House Begins Walk-Through of Health Reform Package While House and Senate Democrats Await CBO Cost Estimates Due Out Thursday

House Speaker Nancy Pelosi (D-CA) will start walking her rank-and-file members through major components of the final health care package in a meeting Thursday morning. The briefing comes after another long negotiating session with Senate Democrats and top White House officials in Pelosi’s Capitol office. Meanwhile, Democrats are watching out for two Congressional Budget Office (CBO) cost estimates today on health overhaul measures, an update of the Senate-passed bill and a plan incorporating changes called for by President Obama. The two chambers are trying to resolve a long list of differences, both big and small, between their two bills and discussing changes made through a "reconciliation" process. All parties stated Wednesday that tremendous progress had been made, particularly with issues sensitive to House members who are going to be asked to vote on the Senate-passed version as well as a "side car" bill of changes (reconciliation bill) to deal with issues sensitive to the House in the Senate-passed bill. The changes expected in a reconciliation bill include those the President set out in his February 22nd $905 billion proposal and changes needed to gain House votes--while not upsetting the delicate balance needed to gain 51 votes in the Senate. President Barack Obama pressed Senate Majority Leader Harry Reid Wednesday to go further than Obama had previously disclosed to strip the final reform bill of narrow deals aimed at appeasing specific senators. Read more!

Providers Should Press for State Protection of Services and Supports

CMS March 5th letter to Medicaid Directors affirms HHS announcement regarding additional Federal Relief to states due to ARRA FMAP application to state Medicaid “Clawback.” As ANCOR reported in past WIC’s Updates, HHS announced on February 18th that it would provide $4.3 billion in fiscal relief to states by applying ARRA increased FMAP to the so-called clawback payments states pay to the federal government as required by the Medicare Prescription Drug Improvement and Modernization Act of 2003 that added Medicare cost of assuming drug costs for dually eligible Medicare/Medicaid beneficiaries.The recalibrations mean decreased state contributions for the increased federal FMAP. Providers should take this opportunity to use the additional federal assistance to protect services, supports and rates for individuals with disabilities.
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March Is National Intellectual and Developmental Disabilities Month—One Provider’s Example of Shedding Light on Provider Role and Challenges

Linda Timmons, CEO and President of Mosaic, successfully brought attention to March in with a published column in the Omaha World-Herald as well as providers’ role in reshaping supports and services in the community and enhancing the lives of individuals with disabilities. Timmons also wove this month’s designation to the intersection of debates surrounding health reform and budget challenges. What are you doing to bring positive awareness to the supports and services you provide? Of the challenges you face as an economic and social force in your communities? Of the positive affects you have on individuals with disabilities? Read more!

New Version of "Extender Bill" Passes House and Moves to the Senate

The House sent legislation aimed at spurring job creation back to the Senate Thursday after tacking on language to fully offset the package’s cost.

The move means that the bill will have to return to the Senate for another vote, further delaying implementation of the first portion of the Democrats’ “jobs agenda.”

The centerpiece of the $17.6 billion package is payroll tax relief for businesses that hire new workers, which would cost $13 billion over 10 years. The bill also includes extensions of the Highway Trust Fund, the Build America Bonds program and expense deductions for small businesses.

Certain House Democrats complained that it violated the pay-as-you-go budgetary rule. To make the bill compliant with the rule, the House changed some of the tax provisions that were in the Senate-passed version, including the section on delaying worldwide interest allocation. This is the version that will go back to the Senate for consideration.

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Senate Continues Consideration of Large Jobs Bill with FMAP Extension--No Votes Until Tuesday March 9th

The Senate spent Thursday resuming consideration of H.R. 4213 disposing of a growing number of pending amendments. Majority Leader Reid considered bringing a motion to close debate. However, he announced that the Senate would continue consideration of the bill Friday and Monday with no roll call votes scheduled until Tuesday, March 9th.
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President Obama Calling for Passage of Health Care Bill by March 18th

While deadlines on the overhaul of health have been set repeatedly and unmet repeatedly, the President wants the House to clear the Senate-passed bill by the 18th. Having decided on a two-step process to complete comprehensive health care reform, Democrats plan on using the Senate-passed bill as the foundation bill and passing a side-car bill with changes to the Senate bill agreed to by the administration, House and Senate. House Speaker said she could not guarantee a House vote by the 18th, but expected such a vote before the Easter recess. Obama held a meeting Thursday with a mix of House Democrats in order reverse some previous House "no votes" and potential new House "no" votes to gain the necessary 217 votes to clear the Senate bill with reconciliation changes.
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Senate will take up S. 4213 Thursday morning

