First HHS Year of Community Living Initiative Field Forum to Take Place in San Diego

The HHS Office on Disability will hold its first of 5 or 6 forums throughout the country in San Diego on February 18th. The purpose of the forums is to hear directly from state and local representatives (people with disabilities of all ages and their families, service providers, government) on barriers as well as solutions to community integration. Other forums will take place in the South, Mid-Atlantic and Northeast beginning in late March or early April. Details regarding the San Diego and other public forums will be forthcoming as soon as the Office on Disability provides them to ANCOR. Read more!

HHS Office on Disability’s Year of Community Living Initiative Includes Federal Workforce and Housing Work Groups

ANCOR staff were invited to attend a meeting Thursday held by the HHS Office on Disability (OD) Director Henry Claypool and a number of administration officials spanning many federal agencies to discuss the President Obama’s Year of Community Living Initiative. That initiative was announced June 22, 2009 on the 10th anniversary of the U.S. Supreme Court’s Olmstead decision. The OD has been tapped to take the lead in forming a coordinating council spanning multiple HHS agencies, including CMS, as well as partnering with HUD, DOL, and the Department of Justice. Claypool announced that the purpose of the meeting and future meetings was to help craft an agenda for the initiative and to discuss ways to work with states on solutions. He also announced the formation of five federal working groups: services, housing, workforce, data and quality, and communications strategy. ANCOR was the first to comment on the plans announced, calling attention for the first time ever a real commitment to focus on the biggest barriers to community living—inadequate paid workforce and lack of housing. ANCOR also stressed the importance of including a focus on technology in both areas. Barbara Edwards, the new CMS Director of the Disabled and Elderly Program Group was also in attendance and ANCOR staff spent time talking with her in her new capacity. ANCOR has also spoken with federal chair of workforce group in order to further discuss our National Advocacy Campaign efforts and ideas on recruitment and retention issues.
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Watch for ANCOR Alert Monday on Health Care and Long Term Services and Supports

ANCOR in conjunction with the alliance of some aging and disability national organizations are planning a national call-in day to Congress on Tuesday, January 26th that focuses on completing the work on health care legislation that includes vital expansions to home and community services and supports. We’ve come too far to let the ball drop now and let Congress off the hook. The alert will include a toll-free number; however, many Congressional office phone lines are swamped and we will urge you to contact your Congressional district offices if you can not get through to their offices in Washington. Congressional staff are telling us that, at this point, emails aren’t the way to reach members of Congress—staff aren’t even looking at emails with health care in subject line. We need to flood phone lines and fax machines on Tuesday.
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ANCOR Foundation CARES Fund Assists Individuals in Haiti and Begins Campaign for Disaster Relief

When the earthquake in Haiti hit, the ANCOR Foundation responded. ANCOR Foundation reached out to member Trudy Bekker of International Child Care, Dominican Republic, to see what the ANCOR community could do to assist individuals with disabilities in Haiti.

By leveraging the power of the ANCOR Foundation CARES Fund, the foundation quickly sent a $5,000 charitable contribution to assist the International Child Care, Dominican Republic team assess and address the concrete needs of individuals with disabilities in neighboring Haiti.
Contribute to the bold $100,000 campaign ANCOR Foundation is developing to build the financial wherewithal to assist providers and those they support in this and future emergency relief efforts.

Contribute NOW to the ANCOR Foundation CARES Fund: http://www2.ancor.org/foundation/CaresFundForm.cfm *

*Note: The ANCOR Foundation is a 501(c) 3 organization. Contributions to the foundation are tax-deductible. Any funds collected above and beyond this amount will remain in the fund for future use.

About the ANCOR Foundation CARES Fund:
Contributions to this fund provide emergency assistance to national and international provider organizations affected by acts of terrorism, hurricanes, floods or other natural disasters and are utilized to help:
• Resettle individuals with disabilities.
• Organizations provide supports/services that will not be covered by the government and other relief agencies or will be delayed for several months.
• Stabilize an organization's infrastructure to meet the immediate needs of the individuals supported.




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Democrats Struggle to Find a Pathway to Move Health Care Legislation

In the wake of the surprise victory this week of Senate-elect Scott Brown (R-MA) to fill former Senator Ted Kennedy's, House and Senate Democrats continued to struggle Thursday to find a way to salvage health care overhaul. Democrats were faced with two options to health care legislation with the loss of their 60-vote Senate supermajority after the Massachusetts special Senate election on Tuesday: 1) get the House to vote on the Senate bill passed along party-lines Christmas Eve or 2) get the House and Senate to each pass a stripped-down new bipartisan bill. Each option poses challenges to the House and Senate. ANCOR believes that the first option is the better one and will be urging the House to adopt the Senate bill. It is critical to move health care legislation immediately and the Senate bill includes more provisions that expand home and community based services—including The CLASS Act and two Medicaid provisions providing federal incentives to expand HCBS, as well as some important provisions affecting recruitment and retention. Should the House and Senate decide to move a series of stripped-down legislation there is no guarantee that the hard fought gains in the Senate bill will prevail.


The first option, preferred by the Senate and White House, would avert the problem of the Senate facing another 60-vote cloture to end a filibuster if Democrats proceeded on the path of a compromised House-Senate bill that incorporated changes to the Senate bill negotiated by House, Senate and the Administration. Those changes have been sent to the Congressional Budget Office to score costs. However, some House members were more than reluctant to merely vote on the Senate-passed bill. Some were suggesting the House pass the Senate bill with the guarantee that critical House changes be included through a second bill--a "budget reconciliation bill"--that requires only 51 votes to clear the Senate. However, by the end of the week, House Speaker Pelosi (D-CA) declared Thursday that she did not have the votes to pass the Senate's health care bill without changes.

While leaders in both chambers continue to leave open the idea of somehow amending the Senate package with a budget reconciliation bill, the idea that seems to be gaining traction among Democrats in the House is to move forward with several smaller health care bills that break the package into smaller, easier-to-digest and easier-to-sell chunks that could attract Republican votes. Following a Senate meeting Thursday evening, Senate Democrats conceded that they might have to change the subject away from health care for a period of time while they negotiate some sort of compromise agreement with the House that could include passing a separate budget reconciliation bill. Some are suggesting that Congress wait until the President's State of the Union Address next week to make a decision on which path to take.

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Current HHS Poverty Guidelines Remain in Effect

Health and Human Services (HHS) poverty guidelines will remain in effect until updated 2010 poverty guidelines are published, which shall not take place before March 1, 2010.
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NCD Released Report on Housing Opportunities for People with Disabilities

The National Council on Disability (NCD) has released a report entitled The State of Housing in America in the 21st Century: A Disability Perspective. The report provides recommendations to improve housing opportunities for people with disabilities. The research contained in this report presents a comprehensive overview of the state of housing in the twenty-first century, and answers important questions about the current housing needs and options for people with disabilities living in the United States.

For more information click here: http://www.disability.gov/housing/news_%26_events
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New York Governor Proposes Budget With Reduced Medicaid Spending Growth

Governor David A. Paterson (D) January 19 proposed a fiscal year 2010-2011 state budget that would reduce the growth in New York's Medicaid program and impose some $240 million in new health care assessments and surcharges. The $134 billion budget for the fiscal year that starts April 1 would reduce Medicaid reimbursement for hospitals, nursing homes, and home care providers by $459 million in FY 2010-2011.

The state's Medicaid caseload is expected to increase by 400,000 in FY 2010-2011.

Under the budget, the state expects to recover $1.2 billion from fraud and abuse in the Medicaid program, a $300 million increase from the current fiscal year.

The budget also would reinstitute a requirement that health insurers obtain prior approval from the state before imposing rate increases.

Further information on the health care portion of the budget is available at http://publications.budget.state.ny.us/eBudget1011/fy1011artVIIbills/HMH_ArticleVII_MS.pdf


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National Council of Disability Publishes Study on Workforce Infrastructure

The National Council of Disability released a study entitled Workforce Infrastructure in Support of People with Disabilities: Matching Human Resources to Service Needs. Read more!

Thompson Reuters Releases 2008 Medicaid LTC Expenditures

ThompsonReuters has released the 2008 Medicaid long-term care expenditures and HCBS waiver expenditures. To access them please visit our Data & Statistics website. Read more!

White House Announces Date for State of the Union

President Barack Obama will deliver his 2010 State of the Union address on January 27 at 9 p.m., White House Press Secretary Robert Gibbs announced Monday. Obama will then unveil his budget blueprint on February 1, according to a White House official. Read more!

New H.R. 868 Co-Sponsors

Representative Shelley Moore Capito (R-WV) and Representative (D-CA) signed on as Co-Sponsors for H.R. 868, The Direct Support Professional Fairness and Security Act. Thank you to everyone who contacted their members encouraging them to sign on. Read more!

HHS Provides an Additional $1.2 Billion to States to Help Low-Income Households with Energy Costs

HHS Secretary Kathleen Sebelius today announced the release of $1.2 billion to states to help low income citizens in the coming weeks with their heating bills. These funds represent grants to states, tribes and territories under the Low-Income Home Energy Assistance Program (LIHEAP).

LIHEAP helps eligible individuals families pay the costs of heating and insulating their homes in the winter and cooling their homes in the summer. HHS is releasing such a large allocation of LIHEAP funds now in order to ensure that states have resources available to support their energy assistance programs as the weather turns colder and the nation faces high unemployment rates.

