuit seeking to provide individuals with developmental disabilities in Illinois the opportunity to live in the community.Advocates in Illinois had reached a settlement with the state to place 6,000 people in the community over a multi-year period. The suit, filed four years ago, alleges that Illinois does too little to offer community-based living options to people with disabilities as guaranteed in the Supreme Court’s 1999 Olmstead ruling. Under that decision, the court said that states have an obligation to provide care for people with disabilities in a community setting, where medically possible. However, according to the American Association for People with Disabilities, the Voice of the Retarded (VOR) rallied objections, leading the judge to decertify the class. The VOR stated their family members are best cared for in institutions and feared the settlement would divert funding from those facilities.
Read more!

Please Welcome Our New Government Relations Staff Member Mary Pauline Jones

Mary Pauline Jones comes to us from the House Oversight and Government Reform Committee where she worked under former Congressman Tom Davis (R-VA). Previously, she has worked for the U.S. Department of Education Office of Special Education and Rehabilitative Services and has done political consulting in Virginia. Mary Pauline is ANCOR members’ direct contact on state budget and Medicaid, Emergency Preparedness, and ANCOR’s grassroots efforts. Mary Pauline can be contacted at mpjones@ancor.org.

Please join ANCOR in welcoming Mary Pauline!
Read more!

Braddock Releases Study on Illinois Developmental Disability Services and Funding

Dr. David Braddock today released Services and Funding for People with Developmental Disabilities in Illinois: A Multi-State Comparative Analysis, an analysis of services and funding for people with developmental disabilities in the state of IllinoisThe study compares the performance of Illinois with five other Midwestern states of Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Data for this report is drawn from the seventh edition of the State of the States in Developmental Disabilities and supplemented with data from the state of Illinois.
Read more!

Franken Takes Seat in Senate and on HELP Committee

Al Franken (D-MN) was installed as Minnesota’s junior Senator. With Franken’s swearing-in, the Democratic caucus would now have a filibuster-proof, 60-vote majority, if Senators Kennedy (D-MA) and Byrd (D-WV) were not absent for health reasons. Franken will serve on the HELP committee, relieving Senator Whitehouse (D-RI) of his temporary duty on that committee. Franken will also serve on the Aging, Indian Affairs, and Judiciary committees. Read more!

HUD Releases 4000 Section 8 Housing Choice Vouchers

July 10, 2009 Reminder: Comments on the Section 8 Housing Choice Voucher Notice of Available Funding are due Monday, July 13th. ANCOR will be commenting on the notice. See below for a link to the notice from HUD.

On July 1st, HUD joined President Obama's commemoration of the tenth anniversary of the Supreme Court's Olmstead decision by announcing that it will offer rental assistance to 4,000 non-elderly families with disabilities, including 1,000 vouchers specifically targeted to those transitioning out of nursing homes and other facilities. Through its funding notice, HUD is seeking comment from public housing authorities and others to ensure this critically needed assistance is distributed and administered in the most effective manner possible.

Today's announcement coincides with the tenth anniversary of the Supreme Court's ruling in Olmstead v. L.C. & E.W. which affirmed the rights of individuals with disabilities to live independently. To commemorate this landmark decision, President Obama declared 2009 the Year of Community Living.(see related article)

"As individuals with disabilities leave institutional care, it is essential that they have housing options that will allow them to live independently," said HUD Secretary Shaun Donovan. "As we prepare to launch this initiative, we also want to make certain that we get input from local housing experts, disability rights advocates and others who can help us target this assistance to those who need it most. We also recognize how important it is for HUD and HHS to coordinate our resources to enable community-living for those individuals that live with disabilities."

HUD's Notice of Funding Availability (NOFA) will make $30 million in voucher assistance available to support approximately 4,000 Housing Choice Vouchers for non-elderly disabled families. HUD is making a 1,000 of those vouchers available specifically for individuals transitioning out of nursing homes and other institutions. These vouchers directly support a $1.75 billion initiative of the U.S. Department of Health and Human Services (HHS) to help persons who reside in health care settings move to community-based living. While HHS' Money Follows the Person (MFP) program offers health care, case management and other services to qualified families, it does not include funding for housing. HUD's funding initiative is designed to fill that gap.

The remaining 3,000 Housing Choice Vouchers are available to assist any non-elderly disabled family. The Department is encouraging local housing authorities to give strong consideration to using some or all of these vouchers to provide housing for those non-elderly persons that are living in the community, but are at-risk for institutionalization. Comments on the NOFA are due Monday, July 13th. ANCOR will be submitting comments. Read more!

CMS Releases New FMAP Frequently Asked Questions

Today, the CMS released one of a series of Medicaid Frequently Asked Questions (FAQs) designed to provide guidance on the implementation of the American Recovery and Reinvestment Act of 2009 (ARRA), Public Law 111-5.The FAQs address questions that have been submitted to the ARRA mailbox, CMSOARRAQuestions@cms.hhs.gov. Future Medicaid FAQs letters will be issued in the coming weeks and months. This CMS document, along with other CMS documents on the FMAP increase under the ARRA stimulus legislation is available on ANCOR’s Economic Recovery web page. Read more!

Long Term Services Provisions Gain Bi-Partisan Approval in Senate HELP Committee Health Legislation Mark Up

The Senate HELP Committee today finished marking up long-term service provisions, also known as the Community Living Assistance Supports and Services (CLASS) Act, included in the panel's healthcare overhaul. The measure received bi-partisan support from the committee after members agreed by voice vote to add a provision that would ensure the program’s solvency. ANCOR supports the CLASS Act, which creates a voluntary opt-out payroll deduction that would provide people experiencing functional impairments with tiered benefits if they have contributed a monthly premium over five years. The Congressional Budget Office estimated the program will save the government $58 billion over the first 10 years—taking pressure off Medicaid as the primary financier of long-term care. In addition, the program would be a new, private source of funding for ANCOR members and others that provide long-term supports and services. The Obama administration supports including the long-term care measures in healthcare reform. In a letter sent to Senate Democrats today, HHS Secretary Sebelius called the plan "innovative."

Thank you to ANCOR members that urged their Senators to support the CLASS Act and the inclusion of long-term services and supports in health reform legislation.


Read more!

Secretary Sebelius Releases New State by State Reports Highlighting Urgent Need for Health Reform

HHS Secretary Kathleen Sebelius today released a series of new reports on the health care status quo that highlight the urgent need for health reform across the nation. The new reports are available at www.HealthReform.gov and include information on health care cost and quality in all fifty states. Read more!

Make Appointments to Meet with Your Member of Congress During July 4th Recess

Make appointments to meet with your members of Congress during the July 4th Congressional recess (June 30th -July 3rd)! Watch for Town Hall Meeting notices from ANCOR that list other opportunities to reach out to members of Congress and their staff. Read more!

DOL Annouces Disability Employment Month Theme: Expectation + Opportunity = Full Participation

The U.S. Department of Labor today announced “Expectation + Opportunity = Full Participation” as the official theme for October’s National Disability Employment Awareness Month. It is intended to urge employers, as they seek to fill positions, to embrace the richness of America’s diversity by considering the talents of all workers, including workers with disabilities.

This year’s theme emphasizes the vision of the Labor Department’s Office of Disability Employment Policy (ODEP): a world in which people with disabilities have unlimited employment opportunities. Early selection of an annual theme for upcoming National Disability Employment Awareness Month helps the private sector; federal, state and local governments; and advocacy organizations plan events and programs that showcase the abilities and skills of job seekers and working Americans who have disabilities.

ODEP is the nation’s first assistant secretary-led office that addresses policies that impact upon the employment of people with disabilities. The office provides national leadership on disability employment policy by developing and influencing the use of evidence-based disability employment policies and practices, building collaborative partnerships, and delivering authoritative and credible data on the employment of people with disabilities.