The Senate adjourned Wednesday at 8:00 p.m. after considering numerous amendments to the larger $149 billion jobs bill (S. 4213)which extends many tax cuts and federal funding from programs until December 31st -- including temporary federal assistance in the form of enhanced FMAP to states. It will resume consideration of the $149 billion larger jobs bill with FMAP extension on Thursday. Once it passes, the House will take up the measure.


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Center on Budget and Policy Priorities Issues New Briefs

The March 2nd brief finds that if a state cuts a tax, it generally has to make an offsetting cut to expenditures for a program or service in order to maintain balance. This spending cut is likely to reduce demand in the state just as much as the reduction in taxes may stimulate demand.[1] It is at best a zero-sum game, where the gains in one area are offset by the losses in another. Given states’ balanced budget requirements, neither a broad-based tax cut nor a jobs credit can do much to increase overall economic activity in the state. This tax brief is a good companion to the February 16th CBPP brief A Balanced Approach to Closing State Deficits used in connection with ANCOR's February 18th Audio Conference.

CBPP also released on March 3rd an update on state budget cuts. The report found 45 states making cuts that are harmful to vulnerable populations.
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GAO March 2010 Report on State and Local Governments' Fiscal Outlook

The new report found that state and local government sectors continue to face near and long-term fiscal challenges and although the sector's near-term operating balance remains negative the federal Recovery Act assistance alleviated pressure with March 2010 operating balance measures showing an improvement compared to January 2009. In the near-term the sector's fiscal position can be attributed to several factors--including steep revenue declines. Absent any policy changes, GAO projects that the sector's long-term fiscal position will steadily decline through 2060. The decline is primarily driven by rising health care costs. Read more!

Democrats Readying to Move on Comprehensive Health Care Plan

Senate Majority Whip Durbin (D-IL) said Wednesday that House and Senate were “coming to closure” on revised language for comprehensive health care legislation that most likely could muster sufficient votes to pass both chambers—most likely using expedited budget reconciliation procedures. He said that Democratic leaders expect to send legislative language by the end of the week soon to the Congressional Budget Office (CBO) for cost estimates. The process would be at least a two-step process with the House passing the Senate-passed bill and both chambers passing House fixes or Administration changes (amendments to the base Senate bill) as a “side-car” reconciliation bill that allows legislation to avoid filibusters and pass with a simple majority.
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U.S. 9th Circuit Court of Appeals Rules Maintains Injunction Against California Regarding Wage Lawsuit

Thanks to Ron Cohen, President of UCP of Los Angeles, Ventura and Santa Barbara Counties for this news item. The Court today issued a decision against the Schwarzenegger Administration, upholding Federal District Court Judge Wilken's injunction that has blocked since June 2009 the reduction in the state's participation toward in-home supportive worker wages. The decision is a setback to the State of California, which on Monday won a ruling from the California State Court of Appeals on the issue of the Governor's line item vetoes, which that court declared was unconstitutional. The State could decide to appeal the 9th Circuit Court's ruling to the U.S. Supreme Court. The text of 21-page Circuit Court's opinion in Dominguez et al v. Schwarzenegger (formerly Martinez v. Schwarzenegger) and original federal district court case is available on the California Disability Action Center (CDCAN) website at http://www.cdcan.us/.
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Judge Orders New York City to Move Mentally Ill Out of Large, Institutional Housing

A decision in Disability Advocates, Inc. v. David A. Paterson, by Judge Nicholas G. Garaufis of Federal District Court in Brooklyn, followed his ruling in September that the conditions at more than two dozen privately run adult homes in New York City violated the Americans with Disabilities Act by leaving approximately 4,300 individuals with mental illness isolated in warehouse like conditions. The remedial plan offered by Judge Garaufis, drawn from a proposal presented by advocates was backed by the Justice Department, calls on New York to develop at least 1,500 units of supported housing a year for the next three years in New York City. That would give nearly all residents the opportunity to move out of adult homes. The state is considering an appeal, according to a one-sentence statement from Governor Paterson's officer.
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FY 2010 State Budget and Economic Survey