For a complete list of state allocations of the funds released today go to http://www.acf.hhs.gov/news/press/2010/liheap_2010.html.

Individuals interested in applying for energy assistance should contact their local/state LIHEAP agency. For more information, go to http://www.acf.hhs.gov/programs/ocs/liheap/ or http://www.acf.hhs.gov/programs/ocs/liheap/brochure/brochure.html.

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DOL Announces Listening Sessions on Increasing Employment for People with Disabilities

The sessions will take place January through March in the Department of Labor’s six regional offices. These sessions will focus on gathering input from key stakeholder groups, including consumers, service providers and advocacy organizations, and employers regarding issues critical to increasing employment opportunities and labor market participation for people with disabilities. Participants will be asked to provide comments on:

• More effective ways to increase the employment of women, Vets and minorities with disabilities;


• Identification of Federal and state systems that are effectively collaborating to achieve successful employment outcomes for people with disabilities; and ;


• The three top issues that the Federal government should focus on to achieve greater labor force participation for people with disabilities.;

Agencies invited to participate in the Listening Sessions include the Department of Labor’s Employment and Training Administration (ETA), Veterans' Employment and Training Service (VETS), and Office of Federal Contract Compliance Programs (OFCCP) and Women's Bureau (WB); the Social Security Administration (SSA); the Department of Education (ED); the Office of Personal Management (OPM); and the Department of Health and Human Services (HHS).

For more details about the Online Listening Sessions, click here.

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Senate Began Series of Health Care Votes This Morning

The mathematics of the Senate—getting to 60—has been a struggle from the beginning to the end of Senate deliberation on healthcare reform this year.Unlike the mid-1990s when the Senate took up the Clinton health care legislation under unanimous consent, this time around the Senate could not proceed on the Senate Leadership bill (The Patient Protection and Affordable Care Act (H.R. 3590)—a substitute to the House-passed bill——without first gaining 60 votes to end a filibuster to proceed. The 60-vote hurdle has continued throughout the month-long struggle to proceed to a vote in the Senate on a historic, comprehensive health care legislation.

The Senate began its 19th day of debate on health care legislation Saturday in the midst of an historic snow blizzard that shut down the Washington, D.C. metro area for three days through today. The weather was surpassed only by the wild ride in the Senate to gain the 60 votes to advance health care legislation before the end of the year.

Majority Leader Reid (D-NV) delivered his 860-page manager’s amendment (substitute package of unknown changes to the underlying Senate health care bill) and CBO score Saturday morning. That sent the signal that Reid had gained his 60th vote. By mid-morning, Senate leadership announced that Senator Ben Nelson (D-NE) would vote to move on health care legislation. The announcement set up a timetable for three cloture votes to end Senate filibusters before a final vote on Christmas Eve.

The Saturday morning revelations followed a week of ups and downs that included last Sunday’s announcement by Senator Lieberman (I-CT) that he objected to some provisions in Senate Majority Leader Reid’s manager’s amendment. The week continued with pronouncements by other Democrats to start over on health care; possible rebellion by both liberals and conservatives in both chambers; a meeting with President Obama and Senate Democrats; Republicans requiring a single-payer amendment to be read aloud by Senate clerks because of objections to the Senate process, arbitrary deadlines, and rush to vote; behind-closed-door negotiations with Reid and deals that gained the support of Senators Lieberman (I-CT) on Thursday and 13 hours on Friday with Ben Nelson (D-NE); and corrected CBO score on Saturday . With President Obama invoking Tuesday the oft-used phrase—don’t let the perfect be the enemy of the good—Majority Leader Reid made the deals to gain the 60 votes needed to cut off debate.

The three cloture votes, which allow for 30 hours of debate each, began 1:01 a.m. this morning. The first vote ended debate on the manager’s amendment; the second vote will be on the underlying substitute bill (underlying Senate bill and manager’s amendment) to the House bill; and the third vote will end Senate debate on its version health care legislation—clearing the way for a final vote on the Senate bill itself on Christmas Eve. This last vote only requires a simple majority vote—not 60 votes—to actually pass the bill.

Highlights of What Is Initially Known

ANCOR is still combing through the manager’s amendment and no analysis is available on effects on the underlying bill. The rubric’s cube puzzle created by the evolving nature of the Senate bill and the effects of the manager’s amendment on the underlying bill will take days to unravel.

What is known is that the bill is paid for through a combination of tax credits, new taxes and penalties, and changes in public policy. It expands coverage to 32 million people—or 94% of those under the age of 65. The Senate Democrats say the bill makes health insurance more affordable and available, reduces the future growth in health care spending, and builds upon employer-sponsored, private and public health coverage. Different provisions in the bill take effect in different years, with most not taking effect until 2014.

ANCOR believes the Senate approach is preferable to the House version which includes an employer mandate for employee and family coverage. Highlights of the Senate bill of greatest interest to ANCOR members include the following:

• Although Lieberman and Nelson both objected to the new voluntary, opt-out public long-term services insurance program, The CLASS Act provisions are included in the manager’s amendment. Employers are not required to make any contributions. CBO estimates $2 billion in federal Medicaid savings (does not include state Medicaid savings) in the first five years due to CLASS provisions.
• Senator Maria Cantwell’s (D-WA) Medicaid Balanced Incentives amendment that provides a tiered enhanced federal medical assistance percentage (FMAP) to states that increase Medicaid home-and community-based services is included in the manager’s amendment.
• Funding for the State Children’s Health Insurance Program is continued for another two years (September 30, 2013 through September 30 2015) and the amendment also creates a new option for states to provide SCHIP coverage to children of state employees eligible for health benefits.
• Individual mandate (not employer mandate as in House bill) requiring most Americans to have qualifying health insurance with penalties beginning in 2014. Those without coverage must pay a tax penalty of $750 per year up to a maximum of three times that amount ($2,240) per family. (Effective 2016)
• Imposes an excise tax on insurers of employer-sponsored health plans that exceed $8,500 for individual coverage and $28,000 for family coverage. (Effective 2013)
• Creates state-based Health Benefit Exchanges through which individuals can purchase coverage, with federal premium and cost-sharing credits available to individuals/families with income 100-400% of the federal poverty level.
• Expands Medicaid coverage for non-traditional Medicaid recipients under age 65 (non-disabled individuals, parents, adults without children) to 133% of federal poverty level. States will receive 100% FMAP from 2014 to 2016 for newly eligibles; thereafter, financing will be shared by both state and federal with increased federal share.
• Requires employers with more than 200 employees to automatically enroll employees into health insurance plans offered by the employers. Employees may opt out of coverage.
• Assess employers with more than 50 employees that do not offer coverage will pay the lesser of $750 for each full-time employee or $3,000 for each employee receiving a premium tax credit. For employers who require a waiting period for employees, require payment of $400 for any full-time in a 30-60 day waiting period and $600 for any employee in a 60-90 day waiting period. (Effective 2014)
• Require employers to pay penalties for employees who receive tax credits for health benefit exchanges.

The next step will be a House-Senate conference to reconcile (iron out the differences) between the two widely different versions of health care legislation. A single bill will emerge in early January which will require another vote by both the House and Senate. ANCOR will provide additional information in early January.

NOTE: ANCOR’s office will be closed from the afternoon of December 24th through January 1st.


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WICS Live: Around the States

Nine States Awarded $72 Million for Boosting CHIP Enrollment: HHS Secretary Kathleen Sebelius announced Friday, December 18th that Alaska, Alabama, Illinois, Louisiana, Michigan, New Jersey, New Mexico, Oregon and Washington were awarded the federal funds for improving access to health insurance to children through Medicaid and CHIP. Funding for the “performance bonuses” was included in the Children’s Health Insurance Program Reauthorization, which set performance standards for states to qualify for a bonus. Read more!

WICS Live: Around the States

Iowa: Executive Order Makes Medicaid Changes to Help Cover State Budget Shortfall: Governor Chet Cultver (D) signed Executive Order 20 December 16th, aiming to save Medicaid $11.4 million over the next year and $60 million over the next five years. Culver’s action comes just weeks after ordering a 10% across-the-board budget cut to each of the state's agencies. The state plans to crack down on fraudulent and improper Medicaid billing to recover an estimated $8.1 million in savings. The state also plans to add more generic drugs to its Medicaid formulary and using a competitive bidding process to purchase Durable Medical Equipment. The governor also called for the state to increase the staff of its Department of Inspections and Appeals so as to better investigate the asset transfers of those qualifying for Medicaid benefits. Read more!

WICS Live: Around the States

Colorado: State Receives $1.5 Million Medicaid Infrastructure Grant: The grant, awarded by the Centers for Medicare and Medicaid on December 18th, will be used to design the state’s Medicaid Buy-In program, to allow people with disabilities to retain Medicaid benefits while obtaining and maintaining gainful employment. The grant funding will provide for stakeholders input to assist with the in design the program, communications infrastructure, and outreach and training to assist efforts to increase competitive employment opportunities for people with disabilities, a needs assessment and environmental analysis, as well as research and evaluation. Read more!

Senate Health Care Debate Stalled This Week With GOP Request to Read Aloud 767-Page Healthcare Amendment

Senator Bernie Sanders (I-VT) offered a scheduled amendment to the Senate’s health care bill Wednesday to create a single-payer health care system under Medicare. However, in a rare move, Senator Tom Coburn (R-OK) objected to a routine request to waive the reading of the amendment by the clerk—a reading which was expected to last until midnight. After three hours of the reading of the amendment, Sanders withdrew his amendment. Republicans requested the reading both on the grounds of transparency and as a means of delaying Senate action to file cloture on the Defense Appropriations bill and further action on the health care bill.