As background for National Disability Employment Awareness Month, Public Law 176, enacted by Congress in 1945, designated the first week in October as “National Employ the Physically Handicapped Week.” President Harry S. Truman designated the (now former) President’s Committee on Employment of People with Disabilities to carry out the law. Congress changed the name to “National Disability Employment Awareness Month” in 1988. The responsibility for leading the nationwide recognition was transferred to the newly created ODEP in 2001. Read more!

Six New Co-Sponsors in June for Workforce Bill

Representatives Betty McCollum (D-MN), Pete Sessions (R-TX), Rosa DeLauro (D-CT, and Steve Isreal (D-NY) have recently signed on to the Direct Support Professional Fairness and Security Act (H.R. 868)! Thank you to ANCOR members in Minnesota, Texas, Connecticut, and New York for reaching out to these members.

See all 23 members of Congress supporting the bill so far! Read more!

Questions About Pan Flu?

ANCOR will continue its dialog with CMS as this situation unfolds. If you have questions about pandemic flu or emergency preparedness, or information on what your state is doing to prepare providers, please contact Jessica Sadowsky (jsadowsky@ancor.org) Read more!

CMS June 17th Letter to Medicaid Directors Summarizing ARRA

This letter is one of a series designed to provide guidance on the implementation of the American Recovery and Reinvestment Act of 2009 (ARRA), Public Law 111-5. It summarizes most sections of ARRA that impact titles XIX (the Medicaid program) and XXI (the Children’s Health Insurance Program, or CHIP) of the Social Security Act (the Act) and provides detail on the sections specific to payments that should not be counted for purposes of eligibility for Federal programs. This letter includes information on the FMAP and disregard of one-time only SSI $250 check for purposes of all federally funded programs. Read more!

State Revenues Plunge

Personal income taxes paid to the states plummeted 26 percent, or $28.8 billion, in the first four months of 2009, compared with the same time period last year, the Nelson A. Rockefeller Institute of Government said in its June 18 report.
Read more!

President Proclaims Year of Community Living

Marking the 10th Anniversary of the U.S. Supreme Court’s Olmstead decision, President Obama launched a new effort to assist Americans with disabilities—The Year of Community Living. The President directed Health and Human Services Secretary Kathleen Sebelius and Housing and Urban Development Secretary Shaun Donovan to work together to identify ways to improve access to housing, community supports, and independent living arrangements. In joining the President in commemorating the anniversary of the Olmstead decision, HHS Secretary Sebelius announced that agencies within her department would begin aggressively addressing barriers that prevent some Americans with disabilities from enjoying a meaningful life as part of their community.

Throughout this “Year of Community Living,” HHS will hold listening sessions, giving stakeholders an opportunity to come together for a common purpose: overcoming barriers to community-based living for people with disabilities and the elderly. These forums will help HHS craft the agenda to improve federal programs and better support the efforts of state and local government.

HUD announced that it will make1,000 housing vouchers available for individuals with disabilities transitioning from institutions to the community—targeting states operating Money Follows the Person Demonstration programs. HUD will award an additional 3,000 housing vouchers to serve non-elderly people with disabilities and encourage Public Housing Authorities to form working relationships with state Medicaid agencies interested in addressing community living needs of beneficiaries.
See the next issue of LINKs for more information. Read more!

CMS Issues Advance Notice of HCBS Waiver Rulemaking

The June 22nd Federal Register included a CMS Advanced notice of proposed rulemaking on the Medicaid 1915(c) waiver. The notice invites advanced public comments by August 21, 2009. The “advanced” notice is an announcement of CMS’ intention to publish a proposed rule and solicit public comments on the changes. Last year, ANCOR provided CMS with comments on the areas it is now asking for public comments on in this advanced notice. CMS is seeking to make changes in several areas: providing states with the option of designing 1915(c) waivers to serve more than one targeted population based on functional need rather than diagnosis or condition: recommendations to strengthen person-centered principles in HCBS waiver; requirements related to identifying home and community-based character of HCBS settings; and standards for defining home and community under waivers and CMS approval of a state’s definition. ANCOR will be submitting comments to CMS. Read more!

Senate Health Reform Proposals Hit Bumps

The HELP committee began marking up this week its version of health care reform as scheduled. The incomplete proposal, according to the CBO, has an initial price tag of $1 trillion. HELP and Finance originally planned to mark up their bills this month and then merge negotiations after the July Fourth recess. However, Senate Finance Chairman Baucus (D-MT) announced that the Finance committee’s scheduled markup next week would be delayed until after July Fourth due to his determination to bring the $1.6 trillion Finance proposal down to less than $1 trillion AND make it deficit neutral. Read more!

House Plan for Health Care Reform Unveiled

House Democrats released today an 852-page discussion draft of their health care reform proposal. The three House committees that worked together on the proposal(Ways and Means, Energy and Commerce, Education and Labor) will begin debate on the measure in hearings next week. They are expected to mark up the bill soon after the July Fourth recess. Watch WICs Live and ANCOR's web for more information next week. Read more!

Iowa Makes Good on Pledge to Use Enhanced FMAP Exempt Providers from Across Board Cuts

Iowa Governor Chet Culver implemented an across-the-board cut of 6.5% in his FY09 budget. For FY10 beginning July 1, 2009 there was an additional across-the-board cut of 4.8% on top of the previous 6.5%. The good news for Iowa providers is that the Governor made a commitment to them that they would be exempted from the across-the-board cuts if Congress came through with the enhanced FMAP funding via the American Recovery and Reinvestment Act (ARRA) of 2009. The Governor kept his commitment and providers were exempt. Thanks to Rod Braun of Christian Opportunity for this update. Read more!

Federal Sick Leave Bill Introduced

Senator Kennedy (D-MA) and Representative DeLauro (D-CT) introduced The Healthy Families Act (S.1152 and H.R. 2160) which would require employers with 15 or more employees to accrue paid sick leave (with up to 56 hours of paid sick leave) for every 30 hours worked. The paid sick leave could be used after 60 days for an employee to care for the medical needs of a child, parent, spouse, or any blood relative, or for their own medical needs including those resulting from domestic violence. The HFA mandated sick leave would be in addition to leave required under the Family Medical Leave Act or state workers compensation laws, and employers' leave policies would have to be meet the HFA requirements should it be enacted. The Senate bill has 20 cosponsors and the House bill has 105 cosponsors. ANCOR will provide members with additional information on the HFA. Read more!

Bill Watch: The Community Choice Act

The Community Choice Act would provide Americans with equal access to community-based services and supports. This ANCOR-supported bill would provide individuals with disabilities in nursing homes and other institutional settings with options to receive community-based services.Senators Tom Harkin (D-IA) and Arlen Specter (R-PA) along with Representative Danny Davis (D-IL) introduced the Community Choice Act (S. 683; H.R. 1670) on March 23, 2009. The legislation has bi-partisan support. The Community Choice Act has been referenced in testimony at hearings concerning long-term services and supports within the context of health care reform. For more information visit www.passthechoiceact.com. Read more!

Senate Schedule Calls for a Single Bill to Come to Floor in July

Earlier this year, Senators Baucus (D-MT) and Kennedy (D-MA), chairmen of Senate Finance and HELP committees respectively (the Senate committees with jurisdiction over health care), established a joint process to lead a single health care bill to be merged on the Senate floor. Following committee mark-ups, the plans are to take one to two weeks to combine the two bills after the July 4th recess. Type rest of the post here. Read more!