ANCOR State Budget Survey Shows Cuts in Services
Members are Urged to Respond to Next Survey

ANCOR asks its members to fill out a quarterly survey that asks questions about your state budgets and how they affect your organization and its ability to support individuals with disabilities. This survey is important because staff can take this information to Capitol Hill when meeting with members of Congress. The answers you give help paint a picture, with real people—the people you support, their families, and your employees -- of what cuts in Medicaid mean to services and supports for individuals with disabilities. In fact, ANCOR encourages you to talk to your federal lawmakers; the more they hear from you the more they will remember how important Medicaid funding is to the work you do.

ANCOR’s most recent survey yielded 65 respondents and a total of 33 of states. Over half of the agencies that responded to the survey received a cut in reimbursement. To deal with cuts, some providers increased the size of living arrangements and decreased the amount of direct support hours.

ANCOR members report the numbers of individuals on waiting lists continue to increase and in many states no funds are available to provide supports to anyone on the waiting list, while provider capacity to take emergency referrals has diminished.

Many providers have been forced to reduce the amount of support to “essential services,” greatly limiting the participation of individuals in their community and their independence. Defining elements of community life, such as access to social, recreational, and religious opportunities, have become limited or eliminated due to transportation and staffing cuts.

This information is just a snapshot of what ANCOR members report. Specific agency names and those making these reports are kept confidential. We hope as more information is collected over time, we can show more data; however, in the mean time, the information collected in this survey is critical to influencing individual members of Congress. Please watch for another survey in April and take the time to respond. Your influence in Congress depends on it!



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Save the Date: Learn About Cuts to Critical Section 811 Housing Programs

On Wednesday March 10 at 1:00 PM (EST) the Consortium for Citizens with Disabilities (CCD) Housing Task Force in conjunction with the Technical Assistance Collaborative (TAC) will host a very important conference call on HUD Section 811 Supportive Housing for Persons with Disabilities program highlighting drastic cuts to the Section 811 proposed FY 2011 budget and critical Section 811 legislation which must be enacted to reinvigorate the program.
What the Call Will Cover:

• The HUD FY 2011 Budget proposal eliminates all funding for new permanent supportive housing units financed through the Section 811 program until the new legislation is enacted. We need your help to advocate with Congress to restore these cuts.
• Currently critical Section 811 legislation is pending in the Senate and has already passed the House with strong bipartisan support. The call will focus on strategies and information you can use to engage your Senator to sign on as a cosponsor to S.1481 and save the Section 811 program.

Please join this call on Wednesday, March 10 at 1:00 PM (EST) to learn how to engage your Senator to cosponsor this important legislation.

Conference toll free call in number:
866-266-3378
Pass code 8224620005#

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New Reports on Medicaid and State Conditions

Kaiser releases a new report on Medicaid’s Continuing Crunch in a Recession: A Mid-Year Update for State FY 2010 and Preview for FY 2011. From the beginning of state fiscal year 2010, fiscal pressures have escalated and additional program reductions have become a necessity to balance state budgets. Half-way through the states' fiscal year, a total of 44 states and D.C. report that Medicaid enrollment and spending trends are above projected levels. Twenty-nine states report that additional mid-year cuts are likely. The February 22nd issue brief reports on interviews with all Medicaid directors about several issues, including the effects of the recession. Their primary concern is the upcoming end of the enhanced federal Medicaid match (as provided in the ARRA) and what that will mean for state budgets.

Kaiser Update on State Fiscal Conditions and Medicaid on How States Used ARRA Enhanced FMAP and State-by-State Measure of State Fiscal Distress.
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Health Summit Yields No Bipartisan Accord and Sheds Light on Divergent Party Philosophies on Health Care Reform

President Obama and congressional Democrats and Republicans debated health care reform for more than six hours February 25th, but as expected, the meeting did not bring the parties closer to a bipartisan agreement on reform legislation. While participants of the summit found some areas to which there were broad agreement, Republicans stated that they wanted the President to scrap the Senate-and House-passed legislation and White House proposal released on Monday and begin anew with an incremental approach to health care reform. Obama ended the unprecedented, day-long session by saying Democrats and Republicans likely could agree on several reform issues, and he called on Republicans to provide solutions over the next month to six weeks on how to extend coverage to more Americans than under the House GOP bill. If a bipartisan agreement cannot be reached, “then I think we have to go ahead and make some decisions,” the president said. “We cannot have another year-long debate on this.” While some expect the next step will be House and Senate Democrats agreement to the Senate bill and then passage of a "reconciliation" bill with fixes negotiated by Congressional Democrats and the Administration, others are reporting that the President has already prepared a fall-back, scaled down version of health care that would provide coverage to 15 million people rather than 31 million that he might consider should other choices fail to gain enough Congressional support.