In addition, Senator Coburn has made two unanimous consent requests—(1) all amendments considered to the health care bill in the future must be available online 72 hours ahead of time and 2) be fully scored by the Congressional Budget Office (CBO). This week’s request by Coburn to read the Sander’s amendment aloud may be used again regarding Reid’s health care manager’s amendment or other Senate action to be taken up before Christmas.

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Senate Short One Vote to End Several Health Care Filibusters

Following last weekend’s unexpected announcement by Senator Joe Lieberman (I-CT) that he would not accept new provisions (i.e., opening Medicare to individuals aged 55-64 or a public option in a manager’s amendment to the Senate health care legislation), Senate Majority Leader Reid (D-NV) brokered a deal earlier this week with Lieberman that brought the total of votes needed for cloture (ending filibuster) to 59. However, Senator Ben Nelson (D-NE) appears to be the lone hold-out on the 60 Senators who caucus with Democrats needed to end the first of several cloture votes (ending filibuster) in the Senate’s adoption of health care legislation by Christmas. Among the issues over which Nelson has concerns include the abortion language, Medicaid expansion, public option, and taxes.
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Senate Health Care Bill A Moving Target, Still Evolving and Awaiting CBO Scoring on Reid Manager’s Amendment Before Continuing Action on HealthCare

Last week Senate Majority Leader Reid (D-NV) announced work he had completed on a manager’s amendment to the current Senate health care legislation that has been under debate for three weeks. He had requested the Congressional Budget Office to score changes in the manager’s amendment—expecting scores back last weekend. However, to date, the Senate is still awaiting the CBO scores and all details of the tightly-kept manager’s amendment. No one knows what is or will be in the manager’s amendment (i.e. changes to mandates on individuals rather than employers, penalties on employers, or excise tax on individuals with health care plans exceeding $8,000)—especially with individual negotiations ongoing with some Democratic Senators.

The latest word is that the manager’s amendment and CBO scores will be released Saturday with the first cloture vote to take up the amendment on Monday. With a total of three cloture votes to end filibusters needed before a final vote on a Senate bill, Reid has said the vote may occur Christmas Eve, Christmas Day, or on December 28th. Keep in mind that although 60 votes are required to close filibusters, it would take only 51 votes to pass final legislation. It is possible that either Senator Ben Nelson (D-NE) or Senator Snowe (R-ME) could agree to be the 60th vote to end cloture, but still vote against the final legislation.

After the Senate adopts its bill, differences with the House-passed bill must be ironed out or, as we usually think about the two chambers passing different versions of a bill, going through a conference committee to develop one single bill to be passed by both chambers. However, Congressional Democratic leaders are talking about a ping-pong-ping approach which would bypass the usual conference committee process. In this scenario, the Senate would send its bill to the House and request them to pass the Senate. House members would likely make some marginal changes--but would still have to garner 218 votes to pass the bill. If the House makes changes, then the bill would have to go back to the Senate for another vote. This ping-pong-ping approach would likely occur in late December or early January--in time for President Obama to claim victory on healthcare legislation before his State of the Union Address. All of this depends on some timely votes and negotiations with the Democratic party and between the two chambers.

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House Recesses After Adopting Four Bills on Wednesday—Including FMAP Extension—Senate Likely to Take Up All But FMAP Extention This Weekend

After passing four bills—clearing a short-term $290 billion increase in the $12.1 trillion statutory limit; a $150 billion jobs package with $23.5 billion in a six-month extension of ARRA’s FMAP increase, $75 billion for infrastructure projects, and state assistance for police, firefighters, teachers, and other government workers; a Defense spending package extending unemployment insurance and COBRA; and a five-day continuing resolution—the House began its end-of-year recess. However, depending upon Senate action on health care or consideration of other bills, the House may return next week or anytime before its scheduled return on January 12th. Senate work on the Defense package, continuing resolution and debt measures are expected to begin 1:00 a.m. on Saturday morning and run through the weekend. The Senate is not expected to take up the House jobs package—preferring to develop their own jobs package with Senate Finance Committee on any tax incentives or FMAP extension. Read more!

Recession Continues to Batter State Budgets

The Center on Budget and Policy Priorities (CBPP) updated its state fiscal report on December 18th projecting budget gaps for this year and next year combined for a total of more than $350 billion. Although the ARRA fiscal relief to states mitigated states’ fiscal problems—closing state-shortfalls by 30-40%--states are continuing to cut services like education and health care as they implement 2010 budgets. Additional cuts are likely for 2011.was enough to close 30-40% of state shortfalls. More than 30 states have raised taxes and several are considering similar measures. Visit the website for the complete updated policy brief.
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President Nominates ANCOR Member Blumenthal and SABE President as New Members of the National Council on Disability

President Barack Obama announced December 16th his intent to nominate a number of individuals to key administration posts. Among the appointments is that of Gary Blumenthal to the National Council on Disability (NCD). Gary is the Executive Director of the Association of Developmental Disabilities Providers (ADDP), located in Waltham, Massachusetts and Chester Finn, Special Assistant with the New York State Office of Mental Retardation and Developmental Disabilities and President of the Safe-Advocates Becoming Empowered (SABE). Congratulations to Gary and Chester! See White House press release on announcement of all appointees.
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FY 2010 ANCOR State Budget Survey

The purpose of this survey is to continue ANCOR's quarterly efforts to collect information from individual providers and state associations on FY 2010 state budgets and mid-year state FY budget adjustments (announced or anticipated cuts) and their effects on disability providers' capacities to support individuals with disabilities of all ages.

There are "inside beltway conversations" by economists and public-interest "think tanks" with some key Congressional leaders about a one-year extension to the American Reinvestment and Recovery Act (ARRA) federal, Medicaid temporary increase to states (FMAP). These discussions are occuring very early in the process (ANCOR is a part of these) with rumors that no real movement will take place until after the first of the new year. There is very mixed Congressional interest regarding FMAP extension and a state stabilization fund with some in leadership stating that it will be either a FMAP extension OR a broader, more flexible state stabilization fund, but not both.

The information we are asking in this survey will help ANCOR demonstrate in the coming weeks to Congress the case for FMAP extension on behalf of state need, but even more importantly, on the specific direct effects on individual providers and individuals with disabilities.

Please complete this online survey by December 31st!
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WICS Live: Around the States

Washington: Large Waiting List for State’s Basic Health Program. As of mid-November, nearly 78,500 residents were on a waiting list for the program, which provides low-cost health care coverage to eligible state residents. That’s about as many that are current enrolled in the program. Recent state budget cuts are forcing the program to trim its rolls, rather than accept new members. As of July 1st, the program was subject to a 43% budget cut—the same time as the poor economy leaves more state residents without health insurance. In addition, current enrollees will face premium increases as of January 1st, which state officials believe will result in a drop in enrollment. Read more!

WICS Live: Around the States

Tennessee: AccessTN Opened to Children with Chronic Medical Needs. Because the state has frozen enrollment in its CoverKids program as of November 30th because it reached its budgetary limit, the state December 3rd opened enrollment in AccessTN, the state’s high risk pool to children with chronic and acute conditions who would normally be eligible for the state’s expanded CHIP. Read more!

WICS Live: Around the States

Montana: Healthy Montana Kids Faces Backlog of Applications. Montana: Healthy Montana Kids Faces Backlog of Applications. The program, which voters approved in 2008, had the goal of covering an additional 29,000 children by expanding Medicaid and the state’s CHIP. Currently, more than 2,300 families have applied to the program as of September, but only 740 children have been added due to a problem with a computer program. Read more!

WICS Live: Around the States

Hawaii: With Existing Employer Insurance Mandate, States Looks to Opt Out of National Reform. For 35 years, the state has had a law on the books with an employer health insurance mandate. As a result, the state has one of the lowest uninsured rates in the nation. The Hawaii congressional delegation has inserted language into the House and Senate bills to protect the state’s Prepaid Health Care Act of 1974, should national health reform legislation pass. Read more!

WICS Live: Around the States

Georgia: State’s Own Health Reform Efforts Result in Savings. Figures released November 12th show that the state saved between $123 million and $140 million over the past fiscal year by reforms implemented in the state’s Medicaid and PeachCare for Kids programs. Both programs utilize a concept called care-management organizations, which require a high level of interaction with beneficiaries and encourage healthful habits and increased interaction with their primary care physicians, rather than emergency rooms. Read more!

WICS Live: Around the States

New Report Shows 11 States Emerging from Recession. According to a November report from MoodysEconomy.com, Alaska, Idaho, Indiana, Iowa, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Dakota, South Dakota and the District of Columbia are showing signs of economic recovery, based on several factors, including employment rates, home prices, manufacturing, and home construction. While the recession is moderating in just about every other state, the one state still in the grip of recession, according to the report, is Nevada. Read more!

WICS Live: Around the States

Nine Other States Facing Budget Crisis of Par With California. A new Pew analysis has found that nine other states are on the edge of financial disaster and urges state legislatures to act quickly. The report identifies Michigan, Arizona, Florida, Illinois, Nevada, New Jersey, Oregon, Rhode Island, and Wisconsin as states in dire fiscal situations. These states all rely heavily on one type of industry, a history of persistent budget shortfalls. Compounding the historical problems are widespread home foreclosure, rising unemployment, and poor financial management. View the report. Read more!