Finance Committee to Release Health Care Reform June 17th

Senate Finance Chairman Baucus (D-MT) is expected to release his health care document in time for a June 18th committee mark up. Finishing touches are being made this weekend on the reform.Baucus said earlier this week that he will keep on schedule, despite still needing cost information from the Congressional Budget Office. The word is that the Finance Committee document will include several of the Medicaid long-term options discussed in an earlier document and supported by ANCOR. Read more!

HELP Committee Releases Health Reform Bill That Includes Long Term Services

Senate HELP Committee Chairman Kennedy (D-MA) released the Affordable Health Choices Act Tuesday which includes the following five major elements: choice, cost reduction, prevention, health system modernization, and long term services and supports. The committee will begin consideration of the 615-page bill, Tuesday, June 16th. The Chairman’s inclusion of his CLASS Act (S. 697), supported by ANCOR, would create a new national insurance program to help adults who have or develop functional impairments to remain independent, employed, and stay a part of their community, is incorporated. This new program, self-funded and actuarially sound, would provide significant savings to the Medicaid program, relieving state and federal budgets as the primary funder of long-term services. It would offer a new funding resource for providers of home and community-based services. Senator Dodd (D-CT), second in Democratic seniority on the committee, is managing the day-to-day work of the HELP Committee during Chairman Kennedy’s absence. Read more!

Celebrate Landmark Olmstead Decision 10th Anniversary

June 22, 2009 marks the 10th anniversary of the U.S. Supreme Court Olmstead decision that upholds the Americans with Disabilities Act requirement that states serve people with disabilities in community settings, rather than segregated institutions. June 22, 2009 marks the 10th anniversary of the U.S. Supreme Court Olmstead decision that upholds the Americans with Disabilities Act requirement that states serve people with disabilities in community settings, rather than segregated institutions. Read more!

Campaign for Disability Employment Announces Video Contest

The Campaign for Disability Employment, a newly-formed collaborative of leading disability organizations funded by the Office of Disability Employment Policy of the U.S. Department of Labor, has announced an online video contest to promote the talent and skills that people with disabilities bring to America's workforce and economy. Videos received by July 15, 2009 will be judged by a panel of representatives from member organizations of the Campaign for Disability Employment. Type rest of the post here. Read more!

Did You Know?

A record 10,552 fair housing discrimination complaints were filed in fiscal year 2008, according to a report released by the U.S. Department of Housing and Urban Development (HUD). The report shows that a large portion of the complaints, 44 percent, were filed by persons with disabilities. Type rest of the post here. Read more!

Chairman Pallone Introduces Senate Version of Empowered at Home Act

House Energy and Commerce Subcommittee on Health Chairman Frank Pallone (D-NJ) introduced today the House version of the Empowered at Home Act (H.R. 2688). This bill would improve the state plan amendment option (1915i) for providing home and community-based services under the Medicaid Program. The state plan amendment option was passed as part of the DRA. Senators John Kerry (D-MA) and Charles Grassley (R-IA) introduced the Senate version in July. Read more!

Survey Shows Weak Fiscal Outlook for States

Although federal Recovery Act dollars have helped states avoid the most drastic budget cuts, state fiscal conditions declined for nearly every state during fiscal year (FY) 2009, according to the latest Fiscal Survey of the States from NGA and the National Association of State Budget Officers (NASBO). Overall, NGA and NASBO found that while general fund expenditures and revenue collections increased for many states in FY 2008, the ongoing recession is adversely affecting states' fiscal outlook for the next several years. Between FY 2009 and 2011, states must fill more than $183.3 billion in budget gaps, after previously closing gaps totaling $46.2 billion.
Read more!

Energy & Commerce Committee Summary of Health Care Reform Legislation

The House Energy and Commerce Committee released today its outline of health reform legislation. House Majority Leader Steny Hoyer (D-MD) said on Monday, "We hope to pass health care reform by August," adding, "That is a target, not a deadline."

Structural Overview
• Ability to keep what you have and minimize disruption.
• Provide a National Health Exchange for individuals and the smallest employers
• Requires shared responsibility among individuals, employers, and the Federal and State Government.
• Provides affordability credits to low and middle income individuals.
• Implements delivery system reforms to promote efficiency and reduce costs.
• Invests in the health care workforce and public health.
• Slows the growth of health care costs and maintains fiscal sustainability.

National Health Exchange, Affordability Credits, Medicaid Improvements
Role of the Exchange
• New independent entity would make health insurance choices available to those without an employer offer, and smallest businesses (the first year: biz under 10 employees; second year: under 20 employees; etc). It would be open to large businesses over time.
• The Exchange would set and enforce standards for health plans; facilitate enrollment; receive/monitor complaints; and administer affordability credits.

Affordability
• Creates Sliding scale affordability for use in exchange for eligible individuals with incomes between Medicaid eligibility and $88,200 for family of 4 (400% of poverty); everyone would be protected by an annual cap on out-of-pocket spending

Choice
• Ensures choice of private and public health insurance plans; provides new options for employers; and maintains and improves Medicaid for low-income individuals and families.

New Public Health Insurance Plan
• Health exchange includes a new public health insurance plan that would be subject to the same market reforms and consumer protections as private plans.
• Plan would have geographic adjusters for prices.
• Plan would ensure transparency, accountability, cost-containment and competition in the market.
• The public health insurance plan would likely be run by HHS, and would be independent of the Health Exchange.
• It would not have government subsidies-it’ll compete on its own.
Provider Participation and Payment
• The public plan would build on Medicare providers and rates, similar to the practices of private plans today.
Benefits, Insurance Market and Reforms, and Consumer Protections
• A public private independent advisory committee would recommend benefit packages based generally on the Federal Employee Health Benefit Plan.
• Several levels of benefits would be available in the Health Exchange. They would predominately differ by cost sharing but additional benefits would be available in higher cost plans.
• After several years employer sponsored health plans would either have to meet the minimum benefit standard of plans operating within the Health Exchange or allow their employees to purchase coverage in the Health Exchange.

Market Reforms and Consumer Protections
• Health insurers, both inside and outside the Exchange, would be required to adhere to new insurance market reforms and consumer protections.

Shared Responsibility- Individual, Employer & Government Requirements
• Individual Responsibility: Individuals would be responsible for having health insurance.
• Employer Responsibility: employers would have the choice to “play” by offering health insurance to employees, or contribute:
o Play: Employers would offer and contribute towards the health coverage of their full-time employees and their dependents.
o Pay: Employers who do not “play” would “pay” by contributing a percentage of payroll.

Investments in Health Care Workforce
• Expand the primary care, nursing and public health work forces through increased support for key programs.
• Create a broad, inter-disciplinary commission to examine ongoing health workforce issues.
• Support workforce diversity efforts including data collection and expansion of workforce programs.
• Remove barriers so hospitals can more easily train residents in community settings.
• Increase funding for scholarships and loan forgiveness to promote primary and nursing care.

Improving Health & Wellness
Prevention & Wellness Programs
• Reduce disparities by supporting evidence-based, community wide efforts & health empowerment zones to improve health and wellness.
• Incorporate and improve prevention services provided in Medicare, Medicaid.
• Strengthen State Departments of Public Health.
• Substantially increased support for Comm Health Centers.
• Data collection improvements; Health IT providing & collecting data to reduce disparities
Read more!

President Obama’s Council of Economic Advisers (CEA) Releases Report June 2nd Making An Economic Argument for Health Care Reform

The new 56-page report argues that reform would raise Americans’ standard of living, lower the federal budget deficit, reduce the unemployment rate and increase the labor supply, and boost the rate of growth of the gross domestic product. By slowing the annual growth rate of health care costs by 1.5 percentage points, the report contends that it “would increase real gross domestic product”—resulting in $2,600 higher income for a family of four in 2020 and $10,000 in 2030. By focusing on containing health care cost growth and expanding health coverage to the uninsured, the report argues that reform would not only raise the standard of living by freeing up resources now spent on medical care, but would also lower the federal deficit since the government spends a significant amount of money on programs such as Medicare and Medicaid. The report comes as both the Administration and Congress gear up to tackle health care reform legislation this month. Read more!

Congress Returned This Week to Face a Four-Week Ambitious Stretch

Among the items on the agenda for the returning Congress are the following: moving ahead on sweeping health care legislation, progress on writing the 12 annual appropriations bills, and global warming legislation. The House expects to markup its 12 spending bills before the month long August recess. Senate Finance and HELP Committees expect to have their health care legislation and markups before the July 4th week-long recess that begins June 29th. Health care is what is on the front burner is pushing other issues that divide the Democratic majority to the sidelines for now. President Obama has said he wants health care reform passed by the August recess and he is planning for he and his Cabinet officials to take to the airwaves to push reform this year. Read more!

ANCOR Submits Written Testimony on Ticket to Work and Social Security Work Incentives

ANCOR submitted this week testimony on 2009 ANCOR Government Relations Priorities on the Ticket to Work and Work Incentives Improvement Act (TWWIIA). 2009 ANCOR Government Relations Priorities ANCOR strongly supported the passage of TWWIIA) because of the program’s possibility to remove work disincentives that prevent individuals with disabilities from working. Special thanks to Tommy Cox of RHA/Howell Care Centers, Inc. in North Carolina for his assistance in drafting the testimony.
Read more!

Secretary Sebelius Announces Appointment of Cindy Mann as Director of the Center for Medicaid and State Operations

U. S. Health and Human Services Secretary Kathleen Sebelius today announced the appointment of Cindy Mann to serve as Director of the Center for Medicaid and State Operations (CMSO), part of the Centers for Medicare & Medicaid Services (CMS). Mann most recently served as a research professor and executive director of the Center for Children and Families at Georgetown University's Health Policy Institute. "Cindy Mann has decades of experience in health care financing at the federal and state level, and vast knowledge of health care policy," said Secretary Sebelius. "She has devoted her career to working on behalf of children and families, the elderly and people with disabilities. She will be an outstanding leader at CMSO, particularly as the nation moves forward with health care reform."

Mann previously served as director of the Family and Children's Health Programs at CMSO from 1999-2001; in that capacity she played a key role in implementing Medicaid and the Children's Health Insurance Program (CHIP).

"Cindy has been instrumental in recent efforts to expand health care coverage in our country," said Sebelius. "Her knowledge of health care issues and management experience will be a great asset to CMSO and to the millions of Americans who rely on Medicaid."

A brief biography is included below:

Cindy Mann, J.D., is a research professor at Georgetown University, Health Policy Institute and the executive director of the Center for Children and Families at the Institute. Her work focuses on health coverage, financing, and access issues affecting low-income populations.
She has written extensively on these issues -- and on how they relate to the Medicaid and CHIP, in particular -- and has worked closely with state and federal policymakers and program administrators on the design and implementation of Medicaid and CHIP. From 1999-2001, Ms. Mann was the director of the Family and Children's Health Program Group at the Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services. In that capacity, she directed, at the federal level, the implementation and oversight of the Medicaid program with respect to families, children, and pregnant women, and oversaw the implementation of CHIP. Prior to her work at HCFA, Ms. Mann led the Center on Budget and Policy Priorities' federal and state health policy work. She also has extensive state-level experience, having worked on health care, welfare, and public finance issues in Massachusetts, Rhode Island, and New York. She holds a law degree from New York University School of Law.

Read more!

Idaho District Court Issues Temporary Restraining Order April 28th Regarding HCBS Habilitation 15 Minute Unbundling and 55% Reimbursement

See Memorandum Opinion on Granting a Temporary Restraining Order on ANCOR's Medicaid One Stop Litigation web page. Read more!

Senate Finance Committee Releases Third and Final Health Care Discussion Document

The Senate Finance Committee released its third health care discussion document May 20th—Financing Comprehensive Health Care Reform—following the May 14th release of Policy Options for Expanding Health Care.This second document included discussion of Medicaid long-term services and supports and policy options. ANCOR, in conjunction with the Consortium for Citizens with Disabilities, are providing comments on these options, as well as offering additional options regarding issues affecting long-term services. As with the first policy document released on April 29th—Transforming the Delivery System—the Committee’s work followed round-tables by leading experts and closed-door Committee sessions. The documents are intended to spur discussion of proposed options.
Read more!

Take Advantage of Memorial Day Recess and Meet with Your Members of Congress

Members of Congress will be in their home states and districts during recess, May 25-29th, making them accessible to you, their constituents. It is up to you to tell you members of Congress how federal legislation will affect your organization and the people you support and employ. A great way to personalize issues is to introduce them to individuals you support, their families, and Direct Support Professionals. Bring them to your meetings with your members of Congress and have them help tell your story.
There are two great ways to reach out to your members of Congress during recess:

• Schedule a meeting with them in their state and district offices -- Use ANCOR's talking points and Advocacy Tool Kit to help get your message to Washington;
• Attend a town hall meeting hosted by your Representatives or Senators. If your members of Congress are holding town hall meetings, you will receive a notice from ANCOR.

Issues currently being addressed in Washington to discuss with your members of Congress include:

• Supporting health care and long-term supports and services reform-including the Community Choice Act (H.R. 1670 and S. 683), the Community Living Assistance Services and Supports Act--CLASS Act (H.R. 1791 and S. 697), and the Empowered at Home Act (S. 434)
• Opposing The Employee Free Choice Act--Card Check Bill (H.R. 1670 and S. 683)
• Supporting the Direct Support Professional Fairness and Security Act (H.R. 868)
• Supporting Frank Melville Supportive Housing Investment Act (H.R. 1675)

Click here for talking points and more information about these topics.

Visit ANCOR's Advocacy Tool Kit for Information on:

• Finding your Members of Congress and their contact information
• Attending town hall meetings
• Sending feedback to ANCOR through our online feedback form
• Don't forget, ANCOR's new handbook, Effective Communication with Congress: Your Guide to Influencing Capitol Hill is a comprehensive publication designed to help you successfully advocate to Congress on behalf of your organization and the people you support and employ. Visit ANCOR's publications web page to order your copies today.

Read more!

Congress Prepares for Four-Month Sprint to Pass Health Care Reform

Two Senate Committees (Finance and Health, Education, Labor and Pensions) and three House Committees (Energy and Commerce, Ways and Means, and Education and Labor) are working on health care reform legislation under their individual committee’s jurisdiction. The Senate is further along in developing its reform packages than the House. In fact, the HELP Committee was expected to introduce legislation by the end of this week. Senate Finance Chairman Baucus (D-MT) still plans to have his committee’s legislative markup completed by the end of June, with a melding of Finance provisions and HELP provisions melded on the Senate floor before the August recess. Read more!

Arizona Court Rescinds Injunction Against State Cuts to DD and Remands Case to Superior Court for Further Proceedings

UPDATE: Yesterday, an Arizona court granted a motion for emergency stay on the injunction issued in March. The state of AZ issued today a notice that provider rates will decrease by 10%.

On April 30, an appellate court in Arizona lifted an order from a lower court blocking the state from cutting funds for disability programs. In a preliminary injunction issued in March, a county Supreme Court moved to block the state from carrying out budget cuts to home and community-based services. The three-judge appellate court ruled unanimously to vacate the lower court’s ruling saying that the plaintiffs had not proven that the budget cuts violate state or federal laws. The judges have remanded the case to a superior court for further proceedings. Read more!