WICS Live: Around the States

New York: Governor Signs Bill Further Reducing State Budget. Governor David A. Paterson (D) December 4th signed a package of bills to reduce a mid-year $3 billion budget shortfall. The new law includes $107 million in reduced Medicaid and health care spending. The bills also would raise the fraud recovery target for the Office of Medicaid Inspector General by $150 million for the current fiscal year, which ends March 31. The state will save $21 million by eliminating the 2010 trend factor in Medicaid reimbursement rates in 2010 for hospitals, nursing homes, and home and personal care providers. Other savings, under the bills, include $18.5 million by reducing pharmacy reimbursement rates under Medicaid and the state's Elderly Pharmaceutical Insurance Coverage (EPIC) program. The budget cuts were far less than those proposed in November by Paterson, who called for $280 million in Medicaid and health care reductions. Read more!

WICS Live: Around the States

Nebraska: Governor Proposes Additional Spending Cuts. Facing a $334 million shortfall in the state’s biennial budget, Governor Dave Heineman (R) November 3rd proposed widespread budget cuts for lawmakers to consider. He said that he would oppose any legislative plan to increases taxes to address the budget deficit. Read more!

WICS Live: Around the States

Mississippi: More Budget Cuts as State Budget Revenue Continues to Fall. Governor Haley Barbour (R) made a second round of budget cuts in early December, totaling $54.3 million. The latest round of cuts includes a 5% reduction to most state agencies and programs, including Medicaid, which will be effective in February. Overall, the Governor has cut $226 million from the state budget this year. However, there is a $160 million budget shortfall remaining. Barbour has said that he has made all the cuts he can under existing law and it will be up to legislators when they return to session in January to address the shortfall in order to have a balanced budget. Read more!

WICS Live: Around the States

Indiana: Healthy Indiana Plan Will Enroll 5,000 More. The Indiana Family and Social Services Administration November 6th announced that 5,000 Healthy Indiana Plan (HIP) enrollment slots have been opened to childless adults. The program, which began in January, currently enrolls more than 46,000 adults. The 5,000 slots opened up largely through attrition in the program. The program is open to childless adults who earn less than 200% of the Federal Poverty Level and who have been uninsured for at least six months; participants pay 2-5% of their income for program coverage, which includes hospital and physician services, and prescription drugs. Read more!

WICS Live: Around the States

New Income Eligibility Information for Medicaid & State-Funded Coverage for Adults Available by State from Kaiser Commission on Medicaid and the Uninsured. Read it. Read more!

WICS Live: Around the States

Enhanced FMAP Rates for Second Half of FY 2009 Published. The American Recovery and Reinvestment Act of 2009 (ARRA) increased states federal Medicaid matching rates by 6.2%, with additional increases depending on unemployment. The recession adjustment period included in ARRA began October 1 and will end December 31. Rates are available from the Federal Register. Read more!

WICS Live: Around the States

Despite Budget Struggles, 26 States Expanded Medicaid/SCHIP with Help from Federal Stimulus Funds. See December 8th survey by the Kaiser Family Foundation. Read more!

WICS Live: Around the States

States Continue to Face Fiscal Difficulties in the Face of Medicaid Enrollment and Spending Increases. A November 12th report from the National Governor’s Association and National Association of State Budget Officers finds that states continue to cut expenditures, and still face $14.5 billion in budget shortfalls in FY 2010 and at least $21.9 billion in funding gaps for FY 2011. Medicaid Is projected to grow at a rate of 6.6% in FY 2010. The reports are available at http://www.nga.org/ Read more!

WICS Live: Around the States

Wisconsin: State May Need to Cut $1 Billion From State Medicaid Programs. Over the next eighteen months, the state may be forces to make cuts to BadgerCare Plus, Family Care, SeniorCare, and other programs. For months, the state has been working to find approximately $608 million over the next two years. The state has identified 66 cost-saving measures so far, hoping to avoid service cuts or reductions in provider reimbursements. One of the largest savings will come from one-time accounting changes, delaying payments until the new state budget beings in July 2011. The shortfall is coming when more state residents are seeking to enroll in the programs because of the economy. About 700,000 residents were enrolled in BadgerCare Plus as of November 30th—nearly 70,000 more than in January 2009. The sharp increase in program enrollment will force the state to find an additional $450 million in savings or make program cuts. Read more!

WICS Live: Around the States

Oklahoma: State Board Cuts $17M from Medicaid Program. On December 10th, the Oklahoma Health Care Authority board voted unanimously to make cuts in services that may affect 700,000 SoonerCare beneficiaries. The cuts, which will take effect January 1st, come after Governor Brad Henry (D) and the state Legislature ordered state agencies to reduce the remainder of the year's budget by 5%. At present, the Authority’s board did not vote to reduced provider reimbursement rates, but those reductions could be on the table if budget issues remain. Read more!

Wics: Around the States

Louisiana: State Facing $306 Million Medicaid Shortfall. To make up for a mid-year shortfall, the state plans to dip into one-time revenue sources and cut mental health, public health, and prescription drugs, the state Department of Health and Hospitals announced in mid-November. The Department attributed to the mid-year shortfall to treating the H1N1 epidemic , to community-based programs for individuals with disabilities, which are over-budget by $44 million, and the economic downturn, which has added 22,000 to the state Medicaid rolls since July 1st. Read more!

WICS Live: Around the States

California: State Seeks to Restructure Medi-Cal Waiver Through 1115 Waiver. The state announced last month that it intends to seek a waiver from the Department of Health and Human Services to overhaul the state’s Medicaid program. The waiver would replace the state’s current Section 1115 Waiver, which is set to expire August 31, 2010. In addition to slowing the growth of spending, the goals of the overhaul include creating a more accountable, streamlined system of care, reward quality, and expand coverage to uninsured residents. A core component of the plan is to reduce expenditures for “high-cost beneficiaries” and provide better coordinated care to these individuals and well as people with disabilities, children with special health care needs, and dually eligible individuals. A draft of the waiver proposal is available online at http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx Read more!

Ask Senator Reid to Include Direct Care Workers as a High Priority for the National Health Care Workforce Commission in Health Reform

As the Senate continues to sort out its health reform bill, ANCOR asks you to call on your Senators to ensure that the direct care workforce, which includes DSPs, is designated as a "high priority" research area for the proposed National Health Care Workforce Commission. The Senate health reform bill already contains a provision that establishes a National Health Care Workforce Commission, but we need to make sure DSPs aren’t left out from this Commission’s work!

Ask your Senators: Urge Senator Reid to include the Kohl, Casey, Feingold amendment in the final Senate health care legislation designating the direct care workforce as a high priority research area for the proposed National Health Care Workforce Commission. This no-cost amendment will ensure that the Commission will review the current and projected workforce needs of direct care workers and provide comprehensive recommendations to Congress and the Administration on how best to align direct care workforce resources with our national needs.

Use ANCOR’s Action Center to call your Senator.

Please contact Jessica Sadowsky (jsadowsky@ancor.org) or Mary Pauline Jones (mpjones@ancor.org) if you have any questions.

Read more!

Senate Health Care Reform Floor Debate at Standstill; Additional Provisions Unknown

The Senate Democrat’s race to pass a health care reform bill by Christmas is on hold while the Congressional Budget Office (CBO) analyzes their latest batch of proposals to be considered as part of a “manger’s amendment.” The CBO analysis will likely not be completed before next week. Deep secrecy surrounds the manager’s amendment provisions and discussions about unresolved aspects of the health reform bill. The amendment may address concerns of moderate Democrats in components that have yet to be worked out. It is likely that statutory language for a new Federal option managed by the Office of Personnel Management and a new Medicare buy in for individuals age 55-64 will be included. Provisions related to employers’ role in health coverage are also rumored to be included. Senate Majority Leader Reid (D-NV) will not bring the bill to a vote until he has secured 60 senators to vote in favor of the legislation. Read more!

President Issues Directive to Agencies Requiring Transparency

The Obama Administration released a directive yesterday to all federal agencies requiring them to adapt to a culture of transparency. It imposes a number of deadlines for agencies to publish online high-value data sets (within 45 days), create an Open Government page on each agency’s web site (within 60 days), and publish an Open Government Plan addressing transparency, participation, and collaboration (within 120 days). The directives will create a working group on best practices and an Open Government Dashboard to keep track of progress of all agencies. Read more!

Senate to Officially Reconvene on January 19

The Senate will meet January 5 for a pro forma session following the winter recess and officially convene on January 19, according to a copy of the 2010 calendar.

The chamber will then be in session for a four-week work period until February 12, followed by a four-day recess to observe the Presidents Day holiday. The 2010 schedule includes a two-week spring recess falling over Easter and Passover, and breaks for Memorial Day, July Fourth, Columbus Day and Veterans Day weekends. A summer break is scheduled from August 9 to September 10.
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Conferees Agree to Omnibus Spending Bill

Democrats started to wrap up the FY 2010 appropriations process Tuesday night, assembling a package of six spending bills that the House could adopt as early as this week. A House-Senate conference committee agreed to the $446.8 billion discretionary omnibus, which includes all of the remaining spending bills except Defense. That bill is being held in reserve as a vehicle for other end-of-session Democratic priorities, including aid for the unemployed and other expiring policies. The package includes the Commerce-Justice-Science (HR 2847), Financial Services (HR 3170), Labor-HHS-Education (HR 3293), Military Construction-VA (HR 3082), State-Foreign Operations (HR 3081) and Transportation-HUD (HR 3288) funding bills.