Funding Alert: Two HHS Grant Solicitations under ARRA Including Workforce and Job Training/Recruitment

HHS has just announced two funding opportunities (Strengthening Communities Through Private and Public Partnerships) in which it will make $50 million of American Recovery and Reinvestment Act (ARRA) funds available to eligible applicants, including non-profit and for-profit organizations. Partnering with private and public organizations, HHS will provide one-time, two year grants through two program funds. The focus of these two funding opportunities is to build capacity of nonprofit organizations, whether secular or faith-based, to address the broad recovery issues in their communities, help low-income individuals secure and retain employment, earn higher wages, obtain better-quality jobs, and gain greater access to state and federal benefits and tax credits.

ANCOR encourages its members to consider applying for these federal funds or collaborating with state and local governments or other entities to access these funds.
Read more!

Massachusetts and Kansas Grapple with Proposed Budget Cuts to Disability Services While Nebraska Looks to Increase Funding for Disability Programs

The Massachusetts state Senate may consider increasing the sales tax to avoid deep cuts to human services. The Senate released proposed budget cuts earlier this week that would affect roughly 20,000 individuals with disabilities, cutting nearly two-thirds of all disabilities services according to ANCOR member Gary Blumenthal of ADDP.

Invisible Kansas, an advocacy groups for individuals with disabilities, is speaking out against a budget bill that would cut disability programs. The state legislature has accepted a budget that would further starve an already under funded developmental disability system, according to Invisible Kansas. The budget includes $1.6 million in cuts for Family Support Grants, and a 1% cut from the HCBS DD Waiver. Disability advocates warn that such cuts mean less money to pay providers which could force more individuals with disabilities into institutions.

In Nebraska, the state legislature passed a budget this week that would increase funding for disability programs including $15 million for individuals on a waiting for community-based services. The budget needs final approval from the governor who has not indicated whether or not he will sign it.
Read more!

Michigan, Wisconsin, Louisiana and Maine Face Steep Budget Cuts

Michigan Governor Granholm has ordered a 4% across-the-board spending cut as part of $302 million in budget cuts. Granholm’s plan included $16 million dollars in cuts to Medicaid that have drawn criticism from residents who say the cuts will harm the 1.7 million Michiganders who rely on Medicaid.

In Wisconsin the budget deficit has grown to a historic high of $6.5 billion over three years and Governor Doyle is working on his third budget realignment in five months.

Louisiana’s state health agency issued emergency rules on May 1st cutting Medicaid reimbursement rates by 7%. The state Legislature is deliberating Governor Jindal’s budget proposal which would include $445 million in proposed cuts to human services.

In Maine, Governor Baldacci is proposing to cut more than $35 million from health and human services programs to close a $570 million budget gap. Read more!

California Risks Losing Enhanced FMAP, Seeks $20 Billion Loan

California is in danger of losing billions of dollars in enhanced FMAP if it does not restore wage cuts to home healthcare workers. According to a May 5 opinion by CMS, the cuts, which were passed in February, violate provisions of the ARRA prohibiting states receiving enhanced FMAP from making certain changes to Medicaid programs. In the opinion, CMS determined that California’s proposed cuts to home healthcare workers violate ARRA maintenance of efforts rules by increasing the local government’s share of Medicaid costs. Governor Schwarzenegger sent a letter to HHS Secretary Sebelius urging the government to reconsider rescinding California’s $6.8 billion in FMAP. California will also need to borrow more than $20 billion dollars to close its budget deficit unless voters accept a budget ballot measure on May 19. Without loans and a budget overhaul, the state is expected to run out of cash in July but polls indicate that voters are likely to reject the budget ballot measure. Read more!

Public Emergency Declared Due to Spread of H1N1 Influenza Virus (Swine Flu)

HHS declared a public health emergency April 26th because a strain of the H1N1 Influenza Virus (swine flu) (H1N1) has been diagnosed in people in the United States, Mexico, Canada and elsewhere. In the U.S., the CDC has confirmed 3 deaths as a result of the H1N1 flu virus. View an interactive map of swine flu cases worldwide or a flu tracker. On April 29, the World Health Organization (WHO) raised the influenza pandemic alert from phase 4 to phase 5, meaning that a pandemic may be imminent.

HHS Secretary Sebelius announced April 30th that the federal government will purchase 13 million additional treatment courses to fight pandemic flu and is sending 400,000 treatment courses to Mexico to help slow the spread of the H1N1 flu virus. The Agency has approximately 50 million treatment courses in a Strategic National Stockpile and has released 11 million courses to the states to augment the 23 million treatment courses already in state stockpiles. Read an FDA Patient Fact Sheets on Relenza and Tamiflu. Sebelius and Homeland Security Secretary Napolitano also held a webcast on Thursday, April 29th to answer the public’s questions about the H1N1 flu virus.

CDC recommends taking the following steps to prevent the spread of swine flu:
• Avoid close contact with people who are sick or when you are sick.
• Stay home when you are sick.
• Cover your mouth and nose when coughing or sneezing.
• Clean your hands often.
• Avoid touching your eyes, nose or mouth.
• Practice other good health habits.

The CDC has released H1N1 Q&A, information on occupational health issues associated with H1N1 influenza virus and interim guidance. You can also follow the CDC on its Twitter site.

Visit ANCOR's Emergency Preparedness web page for more information about pandemic flu, emergency preparedness and disaster relief.

Additional resources for preparing for pandemic influenza include:
Ready.gov
American Red Cross
Long-Term Care and Residential Services Checklist
Individual and Family Planning and Checklist
Business Pandemic Flu Planning Checklist
State and Local Planning and Response Activities
State Pandemic Plans
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities
CDC Guidance on Protecting At-Risk Populations During a Pandemic

Related Articles:
State and Federal Governments Prepare for Possible Pandemic
Many States Do Not Meet Readiness Standards for Pandemic Flu

Read more!

Secretary Solis Proposes $104.5 Billion for FY 2010 Department of Labor Budget

In a webcast today, Secretary of Labor Hilda Solis proposed a $104.5 billion FY 2010 budget, with the majority used for unemployment insurance benefits. The total includes $13.3 billion in discretionary funding, but does not include $38.3 billion in Recovery Act funding.

Highlights include:

• $3.6 billion to fund the Workforce Investment Act
• $37 million for the Office of Disability Employment Policy
• $65 million for “National Programs,” which includes Supported Employment
  

Read more!

HHS Presents $879 Billion Budget for FY 2010

President Obama proposed today to “hold flat” budgets for agencies under the Department of Health and Human Services in FY 2010, as the department has already received billions of additional dollars in Recovery Act money. Obama is requesting $879 billion for HHS, including $78.4 billion in discretionary spending. The discretionary amount would be slightly less than the $78.5 billion the department received in FY 2009. The Recovery Act provided HHS with $44.3 billion in funds, including $22.4 billion in discretionary funds. Discretionary funds do not include funding of the entitlement portion of Medicaid because individuals receive the benefit because they meet eligibility requirements set by past legislation. HHS Secretary Kathleen Sebelius announced during the Department’s budget briefing that the FY 2010 budget calls for HHS to receive $311 million to combat Medicaid and Medicare fraud to augment existing mandatory resources, such as the Medicaid Integrity Program. She stated that every additional dollar spent by HHS in fighting fraud will yield $1.55 in savings.