Democrats are working against a December18 deadline, when a “continuing resolution” that is currently temporarily funding the government runs out. Another short-term continuing resolution may be required to finish and give the administration time to review the voluminous legislation. It was not the way Democrats had hoped to wrap up the appropriations process — they planned to avoid the type of eleventh-hour omnibus bills that have been common in previous years, but the process slowed down, particularly in the Senate, with a calendar crowded by health reform legislation.

The package reflects the priorities of the Obama administration and congressional Democrats on a host of domestic and international issues.

ANCOR may be interested to know:

--The Transportation-HUD measure includes $67.9 billion in discretionary funds, a $13.4 billion increase over the fiscal 2009 level, when economic stimulus funds (PL 111-5) are excluded. Overall, the bill would provide $122.1 billion.

--Labor-HHS-Education would be funded at $163.5 billion, an $8.5 billion increase over fiscal 2009, excluding stimulus funds.

Information on line items on programs of ANCOR member interest to follow.


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50-State Survey Found that ARRA’s Increase in Medicaid FMAP Helped Many States Preserve and Even Expand Medicaid This Year—But Reversals May Come

The Kaiser Family Foundation warned in its December 8th release of its annual 50-state survey of Medicaid and the Children's Health Insurance Program states will face another crisis in Medicaid funding when the economic stimulus program ends next year (December 2010). Passed in February, the $787 billion economic recovery initiative provided $89 billion in extra Medicaid funding to states that maintained current eligibility and enrollment rules. The Kaiser foundation said that without another infusion states may scale back Medicaid to deal with budget shortfalls in the upcoming fiscal year. "If fiscal relief is not replenished and Medicaid eligibility is not protected," the report said, "many states are unlikely to withstand the pressure to make substantial cuts." Read more!

Bipartisan Lawmakers to Introduce Legislation to Protect All Children in Schools from Abuse

Representative George Miller (D-CA) and Representative Cathy McMorris Rodgers (R-WA) will hold a press conference on Wednesday, December 9 to introduce new legislation protecting all children in schools from misuse of restraint and seclusion.

This legislation is the first national effort to prevent and reduce harmful restraint and seclusion in schools. A recent U.S. Government Accountability Office investigation found hundreds of allegations that schoolchildren have been abused, and some even died, as a result of the inappropriate use of restraint and seclusion in classrooms; a disproportionate number of them were children with disabilities. Read more!

VICTORY! Governor Patrick Rescinds Mass Health/Day Hab Cuts

Massachusetts Governor Reverses Budget Cuts for Day Hab Restoring $100 Million in Recent Medicaid Disability Cuts. Thanks to ADDP Exec Gary Blumenthal for sending news of this victory which is on top of ADDP’s October success in defeating a $60 million cut in DD services. Congratulations Gary and ADDP!
Read more!

Amendment Threatens CLASS Act in Senate Bill: Call Your Senator TODAY!

An amendment to the Senate healthcare bill proposed by Sen. Ben Nelson (D-NE) would strip the Community Living Assistance Services and Supports (CLASS) Act from final health reform legislation.A total of 51 votes are required to defeat any proposed amendment. Speaking to reporters on Wednesday, Peter Orszag, director of the White House Office of Management and Budget, said discussions about the future of the CLASS Act are ongoing, and changes could be made to guarantee the program's long-term solvency. Use ANCOR's Action Center to call your Senators and ask them to make sure the CLASS Act remains in the final health reform bill and to oppose any amendment to strip it from the bill. The CLASS Act will help people to remain independent at home.
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U.S. Response To Health Threats To Be Reviewed

Health and Human Services Secretary Kathleen Sebelius has announced a major review of the government's efforts to develop new protections against pandemics, bioterrorism and other health threats. The review will not just examine the flu, but all public health threats faced today. Sebelius stated, "We'll look for the fastest ways to move to new technologies that will let us quickly produce countermeasures that are more dependable and more robust." The review will be led by Nicole Lurie, assistant secretary for preparedness and response, and will be complete by "early next year," Sebelius said. Read more!

New Co-Sponsor for Direct Support Professionals Fairness and Security Act of 2009 (H.R. 868)

Rep. Donald Payne (D-NJ) signed on as a co-sponsor of the Direct Support Professionals Fairness and Security Act of 2009 (H.R. 868). Thank you to everyone who contacted their representative. Read more!

Federal District Court Bars Medicaid Non-Contract Hospital Payment Rates

A federal district court judge in California November 18th enjoined the California Department of Health Care Services from continuing a 10 percent reduction in the Medi-Cal (California's Medicaid program) reimbursement rate for non-contract hospitals (Santa Rosa Memorial Hospital v. Maxwell-Jolly, N.D. Cal., No. 08-5173 SC, injunction 11/18/09).

At issue in all the cases was the 10 percent Medi-Cal reimbursement rate cut contained in 2008 legislation (A.B. 5) aimed at addressing California's budget deficit. The hospitals argued that the rate cuts violated federal law because they were implemented solely for financial cost savings, and did not take into account a federal requirement that the state DHCS set hospital reimbursement rates to bear a reasonable relationship to hospitals' costs. The courts agreed, essentially finding that the DHCS had to rely on responsible cost studies before it could provide reliable data to justify the reductions. In his order, U.S. District Judge Samuel Conti of the Northern District of California noted that, ordinarily, the court would hold a hearing on the appropriateness of granting the non-contract hospitals' motion for a preliminary injunction barring the cuts. However, largely on the basis of the rulings by a federal district court in Los Angeles in August 2008, and the Ninth Circuit in July 2009, Conti found it was suitable to make his ruling without oral arguments. In July, the Ninth Circuit affirmed the lower court's ruling in Independent Living Center of Southern California Inc. v. Maxwell-Jolly (131 HCDR, 7/13/09).

“Based on the Ninth Circuit's decision, the Court finds that Plaintiffs are likely to succeed on the merits of their claim that these rate reductions violate state law,” Contin wrote. The ruling is available at http://op.bna.com/hl.nsf/r?Open=sfak-7y3unz.



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HHS Using Tougher Standards to Calculate Improper Medicare Payment Rates for 2009

As part of the Obama Administration’s goal of reducing waste, fraud and abuse in Medicare, the HHS and CMS significantly revised and improved its calculations of Medicare fee-for-service (FFS) error rates in 2009. “As we move forward in our review of the Medicare and Medicaid error rate data, we expect to be able to determine if there are specific trends that can better help us identify weaknesses in our programs or systems,” said Acting CMS Administrator Charlene Frizzera. “We hope to be able to use data available through the use of new electronic health record reporting that can help in the design of new and innovative approaches to finding emerging trends and vulnerabilities in high risk areas such as durable medical equipment and home health.” HHS Secretary Kathleen Sebelius and Frizzera also pointed out the HHS and the CMS would invest more time and resources into working with providers to eliminate errors through increased and improved training and education outreach. “It’s important that we continue to work closely with doctors, hospitals and other health care providers to make sure they understand and follow the more comprehensive fee-for-service requirements,” said Frizzera. “We are committed to working closely with them to reduce the rate of improper payments.”
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Senate Health Reform Bill Contains Long Term Services and Workforce Provisions

The newly introduced Senate health reform bill contains the ANCOR-supported CLASS Act, the Community First Choice Option, and other provisions to improve Home and Community Based Services. While the House-passed version contains both of those provisions and a temporary extension of the Recovery Act’s FMAP increase to states experiencing high unemployment, the Senate bill did not include the FMAP bump.

Also of note is Section 6201, which expands an existing nationwide program for national and state background checks on direct patient access employees of long-term care facilities and providers. The provision would require the establishment of a nationwide program for national and state background checks on direct patient access employees of certain long-term supports and services facilities or providers.

Another workforce provision (Section 5507) would establish a demonstration grant program through competitive grants to provide aid and supportive services to low-income individuals with the opportunity to obtain education and training for occupations in the health care field that pay well and are expected to experience labor shortages or be in high demand. The provision would also establish a demonstration program to competitively award grants for up to six states for three years to develop core training competencies and certification programs for personal and home care aides.

ANCOR will be providing further details as staff continue analysis of the bill.

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Reid Presents $848 Billion Health Care Reform Package to Senate

All 2074 pages were introduced on Wednesday and contain provisions (long summary and short summary) that would extend coverage to 31 million Americans. Unlike the House-passed bill, the Senate’s version does NOT contain employer mandates, but employers with 50 or more employees which did not provide health insurance would pay a penalty if workers received government subsidies to purchase coverage through the exchange. The bill also includes and expansion of the Medicaid program eligibility to include people who make up to 133 percent of the federal poverty level.
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Vote to Begin Debate on Health Reform Bill “Patient Protection and Affordable Care Act,” (H.R. 3590) Set for Saturday

Senate Majority Leader Harry Reid (D-NV) has scheduled a vote to begin debate on the chamber’s health care overhaul bill for Saturday night, although it is not definite that Reid has the 60 votes he needs to overcome a Republican filibuster and bring the measure to the floor. Under a unanimous consent agreement reached Thursday, Republicans agreed to waive their prerogative to insist on 30 hours of post-cloture debate if Reid prevails on the procedural question and to forgo a roll call vote on adopting the motion to proceed, which would require just a simple majority to prevail. That could allow senators to begin their Thanksgiving recess on Saturday, rather than Sunday or later. Senate Democrats are attempting to get their version of their bill approved by the Christmas break, but it is unclear whether sufficient time remains on the legislative calendar for that to happen.
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Mid-Year Shortfalls Open a $31 Billion Gap in 35 States

According to an update by the Center on Budget and Policy Priorities, at least 42 states plus the District of Columbia are enacting cuts in major areas of state services—including health care (28 states) and services to individuals with disabilities and the elderly (24 states and DC). The worst recession since the 1930s has caused the steepest declines in tax receipts have led many states to face large budget gaps even after making deep cuts. You can view a table of state-by-state mid-FY 2010 budget gaps at http://www.cbpp.org/cms/index.cfm?fa=view&id=711
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CMS Withdraws Medicaid Rehab Proposed Rule

CMS is withdrawing the proposed rule, “Medicaid Program: Coverage for Rehabilitative Services” originally published in the Federal Register on August 13, 2007 (72 FR 45201). The withdrawal notice will be published in the November 23, 2009 Federal Register. As you will recall, the rule proposed to “clarify the definition of Medicaid ‘rehabilitative services’ [including elimination of rehabilitation services except under certain circumstances], established new documentation [including 15-minute unit billing], and other requirements.”