Other Highlights,State Grants and Demonstrations Include:

• $75 million for the Medicaid Integrity Program
• $584 million in HHS-wide emergency preparedness funding, including $276 million for pandemic flu preparedness
• $40 million for Home and Community Services Alternatives to Psychiatric Residential Treatment Facilities for Children
• $474 million for Money Follows the Person Demonstration
• $68 million for Ticket to Work Grant Programs (extending Medicaid benefits to individuals with disabilities obtaining work using the Ticket to Work program)
• $10 billion for the SCHIP program
• $3.2 billion for the Low Income Home Energy Assistance Program (LIHEAP), a decrease of $1.9 billion from FY 2009. The budget also proposes creating a new mandatory account that would increase funding for LIHEAP in response to spikes in energy prices, at a cost of $450 million
  

Read more!

President Obama Releases FY 2010 Budget Proposal

Today President Obama formally released the administration’s FY 2010 budget proposal. Administration officials may make further changes to the budget to respond to changing economic conditions. The roughly $3.7 trillion plan contains the details the House and Senate Appropriations committees need to put together their annual spending bills. White House Budget Director Peter R. Orszag said there would be “some modest” changes in economic assumptions, mostly technical, and projected deficits as a result of changes in the economy since the administration released its budget outline in February.

ANCOR staff attending several budget briefings that outlined proposed funding for the Departments of HHS and HUD. See WICs Live articles for more details on the FY 2010 proposed budgets of those federal agencies and the Departments of Labor and Education and the Social Security Administration. Read more!

Administration Releases FY 2010 Budget Proposal with Section 8 Voucher Increases and Funding for National Housing Trust Fund

The President’s $43.7 billion proposed Housing and Urban Development (HUD) budget for FY 2010 is an 7.4 percent increase from the FY 2009 funding.
Notable line item expenditures include:

• Section 811—Disabled Housing—$250 million proposed for FY 2010, including $114 million to finance the construction and initial rental assistance for new housing.
• Section 202—Supportive Housing for the Elderly--$765 million proposed for FY 2010, the same amount enacted in the FY 2009 Omnibus Appropriations Act.
• Section 8—Housing Vouchers—$8.1 billion proposed for FY 2010, a $1 billion increase from FY 2009 funding levels;
• Community Development Block Grant (formula grants)—$XXX billion proposed for FY 2010, a $XXX billion increase from FY 2009 funding levels;
• HOME Investment Partnerships Program— $1.825 billion proposed for FY 2010, the same amount enacted in the FY 2009 Omnibus Appropriations Act.
• National Low Income Housing Trust Fund--$1 billion, the first year funding after its creation in last year’s housing bill (PL 110-289).
  

Read more!

States Beginning to Receive Recovery Act State Fiscal Stabilization Funds

Over the past few weeks, states have begun submitting their applications to the U.S. Department of Education for their slice of the Recovery Act funding under the State Fiscal Stabilization Fund. Some states may be using these funds to close budget gaps in their disability systems. To date, the following states have received over $7 billion total in funding:

• California - $4 billion
• Illinois - $1.4 billion
• Maine - $130 million
• Minnesota - $547 million
• Mississippi - $321 million
• Oregon - $382 million
• South Dakota - $85.4 million
• Utah - $321 million
• Wisconsin - $587 million
  

See applications for funding online.
Read more!

Three CMS Regs Rescinded--with Partial Rescission of Targeted Case Management

HHS Published a notice in the Federal Register May 6 rescinding the outpatient and school-based health regulations and partially rescinding the targeted case management regulation. The provider tax regulation is being delayed for one year while more information is gathered. Read more!

Texas Legislature Advances Bill to Allow Children with Disabilities Access to Medicaid

The Texas state House approved a bill on April 30 that will allow children with disabilities to enroll in the Medicaid program regardless of the parents’ income. The bill is designed to help families that earn too much to qualify for Medicaid but are struggling with the high cost of their child’s medical treatment. The State Senate already passed the bill and it will now be sent to the Governor for his signature. Read more!

Federal Government Becomes Primary Source of State Revenue

For the first time ever, state and local governments are getting the largest share if their revenue from the Federal government. Economic recovery funds from the federal government replaced sales taxes and property taxes as the primary sources of state and local revenues in the first three months of 2009. The Federal government plans to allocate roughly $300 billion to state and local governments over the next two years. This bump in Federal spending at a time when revenues from sales and property taxes are declining means that the Federal government is now paying about 23% of the approximately $2 trillion that state and local governments spend each year. Read more!

Idaho Judge Blocks Proposed Medicaid Cuts for Disability Programs

A federal judge in Idaho issued a temporary restraining order on April 28 blocking the state from cutting reimbursement rates for disability programs by as much as 55%. The law suit was brought by 16 Idaho providers who claimed that the proposed cuts would put them out of business, thereby forcing individuals with disabilities out of the community and into institutions. See previous WICs Live article on this case. Read more!

Social Security Administration Unlikely to Raise Benefits in 2010-12

The head of the Congressional Budget Office projects that there will be no cost-of-living adjustment (COLA) for Social Security beneficiaries in the next three years under current law. If this occurs, it will be the first time since 1975 that beneficiaries have not received an automatic increase in benefits. The law determines Social Security COLAs based on the consumer price index. Prices fell at the end of 2008 and inflation is expected to remain low for the next few years meaning that an automatic increase will not occur. Read more!

CQL Spring Webinar Series – Strategies for Quality

The Council on Quality and Leadership is holding a series of webinars that reflect the best practices in person-centered services. Visit their website to learn more. Read more!

ANCOR Urges CMS to Review Medicaid Requirements during a Pandemic Emergency

ANCOR sent a letter to CMS on April 30 highlighting challenges that could face providers in the event of a pandemic emergency and urging action to address these challenges.

In the letter, ANCOR outlined specific concerns and questions including:

• Reimbursement rates during hospital stays
• The prohibition against reimbursement for provider direct support staff/personal assistance for hospitalized individuals
• The financial burden to providers when multiple people supported by the same agency are hospitalized
• The possibility that individuals from ICFs/MR that are considered to be 24-hour health care facilities may be prohibited from being admitted to the hospital during a pandemic
• The lack of clear communication to providers from public health officials
• The need for greater in-home supports of community activities are suspended
• Vulnerable Population’s Access to and Coordination with Public Health Resources
  

ANCOR suggested that:

• CMS sponsor a nationwide webinar or conference call(s) that include providers regarding protection of Medicaid beneficiaries, guidance to providers, and CMS clarification, waiving, or suspension of any Medicaid programmatic and payment requirements.
  
• CMS’ State Medicaid and State Operations establish a public and website devoted to the H1N1 flu virus.
• CMS/CMSO include ANCOR in notice of and dissemination of any information forwarded to state Medicaid agencies, national and state MR/DD agencies, and national and state units on aging.
  

ANCOR will continue its dialog with CMS as this situation unfolds. If you have questions about pandemic flu or emergency preparedness, please forward them to Anne Fiala (afiala@ancor.org). Read more!

Social Security Beneficiaries Will Soon Be Receiving One-Time Recovery Act Payments

Beginning in May, the Social Security Administration will begin distributing one-time payments to over 60 million beneficiaries. A provision in the American Recovery and Reinvestment Act provides for a one-time payment to be delivered to Social Security beneficiaries in the same manner they receive their current benefits. See SSA 's Frequently Asked Questions web page for additional information. Read more!

Congress Passes Budget Blueprint Including Instructions on Health Care Reform Legislation

On April 29, the House voted 233-193 and the Senate voted 53-43 to pass a $3.4 trillion 2010 budget resolution. No republicans in either chamber voted for the non-binding budget resolution. Included in the budget blueprint are reconciliation instructions which will allow Congress to pass a health care reform bill with just 51 votes in the Senate rather than the 60 voted usually needed to move legislation through the chamber. Republican leaders have spoken out against these fast-track rules saying they will allow democrats to force through legislation. Democratic leaders have pledged to move forward in a bipartisan manner and hope to pass health care reform using regular procedures before the fast-track rules go into effect October 15. Read more!

Solis Says Department of Labor to Hire 36 New Inspectors

Labor Secretary Hilda Solis said April 28 that OSHA plans to hire 36 additional inspectors and launch new inspection efforts. Solis said OSHA’s new inspectors will provide guidance, training and outreach to employers. As part of the outreach effort, Solis noted that OSHA will unveil a new Web site offering guidance for stimulus fund recipients. Another DOL official stated that the next step will involve addressing health and safety from the industry and corporate level. The agency is also looking at activities that do not solely rely on inspections, but also finding patterns of violations and systemic problems. Read more!

U.S. District Court Orders Arizona to Uphold 2004 Ruling on Ball v. Rodgers Case Against State on HCBS Access and Attendant Worker Wage Increase

A United Stated Distinct Court ruled April 24 that Arizona’s Medicaid program discriminates against disabled and elderly beneficiaries on the basis of their disability, reinforcing a 2004 decision on this case. Ball v. Rodgers was filed in 2000 on behalf of disabled and elderly Medicaid beneficiaries who claimed that they were not being provided with adequate home and community based services. The ruling found that the state is required to give beneficiaries the choice between receiving services in the community or in an institutional setting and that Arizona’s failure to provide this choice violates provisions of the Americans with Disabilities Act the Medicaid Act and the Rehabilitation Act. A hearing has been set for June 1, 2009 to discuss Arizona’s compliance with the injunction.
Read more!

Louisiana Providers Fight Budget Cuts

Providers in Louisiana are urging employees and consumers to contact their state representatives about proposed budget cuts to supports and services for individuals with disabilities. Louisiana is looking to close a $2 billion budget gap for 2009-10 and is working on a budget that would cut disability services by 4-9%. These decreases would be in addition to a 3.4% cut to disability programs enacted last year during a round of mid-year budget cuts. Read more!

California Disability Activists March to Protest Budget Cuts

Over 2,000 people gathered at the state Capitol in Sacramento on April 22 to protest budget cuts affecting individuals with disabilities. Participants, including people with disabilities, families, providers and support workers, came from across California for this event. Protesters called for an end to budget cuts for California’s Medicaid program, and urged that earlier funding cuts be restored. Read more!

Pennsylvania Senator Leaves GOP to Join Democratic Party

Senator Arlen Specter of Pennsylvania announced April 28 that he is leaving the Republican Party to join the Democratic Caucus in the Senate and will run as a democrat when he is up for re-election in 2010. His decision could mean that democrats in the Senate will have the 60 vote super majority needed to overcome opposition from the minority if democrat Al Franken of Minnesota is seated. Supporters of the Employee Free Choice Act (Card Check bill) had hoped that Specter would be one of a few republicans to cross the aisle and vote in favor of the bill. Specter announced in March that he would not support the Card Check bill. In announcing his move to the Democratic Party, Specter stated that he would not become a party-line voter for the democrats and would not change his position on Card Check. Read more!

Kathleen Sebelius Sworn in as Head of HHS

The Senate voted April 28 to confirm Kathleen Sebelius to be secretary of Health and Human Services on a vote of 65-31. Sebelius was sworn into office by President Obama just hours after the Senate vote.

The Senate Finance Committee approved the nomination of Kathleen Sebelius on April 21 with a 15-8 vote. GOP Senators Snowe (R-ME) and Pat Roberts (R-KS) joined the panel Democrats in approving Sebelius. The final vote in the Senate was delayed with some Senate Republicans objecting to the nomination.
Read more!

Kansas Provider Speaks Out about Waiting List

Tom Laing of InterHab, an ANCOR member and State Association Exec, was published in the Wichita Eagle April 28th with his take on Kansas’ state budget for developmental disability programs. Laing was responding to an earlier editorial in the Eagle praising the state legislature for adding funding to the budget to address the waiting list for services for Kansans with physical disabilities. He called the praise 'premature' because the legislature has done nothing to budget for individuals with developmental disabilities who are on a waiting list for supports and services – a list that could reach 4000 people by July. As Laing so aptly says:

“How would you react if 4,000 Kansas children were told there was now a waiting list for kindergarten? How would you react if your child were told that because of state budget mismanagement, he could not enter the college of his choice for another two or three or four years? … Is it OK that the most important services offered by government for individuals with DD are curtailed, and that people in need may have to wait for up to four years? Of course not. The people of Kansas need to let their elected leaders know the time for action is now.”
Read more!

Mathematica Issue Brief on Money Follows the Person

The findings of the January 2009 Mathematica Policy Research issue brief, Transitioning Medicaid Enrollees from Institutions to the Community: Number of People Eligible and Number of Transitions Targeted Under MFP are based on 2004 data. The report includes demographic information, and tables and figures with more information about states, population groups, and age. An estimated 2.2 to 5.9 percent of MFP eligibles moved from institutions to the community in 2004. Read more!

States Turn to Tax and Fee Hikes To Close Budget Gaps

As budget deficits grow to more than $200 billion, states are turning to tax and fee hikes even as federal recovery funds flow to states. More than a dozen states have raised taxes or are considering doing so. States are hoping that increased sales and income taxes, higher fees for a variety of services and the more than $40 billion in cuts already enacted will help close state budget gaps. Read more!

Health Care Groups and Finance Committee Chair Advocate Expansion of Medicaid Program

Families USA, a national consumer health organization, and PhRMA, a pharmaceuticals group, are joining together to promote the expansion of the Medicaid program. On April 21, the groups launched a campaign to make health care more accessible and affordable by reforming Medicaid eligibility. These policy changes are intended to be included with health care reform legislation being developed in Congress. The groups advocate establishing an eligibility floor for Medicaid of 133 percent of poverty and sliding-scale subsidies for those who cannot afford to purchase insurance but do not qualify for Medicaid. Senate Finance Committee Chairman Baucus (D-MT) released a statement on the proposal saying that “increasing Medicaid access is a critical part of health care reform.” Read more!

HHS Releases FMAP Rates for First Two Quarters of FY 2009 Recalculated Based on ARRA Increases

The Federal Medical Assistance Percentage (FMAP) released today in the Federal Register is for the first two quarters of FY 2009 (effective from October 1, 2008 through March 31, 2009). Rates are recalculated pursuant to the American Recovery and Reinvestment Act (ARRA) including 6.2 increase to every state, plus the unemployment adjustment. See ANCOR's National Issues FMAP page to find your state's adjustment.






Read more!

Providers in Idaho Sue State Over Budget Cuts

On April 3, 16 providers of supports and services to individuals with disabilities filed a lawsuit against the state of Idaho stating that budget cuts could force 900 people with disabilities to lose residential services. The groups have asked the Judge to grant a temporary order preventing the state from enacting cuts set to begin on May 1. If the state is allowed to continue with the cuts it announced in March, providers will be forced to go out of business because of inadequate reimbursement rates, the plaintiffs say, resulting in more individuals with disabilities being moved to institutional settings. The suit alleges that the cuts are in violation of federal laws that require reimbursement rates to be high enough to ensure that all Medicaid recipients in a state have equal access to community-based programs. Read more!

Florida Residents Fight Cuts to Disability Services

Advocacy groups are protesting budget cuts in 2007 and 2008 which are affecting individuals who receive supports and services in Florida. Read more!

California Legislature Asks Disability Community to Help Make Budget Cuts

California’s legislature is asking state agencies and disability groups to help identify potential budget cuts or face another round of rate cuts for group homes and work programs. Providers of supports and services to individuals with disabilities already fighting to stay in business struggled to find ways to identify the $100 million in budget cuts requested by the legislature. Hundred of suggestions which have been gathered through public forums will be considered by the state legislature in the coming weeks. Read more!