CMS received a total of 1,845 public comments in response to the August 13, 2007 proposed rule. Congress included a moratorium on this regulation on December 29, 2007 and that moratorium was extended until April 1, 2009 in the Supplemental Appropriations Act of 2008. Before that moratorium was up Congress included a “Sense of Congress” in the American Recovery and Reinvestment Act of 2009 that the HHS Secretary should not promulgate as a final regulation the August 13th proposed rule. CMS has decided to withdraw the August 2007 proposed rule in light of Congressional concerns, public comments in 2007, and in order to assure agency flexibility in re-examining the issues, options, and alternatives with both the Congress and stakeholders.

Read more!

New Co-Sponsors for H.R. 868

Rep. Chris Van Hollen (D-MD)and Rep. Tim Bishop (D-NY) signed on as co-sponsors of the Direct Support Professionals Fairness and Security Act of 2009 (H.R. 868). Thank you to everyone who contacted their representative. Read more!

ANCOR Supports Introduction of Legislation to Eliminate the Term of Mental Retardation from Federal Law

U.S. Senators Barbara A. Mikulski (D-MD) and Michael B. Enzi (R-WY) introduced a bill on Tuesday, November 17th that would forever eliminate the words stigmatizing terms of “mental retardation” and “mentally retarded” from federal law books. Senator Mikulski said she was introducing the bill—known as Rosa’s Law—after attending a roundtable on special education last year where a mother told the Maryland lawmaker about how her daughter Rosa was labeled at school and the stigma, pain and anguish it caused her daughter and the entire family. The family reached out to their local Arc and the Maryland General Assembly were legislation was passed substituting the phrase “an individual with an intellectual disability. Senator Mikulski stated on the Senate floor today that she was introducing the “at the request of the family, a law on behalf of this little girl and on behalf of all of the children in the United States of America.... I’ve always thought the best ideas come from the people.” ANCOR joined with scores of other national groups in a letter supporting the legislation that would make the change to “intellectual disability. You can read Senator Mikulski’s entire statement on introducing Rosa’s Law at http://mikulski.senate.gov/record.cfm?id=319975&. Read more!

Additional Federal Fiscal Relief Needed to Help States Address Recession’s Impact or State Could Lose 900,000 Jobs in 2010

A November report by the Center on Budget and Policy Priorities finds that without additional federal assistance, states could be forced to institute additional deep budget cuts and tax increases in 2010. Although states received federal assistance for education, jobs and for their Medicaid programs last year with the passage of the ARRA stimulus, states will face a “cliff” on December 31, 2010 unless additional federal funding is forthcoming. With most governors sending their budget proposals to state legislatures between December and February, state lawmakers will have to pass budgets as early as March or April in some states and by the end of June in almost all states. If states do not know they will receive additional federal fiscal relief, they will begin implementing new budget cuts and tax increases by this summer, at the latest. The CBPP report states that budget projections suggest that states will face total deficits for state fiscal years 2011 and 2012 of as much as $260 billion beyond what can be covered by the limited ARRA funding that will remain available—reducing demand in the U.S. economy by as much as $260 billion. Read more!

Maine revenues continue to slip; shortfall as high as $400M

Gov. John Baldacci has ordered the preparation on an executive order to curtail state spending as state revenues continue to fall below estimates with Finance Commissioner Ryan Low expecting the revenue shortfall now will range between $300 million and $400 million for the two-year budget.

He said when preliminary figures were known late last week, the governor ordered the preparation of a curtailment order to stop state spending under his emergency budget authority. He said the curtailment process cannot make up for the entire revenue shortfall, but it is important to stop spending as soon as possible.

Last month the governor ordered agencies to identify how they would cut spending to meet a target of $200 million. Low said instead of another round of requests, his office will use those as a starting point and in one-on-one meetings with state agencies, push for further spending cuts.

Thank you to Bonnie-Jean Brooks for providing ANCOR with this information. Read more!

Clarification on H1N1 Priority Vaccination Groups

Henry Claypool from HHS said that we expect clarification on the issue of DSPs being considered health care personnel as related to distribution of the H1N1 vaccine in the next couple of days. This should also clarify which individuals with disabilities fall into the priority groups. Read more!

Reid Hopes to Debate Health Reform Next Week

Senate Majority Leader Harry Reid (D-NV) Tuesday night started the process of making a place on the Senate calendar to begin debate next week on the Senate health reform proposal. Republicans are expected to mount a filibuster of the motion to proceed, which if successful would prevent the bill from being debated on the Senate floor. Reid needs 60 votes to overcome the filibuster, and he has been working to secure the votes of all 60 members of the Democratic Conference, given unanimous Republican opposition. Despite the formal calendar process, the timing of the Senate’s health care debate is still in doubt. Reid has given his Members assurances that he would not bring a measure to the floor without a formal cost estimate from the Congressional Budget Office (CBO). The CBO score is expected by the end of this week, but once Reid sees the estimate, he may seek tweaks to the bill that could delay the final score.
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NGA and State Budget Officals Project States Will Continue to Face Fiscal Difficuties in Comming Years.

In a preliminary review of the biannual report The Fiscal Survey of States, officials from the National Governors Association (NGA) and the National Association of State Budget Officers (NASBO) today forecasted continued fiscal difficulties for states. In fiscal 2009, states were forced to reduce General Fund expenditures by 4.8 percent and are expected to reduce fiscal 2010 General Fund expenditures by at least 4.0 percent, marking the first time that state spending has declined in back to back years. The weakening of state fiscal conditions is reflected in the $250 billion in budget gaps faced by states between fiscal 2009 and fiscal 2011. Of the $250 billion, states closed $72.7 billion in budget gaps during fiscal 2009 and $113.1 billion before the enactment of their fiscal 2010 budgets to bring them into balance with drastically declining revenues.

"These are the worst numbers we’ve ever seen in the decades of putting together this report," said NASBO Executive Director Scott D. Pattison. "States have been forced to lay off and furlough employees, raise taxes, drain rainy day funds and sharply cut state spending in ways that impact every part of state government."

Even after closing these gaps, an additional $14.5 billion in budget gaps remains in fiscal 2010, and states face at least $21.9 billion in budget gaps for fiscal 2011. To help close these gaps, 42 states cut their enacted fiscal 2009 budgets by $31.2 billion, and 33 states cut their fiscal 2010 expenditures by $53.5 billion. Additionally, states enacted tax and fee increases of $23.8 billion along with additional increases in other revenue measures of $7.7 billion for fiscal 2010.

"States will continue to struggle over the next decade because of the combination of the length and depth of this economic downturn, the projected slow recovery and the overhang of unmet needs," said NGA Executive Director Raymond C. Scheppach. "The unmet needs are those postponed or deferred during the crisis including, replenishing retiree pension and health care trust funds and financing maintenance, technology and infrastructure investments. States will also need to rebuild contingency or rainy day funds. The bottom line is that states will not fully recover from this recession until late in the next decade."
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If ARRA Federal Increase in Medicaid FMAP Is Not Extended, States Will Be Faced with Tough Choices in 2011.

Federal Medicaid fiscal relief in the ARRA have been critical in helping states to address budget shortfalls, perserve eligibility, avoid or reduce provider cuts, and avoid or soften program cuts. See Kaiser’s October 2009 fact sheet: Medicaid and State Budgets: From Crunch to Cliff.
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Connecticut Budget Update

Governor Rell of Connecticut announced rescissions of up to 5% in various state agency line items at the end of the day November 5. The Governor can make line item cuts up to 5% without need for Legislative approval. The total of the rescissions is $34M. The deficit is now projected at $400M by the Office of Policy and Management (the Governor’s budget office) and at $628 by the Comptroller. The Secretary of OPM stated yesterday that the intention is to balance the budget through cuts, not higher taxes.

Most of the cuts in the human services state agency accounts are in the “Personal Services” line – the account for state personnel salary/wage expense. The DCF residential Board and Care – Foster and Residential and Emergency Services had the largest reductions that have the potential to affect community providers. In DDS, the autism pilot was reduced, but other service delivery accounts were not touched. DMHAS wasn’t cut. DSS cuts include a reduction in “Aid to the Disabled,” a large account. Medicaid wasn’t cut.

The Governor’s press announcement
The proposed rescissions (14 pages)

Thank you to Stan Soby of Oak Hill for providing ANCOR with this update.

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House Passes Health Care Reform

Saturday night the House passed their America's Affordable Health Choices Act of 2009(H.R. 3200) with lawmakers voting 220-215. The Senate has yet to take their legislation to the floor and is still waiting on scoring from the Congressional Budget Office. Remember to look at the Senate legislation very closely as it differs greatly from the Legislation passed in the House. Read more!

House Vote on Health Reform May Be as Soon as Tomorrow

The House of Representatives' first floor vote on health reform may come as early as Saturday. This comprehensive bill, the Affordable Health Care for America Act (H.R. 3962), has important provisions that ANCOR supports.

--Inclusion of the Community Living Services and Supports Act (the CLASS Act), a new actuarially sound, premium-based, national long term services insurance program to help adults with functional impairments remain independent in their communities. This cash benefit would reduce the burden on federal and state Medicaid programs.

--Inclusion of the current American Recovery and Reinvestment Act increase in federal Medicaid payments (FMAP) to states with high unemployment rates for an additional six months.

--Inclusion of a statement of support for the Community First Choice Option to encourage states to cover Medicaid community-based attendant services and supports. (included in manager's amendment)

Your Message: Include the CLASS Act, FMAP increase, and the Community First Choice Option provisions in H.R. 3962-the Affordable Health Care for America Act.

Respond to ANCOR’s Action Alert by entering your zip code in the "Call Now" window to get your Representative's telephone number. All you have to do is make the call, use the talking points, and leave your feedback.

You can also send your Representative an email using the message above. Simply find your Representative's email address using ANCOR's Congressional Directory.

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Medicaid Audits Got Down? ANCOR is Offering a Two Part Series on How Providers Can Survive Audits and Reviews with Barb Edwards. Save the Date!

Did you miss ANCOR's most popular Governmental Activities Seminar preconference EVER?

If you couldn't make it to the September conference, or even if you want to hear it all again and want another chance to ask The Expert, ANCOR is excited to bring you a series of two webinars featuring Barb Edwards and her Medicaid expertise. Ms. Edwards is a principal in Health Management Associates, former interim director of the National Association of State Medicaid Directors, and former Ohio State Medicaid Director.

Dates: November 16th and November 23rd

Time: 2:00 PM to 4:00 PM (EST) both days

Registration Begins Next Week-Watch for Details
(Can't make the date - Order a recording)

Driven in part by Congressional pressure to combat fraud, waste and abuse, there is a growing attention being paid to program integrity within the Medicaid program. Many state and federal players have authority to conduct provider audits or other reviews under Medicaid, and audits have increased. Find out what providers need to know to about the purpose and use of audits and how to prepare for them.

Webinar #1: Medicaid Program Integrity and YOU

Ms. Edwards will take you through the history of Medicaid's focus on program integrity and the federal structure of Medicaid. She will also cover the KEY Medicaid integrity programs, including PERM (Payment Error Rate Measurement) and HHS Office of Inspector General audits, including their purpose, audit protocols, how CMS uses these audits, and MUCH more! You will also hear directly from other ANCOR providers about their experiences. Of course, time will be allowed for "Q and A" with Barb and the provider-presenter.

Webinar #2: Providers and Medicaid Oversight: Getting Ready

Ms. Edwards will give a more detailed look at three federal oversight programs: waiver reviews, the Medicaid Integrity Program, and the False Claims Act. She will also focus on provider readiness for these audits. Again, hear from an ANCOR provider with first-hand experience and take advantage of the "Q and A" session following the presentation.

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FDA Fights False Claims About H1N1 Treatments

There are over 140 drugs, devices and pieces of equipment marketed over the Internet that have landed on a list of fraudulent swine-flu-fighting products compiled by the Food and Drug Administration. It is violation of federal law to market products that claim to prevent or treat H1N1 and that have not been approved by the F.D.A. While most claims about products are so outlandish that they are dismissed, it posses the problem that individuals may have a false sense of protection. Read more!

New H.R. 868 Co-Sponsors

Rep. Rush Holt (D-NJ), Rep. Lucille Roybal-Allard (D-CA), Rep. Brian Higgins (D-NY), and Rep. Michael Arcuri (D-NY) signed on this week as co-sponsors to the Direct Support Professionals Fairness and Security Act (H.R. 868). Thank you to Barbara Merrill and the MENTOR Network for contacting Rep. Roybal-Allard's office. Thank you as well to everyone who also contacted their members urging them to sign on. Read more!

NASDDDS Survey on State Plans to Close or Downsize

In late October 2009, NASDDDS conducted a brief email survey of member state agency officials regarding the existence of plans to close or downsize large state-operated institutional programs in their respective states. Respondents were additionally requested to indicate whether or not their current plans were being implemented in response to financial considerations.

Total NASDDDS member state agencies: 51

Total number of states responding to the survey: 49 (96%)

Of the 49 responding states, 11 (22%) states reported that they had closed all state operated institutions for persons with intellectual and developmental disabilities (IDD).

Of the 38 states operating institutional programs that responded to the survey (unduplicated count):

4 (11%) states are planning to close one or more facilities and not downsize other programs or facilities.

14 (37%) states are planning to downsize existing facilities but not close any institutions.

5 (13%) states are panning to close one or more institutions and downsize additional facilities.

15 (39%) states have no plans to close or downsize state operated institutional programs.

Summarizing the results of the data from the 38 states reveals that:

9 states (24%) have plans to close one or more institutions.

19 states (50%) have plans to downsize programs, reducing the census of existing facilities.

Financial Impact

10 states (26%) made the decision to close and/or downsize IDD facilities due to financial reasons.

Of the 4 states with plans to close some facilities but not downsize others, three states are closing the facilities for financial reasons.

Of the 14 states with plans to downsize but not close facilities, three states are downsizing for financial reasons.

Of the 5 states with plans to both close and downsize existing facilities, three states made the decision for financial reasons.
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Updated House health care bill section-by-section summary

The House has posted the attached updated (November 1) section by section summary of the health care bill.
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WICS Live: Around the States

Tennessee: State Freezes CHIP Enrollment. As of November 30th, the state will not accept new applications for the state’s expanded CHIP, which provides coverage to children and pregnant women in families with incomes up to 250% of the Federal poverty level and do not qualify for Medicaid. There will be no service cuts to program beneficiaries already enrolled in the program. Read more!

WICS Live: Around the States

Wisconsin: BadgerCare Plus Core Plan Reaches Maximum Enrollment. Governor Jim Doyle (D) announced October 5th that the program, which provides health insurance coverage for adults without children and not enrolled in any other health insurance program, has reached capacity and suspended enrollment as of October 9th. Those applying for coverage now are being placed on a waiting list. Doyle has directed the state Department of Health Services to design a proposal to provide some basic level of health coverage for those on the waiting list. Doyle said the state received 60,000 applications for the new program since the program began June 15th and most applicants had no income. The program must remain budget-neutral, which means the state can only afford to cover approximately 54,000 individuals. Read more!

WICS Live: Around the States

Texas: Harris County Unveils TexHealth Harris County 3-Share Plan. Officials in Harris County, which includes Houston and Sugar Land, unveiled a new small business insurance option October 20th. Harris County alone has over 1 million uninsured residents; Texas has the nation’s largest uninsured rate. The 3-Share Plan, which hopes to make a small dent in the uninsured rate, will divide monthly premiums among the employer, employee, and a subsidy fund. In the program’s first two years, a $5.5 million subsidy pool will make insurance coverage available to 5,000 uninsured workers. Workers making less than $16 an hour would pay 17% of their monthly premiums. Workers making more would split the premium 50-50 with employers. Read more!

WICS Live: Around the States

Minnesota: Governor Proposes Interstate Insurance Compact. In a letter to other governors October 21st, Governor Tim Pawlenty (R) asked his counterparts to join him in establishing an interstate health insurance compact that would call for standards in the health care market, enabling insurers to compete with one another across state boards. According to Pawlenty's letter, the proposed compact would allow states to share common regulatory standards, thereby facilitating the purchase of health insurance across state lines. It would also allow more insurers to do business in states would both increase competition and choice. The proposal would need Congressional consent and would also likely need legislative approval in Minnesota, since state law now requires health care insurers doing business in the state to be non-profit. Read more!

WICS Live: Around the States

Pennsylvania: Budget Stalemate Is Finally Over. After 101 days without a state budget, Governor Ed Rendell (D) and lawmakers reached a budget agreement, with Rendell signing the state’s $27.8 billion budget Friday, October 9th. The measure cuts overall spending by more than 1 percent and relies on nearly $500 million in new taxes on sales of cigarettes, little cigars and business taxes. The bill does not raise sales or income taxes, the state’s two biggest sources of revenue. Read more!

New York: 500 Show Up At Hearing to Protest More Proposed Budget Cuts. The hearing, which was held by the State Senate in Brookhaven, Long Island, was the second in a series to gauge public reaction to mid-year budget cuts proposed by Governor David Paterson (D) to close a current $3 billion budget gap and a projected $2 billion deficit next year. The majority of the attendees at the 5 ½ hour meeting were people with disabilities and disability advocates, who decried Paterson’s proposal to eliminate $65 million in community services and education programs so that individuals with disabilities can live independently. Read more!