CMS Issues Letter on Implementation of New SCHIP Law

The purpose of the letter, released by CMS on April 17, is to give an overview of the new SCHIP law passed in February 2009. Included in the letter are summaries of key provisions related to funding, eligibility and rates. CMS will release more detailed guidance letters in the coming months. Read more!

HHS Names Henry Claypool as Director of Office on Disability

Henry Claypool currently serves as the policy director for a long-term care provider, has held various advisory positions at HHS, and worked for CMS during the Clinton administration. He has a physical disability and has received Medicaid and Social Security benefits, giving him a unique perspective into these programs. His role as Director of the Office on Disability will be to oversee and advise HHS on policies and programs related to individuals with disabilities.
Read more!

Maine to Run Out of Medicaid Funding in Early May

Maine’s Medicaid program is in dire need of stimulus funds to avoid disruptions in services. The state’s Department of Health and Human Services is reporting that the Medicaid program will run out of money May 8th unless it receives federal stimulus funding. The Governor reports that Maine will use the $334 million in enhanced FMAP allocated to the state in the recovery package to close existing funding deficits and to address rising demand over the next two years due to the poor economy. Thanks to Bonnie-Jean Brooks of OHI for this update. Read more!

Take Action on Federal Housing Legislation!

ANCOR continues to support legislation that would increase the availability of affordable, accessible housing—the Frank Melville Supportive Housing Investment Act of 2009 (H.R. 1675), introduced by Representatives Chris Murphy (D-CT) and Judy Biggert (R-IL).

The bill would increase the number of affordable, accessible housing units for people with disabilities by:

• Removing "red tape" and streamlining the HUD Section 811 application process to encourage nonprofit providers to participate in the program.
• Authorizing a new Section 811 Demonstration Program that would make housing units funded through Low Income Housing Tax Credits and the HOME program affordable to individuals who rely on SSI and SSDI.
• Shifting renewal of Section 811-funded Mainstream Vouchers to the Section 8 Housing Choice Voucher Program Budget
  

Use ANCOR’s Action Center to make your voice heard in Congress! Visit ANCOR’s Action Alert to ask your member of Congress to co-sponsor the Frank Melville Supportive Housing Investment Act (H.R. 1675).

ANCOR members are encouraged to use Priced Out in 2008 when personalizing their letter. (see related article on Priced Out in 2008) Use the data in the report to document the housing crisis in your state. Tell your organizations story--personalize the letter attached to the alert with issues you are facing with supporting individuals in the community and the lack of affordable, accessible housing. Include your state’s sobering statistics to illustrate the housing crisis faced by people with disabilities.

If you have any questions, contact ANCOR Staff Jessica Sadowsky (jsadowsky@ancor.org). For more information on housing issues, visit ANCOR’s housing webpage.

Read more!

People with Disabilities Priced Out in 2008: Beneficiaries Need 112 Percent of Monthly SSI to Rent One Bedroom

A new report issued Monday, April 13th by the Technical Assistance Collaborative (TAC) and the Consortium for Citizens with Disabilities (CCD) Housing Task force reveals data that illustrates the severe housing affordability problems of people with disabilities who must survive on incomes far below the federal poverty line. This report, Priced Out in 2008, compares the federal Supplemental Security Income (SSI) payments of people with serious and long-term disabilities to U.S. Department of Housing and Urban Development (HUD) Fair Market Rents for modestly priced rental units.

Across the United States in 2008, people with disabilities with the lowest incomes faced an extreme housing affordability crisis as rents for moderately priced studio and one-bedroom apartments soared above their entire monthly income. According to Priced Out in 2008:

• SSI income needed to rent a modest one-bedroom unit has risen 62 percent from 69 percent of SSI in 1998 to 112.1 percent of SSI in 2008. The national average rent for a one-bedroom unit climbed to $749 per month and the studio/efficiency unit rent to $663 per month in 2008 – both higher than $667, the average monthly income of over 4 million people with disabilities.
• In 2008, 219 housing market areas across 41 states had modest one-bedroom rents that exceeded 100 percent of monthly SSI, including 25 communities with rents over 150 percent.
• Between 2006-2008, the number of market areas with modest rents higher than SSI rose from 164 to 219 – a 34 percent increase.
• For the first time, there were 3 housing market areas – Honolulu (HI), Columbia City (MD), and Nantucket County (MA) – where SSI recipients needed to spend over 200 percent of their income for a modest 1-bedroom housing unit.
  

ANCOR members are encouraged to use Priced Out in 2008 when discussing the need for affordable, accessible housing with their federal, state, and local officials. Use the data in the report to document the housing crisis in your state. Share this information with housing officials at the local and state level, who are responsible for developing strategies and plans to use federal housing resources. Respond to ANCOR’s new Action Alert on the Frank Melville Supportive Housing Investment Act of 2009 (H.R. 1675). (see related article on Federal Housing Legislation) Tell your organizations story--personalize the letter attached to the alert with issues you are facing with supporting individuals in the community and the lack of affordable, accessible housing. Include your state’s sobering statistics to illustrate the housing crisis faced by people with disabilities.

If you have any questions, contact ANCOR Staff Jessica Sadowsky (jsadowsky@ancor.org). For more information on housing issues, visit ANCOR’s housing webpage.
Read more!

Policy Makers Increasingly View Long Term Care as Crucial to Health Care Reform

The importance of long term care is gaining awareness as members of Congress and health care experts move forward with health care reform plans. Long-time health care champion Senator Kennedy (D-MA) is adamant that a reform bill must include long term care and is pushing for the inclusion of the CLASS Act (S. 697 and H.R.1721), a bill he introduced which would create an optional long term care fund to aid people in paying for long term supports and services. Other groups are pushing for incentives to make long term care insurance more affordable while some have voiced concern that the expansion of government sponsored programs will be too costly. Read more!

TRN Job Coaching Web Course May 7, 2009

Training Resource Network, Inc. (TRN) still has openings for its 2-week, 20-hour Job Coaching web training covering key principles and hands-on tools for effective job design, instructional and behavioral support strategies, and the development of natural and co-worker supports for workers with disabilities.

Registration is $149 US. Participants can start or log on at any time during the course period and participate in the training.

The course is taught by Tammara Geary. Tammara served as Executive Director of APSE: The Network on Employment for 10 years. She has trained and consulted extensively on supported employment, and as a job coach, received an award for Excellence in Direct Service. She is a lead associate for Griffin-Hammis Associates.

Registration is limited, and previous courses have filled to capacity.

Topics include:

• Principles of Job Design: Steps to take after getting the job, including analysis and task design.
• Job Training and Instructional Support: Setting up learning strategies using task analysis, systematic instruction, natural learning and reinforcement, and data collection.
• Natural Supports: Learn to develop supports using natural features of the work site, including co-workers.
• Social-Behavioral Support: Develop strategies to support workers to interact in socially expected ways to enhance job success.
  

Learn more about the training
Read more!

States Cut Social Safety Net as Deficits Grow

Widening budget deficits have prompted a majority of states to cut safety net programs including services to the elderly and disabled. The American Recovery and Reinvestment Act (ARRA) passed in February provides $787 billion for a variety of programs but the money is estimated to cover only 40% of losses to state revenues. As a result, at least 34 states have already cut services to vulnerable populations. Read more!

HHS Seeks Public Input on Comparative Effectiveness

The Federal Coordinating Council for Comparative Effectiveness is soliciting public comments on comparative effectiveness programs. The council will hold a listening session on April 14 in Washington, DC to hear public comments that will help shape its recommendations for how funds allocated in the ARRA for comparative effectiveness should be spent. Members of the public who are not able to attend the session can submit their comments electronically and watch the event online. Read more!