New Mexico: Special Legislative Session Ends with Lawmakers Approving 7.6% Cut for All Agencies Under Governor’s Control. The special session was called to address a $650 million revenue shortfall in the state budget. The state Health Department could lose about $38 million in state funding—and an additional $155 million in Federal funding—if Governor Bill Richardson (D) signs the measure. Richardson must decide whether to sign the measure by November 12th. If enacted, cuts will be required for Medicaid, including mental health and substance abuse services for low-income New Mexicans and medical services for uninsured children and individuals with developmental disabilities. Read more!

WICS Live: Around the States

Missouri: Governor Cuts Additional $204M from State Budget. The cuts, made by Governor Jay Nixon (D) on Wednesday, include cuts to some Medicaid providers. The governor’s budget director said the state will cut $32.5 million from Medicaid, some of which will come from reduced payments to providers, and other cost-saving measures, such as more reliance on generic prescription drugs. Provider payments will only be reduced for services where the state’s reimbursement rate is higher than that of Federal rate. Read more!

WICS Live: Around the States

Colorado: Governor Outlines Second Rounds of Budget Cuts. Governor Bill Ritter (D) October 28th laid out his plan to cut another $286 million from the state budget, including reductions in Medicaid provider rates and more cuts to higher education. The governor cut $3.1 million from Medicaid providers, reducing rates by 1%, bringing this year's total cuts to the program to 4.5%. The cuts come on top of the $1.8 billion budget shortfall the state has already covered over the past year. The governor’s office warned that more cuts may be ahead, before the state’s budget year ends in June. State workers have also been ordered to take 4 additional furlough days in an effort to save money. Ritter this week will present his budget for the next fiscal year, and even deeper cuts are expected. The governor’s budget director said additional cuts are needed because of higher-than-expected Medicaid enrollment growth and previous cuts that Ritter backed away from—including $4.5 million he tried to cut for aid to low-income residents and people with disabilities. Read more!

WICS Live: Around the States

Washington: State Agrees to Restore In-Home Supports to Children with Disabilities Enrolled in Medicaid. According to a settlement agreement, the state has agreed to restore services to 4,000 children with disabilities. The settlement comes after a lawsuit was filed to prevent the state from cutting services as of July 1st; the cuts were directed by the Legislature to manage a budget deficit for the 2009-2011 biennium budget. The state is still in discussions with representatives of adults with disabilities. As of October 19th, plaintiffs and representatives from the Department of Social and Health Services in hopes of submitting a consent decree for Federal court approval. Another case involving Medicaid cuts has been appealed to the U.S. Court of Appeals for the Ninth Circuit after a Federal District Court refused to grant a preliminary injunction for beneficiaries and family members providing in-home supports as employees of other agencies. Read more!

WICS Live: Around the States Blog

North Carolina: Budget Cuts Mean Medicaid Program Will Lose $1.5 Billion. The state continues to squeeze savings out of Medicaid program, cutting provider rates, but state officials are warning that service cuts and job losses in health care could be looming. About 11,000 more people than estimated were enrolled in Medicaid during the months of August and September, increasing the pressure on the state budget. Read more!

WICS Live: Around the States

New York: State Will Reimburse Pharmacies that Provide H1N1, Seasonal Flu Vaccine to Medicaid Fee-for-Service Beneficiaries. It is the first time Medicaid-enrolled pharmacies will provide flu shots since a 2008 law took effect, permitting pharmacist to administer the shots. Medicaid recipients enrolled in managed care plans have access to immunizations through their providers. Read more!

WICS Live: Around the States

Louisiana: State to Audit Medicaid Providers to Root out Fraud and Abuse. The state Department of Health and Hospitals announced October 29th that it will roll out a new effort to combat fraud in the state’s Medicaid program by auditing more than 700 private firms that provide in-home services for the elderly and people with disabilities. The audits come in the wake of years of growth in the state’s home and community-based services; in the last 7 years, costs grew by 174% and now cost the state $673 million annually. Read more!

WICS Live: Around the States

Florida: State Previews First Phase of Electronic Health Records. The state Agency for Health Care Administration (ACHA)October 28th unveiled the MyFlorida Health eBook and eBaby Book, making the state the first in the nation to allow Medicaid recipients to access personal health records over the Internet. Within the next month, 2.6 million Medicaid beneficiaries will be able to access their health records and enter and track their health information by using their Medicaid ID number. Medicaid recipients also will be able to track family histories, print them, and share the information with health care providers, AHCA said. Read more!

WICS Live: Around the States

California: Statewide Study Finds Federal Citizenship Requirement Imposes Significant Burden on Counties.The study, conducted by the California Endowment and California Healthcare Foundation, found that the citizenship requirement made it difficult for most individuals, including children over age 16 and people born outside the state, to access Medicaid because they had difficulty finding birth certificates, driver’s licenses, and other acceptable documentation. Officials reported that no cases of existing Medicaid recipients had previously claimed false citizenship. At the same time, all 58 counties in the state reported increased workloads, backlogs, and costs to implement the citizenship verification requirement. Read more!

WICS Live: Around the States

California: State Prevented From Implementing November 1st Cuts to In-Home Support Services. A Federal judge October 19th issued a preliminary injunction to prevent the state from implementing planned cuts to an estimated 130,000 children and adults with disabilities and the elderly because of the substantial harm that would result. U.S. District Court Judge Claudia Wilken ruled that the plaintiffs in the class action suit were likely to show at trial that the service cuts, resulting for the recent state budget, violate Federal law. Read more!

New ANCOR Website

As you may have noticed, ANCOR unveiled a new website today. In addition to being “easy on the eyes,” we hope information posted in our National Issues section will be easier to find. To get to the National Issues page, click on “National Issues” on the left side of ANCOR’s new homepage. Once you click on “National Issues” you will see a tab listing all of the issues on which ANCOR’s Government Relations updates you on the right hand side of the page. Looking for ANCOR’s Action Center? To get there, simply click on the “Action Center” tab on ANCOR’s home page. If you have any questions or need help locating areas of interest on our new site, please contact Tony Yu. Read more!

CLASS Act Not a “Done Deal” in Senate Health Reform Proposal

ANCOR staff has been meeting with key Senate offices all this week to ensure the inclusion of the CLASS Act in the Senate health reform bill. Although the House bill includes the CLASS Act provisions, key Senators have been reluctant to include the CLASS Act as part of the merged Senate Finance and HELP committee bill.If you have not reached out to your Senators yet to support ANCOR’s efforts to get these provisions in the merged Senate bill, it’s not too late. Use ANCOR’s Action Alert to get word to your Senators that the CLASS Act must be in the final Senate bill.

Remember, the CLASS Act would 1) provide a new private source of funding for ANCOR providers of long term supports and services; 2) reduce federal deficit by 74 billion over 10 years; and 3) produce a savings to Medicaid of nearly 2 billion in first five years of implementation.

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Senate Committee Holds Hearing on Disabled and Elderly Housing Issues

Yesterday, the Senate Banking Committee’s subcommittee on Housing, Transportation, and Community Development held a hearing on Modernizing Affordable Housing for Seniors and People with Disabilities. Witnesses discussed the Section 811 reform bill and the Section 202 elderly housing reform bill. ANCOR supports the Section 811 reform bill, the Frank Melville Supportive Housing Investment Act of 2009 (S. 1481) and encourages ANCOR members to ask their Senators to co-sponsor this bill. The identical companion bill, H.R. 1675, passed in the House by unanimous consent this summer.

Chairman Dodd (D-CT) stated strong support for the Melville bill and committed to move it through the Committee and to the floor quickly. In addition to Chairman Menendez (D-NJ), Senators Johanns (R-NE) and Kohl (D-WI) attended.

Click here to view the hearing.

Click here to read witness testimony.

Click here for more information on the Frank Melville Supportive Housing Investment Act of 2009.
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Senate Health Reform Bill Sent to CBO for Score

Cost estimates for a Senate health care reform bill will likely not be available for another week and a half, pushing back Senate Democratic leadership’s plan to begin debating the bill on the floor sometime next week. Senate Majority Leader Harry Reid (D-NV) anticipates having to resubmit some portions of the measure before bringing it to the floor. That means a final bill is unlikely to be ready for floor action prior to the week of November 9th.

That timeline could complicate Reid's ability to finish debate before Thanksgiving, because the Veterans Day holiday on Nov. 11 falls on a Wednesday and the Senate is not expected to be in session that day or the remainder of that week. That would leave just one full week of floor debate on the bill before Thanksgiving on Nov. 26.

Senate Democratic Conference Vice Chairman Charles Schumer (D-NY) said he believes the CBO scoring holdup will not prevent Congress from sending a bill to the president before the end of the year.

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House Health Reform Bill Official CBO Score is $1.055 Trillion; Possible Floor Consideration Late Next Week

The House Democrats' health care plan would cover 36 million more Americans at a cost of $1.055 trillion over the next decade, while reducing the federal deficit overall by $104 billion, according to a preliminary Congressional Budget Office score released late Thursday.

The House bill contains the ANCOR supported CLASS Act, which would 1) provide a new private source of funding for ANCOR providers of long term supports and services; 2) reduce federal deficit by 74 billion over 10 years; and 3) produce a savings to Medicaid of nearly 2 billion in first five years of implementation.

The bill could come to the floor for consideration as early as November 5, House Majority Leader Steny H. Hoyer said Thursday night. A manager’s amendment will be available as soon as November 2, Hoyer added.

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NEWS FLASH: House Includes $23.5 Billion to Extend the ARRA FMAP Increase Through 2011 in Health Reform Bill

The Senate does not have this provision at this time. Details to follow early next week. Read more!