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HHS Secretary Response to Senate Letter on Medicaid PERM Rates

In response to a letter from Senator Cornyn (R-TX) asking for CMS information on Medicaid's improper payment rates (PERM) for 2007 and 2008, Secretary Sebilius released a letter February 25th detailing state-by-state Medicaid PERM rates for those years. Cornyn had raised the issue because “CMS had reported Medicaid's improper payment rates average between 8.7 percent and 10.5 percent among the states, which is substantial considering the combined federal/state spending on Medicaid reached approximately $438 billion in 2009.” Sebelius reported a national Medicaid error rate of 9.6 percent in its FY 2009 Agency Financial Report. The error rate was based on a weighted average of the states that were measured in FY 2007 and FY 2008.

In her letter, Secretary Sebelius said that that “CMS uses a 17-state rotation so that each state is reviewed once every three years. FY 2007 was the first year in which states were fully measured in each component of the PERM measurement. Therefore, we are only providing information about state rates for FY 2007 and FY 2008; the remaining states will be measured during the FY 2009 rotation.” She reported that for all the states sampled in FY 2007, the average rate was 10.5% with Rhode Island having the largest PERM rate of all sampled states, at 21%--followed by California at 16% and Georgia at 12 %. The combined rate for all sampled states in FY 2008 was 9%--with the top three PERM rates belonging to Oregon at 21%, Washington, D.oiC. at 20%; and Indiana at 17%. Read more!

FMAP Extension Likely on Next Senate Jobs Bill

Senate Majority Leader Reid (D-NV) is following through on his commitment to extend federal FMAP assistance to states through June 31, 2011. Rumored to be in released draft language on a second jobs bill released Wednesday, Reid is including a number of must-pass "health care provisions"that were not included in the first-Senate jobs bill passed Tuesday. In addition to six-month FMAP extension, the next bill in the Senate's job agenda will include an extension of COBRA subsidies for ten months through December 31, 2010 for individuals who have lost employment, an extension of the current fix to Medicare physician rates through September 2010, a full-year extension of the Medicare therap cap exemption, and other Medicare provisions. Stayed tuned for future Alert on when the second jobs bill is introduced and scheduled for a Senate vote. Thanks to everyone who has already responded to ANCOR's previous February 12th alert on FMAP by contacting both of their Senators!
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Administration's New ARRA Relief to States on "Clawback" Medicaid Funds to Cover Dual Eligibles Will Help States Struggling with Medicaid Budgets

The HHS Secretary in a February 18th call to state governors announced that it would provide $4.3 billion in fiscal relief to states by applying ARRA increased FMAP to the so-called clawback payments states pay to the federal government as required by the Medicare Prescription Drug Improvement and Modernization Act of 2003 that added Medicare cost of assuming drug costs for dually eligible Medicare/Medicaid beneficiaries. This temporary adjustment in the clayback payments will be applied from October 1, 2008 through December 31, 2010. The announcement includes a state-by-state table of newly calculated savings to state matching funds.
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State of the States: The State We're In Report Examines Health Reform Efforts in 2009 and Initiatives Underway in 2010

This new Robert Wood Johnson Foundation report it examines how states responded to declining job-based coverage and rising health care costs, as well as Medicaid eligibility and CHIP enrollment in 2009, when many states went forward with meaningful health care reforms despite the fiscal challenges they faced. Read more!

Health Care Summit Thursday Likely to Determine What's on the Table Friday

President Obama invited a host of Congressional leaders to take part in the six-hour meeting, released his health care proposal on Monday, and invited Republicans to do the same. The meeting centers on four health care reform topics — cost control, insurance reforms, deficit reduction and expanded coverage — with Obama, Health and Human Services Secretary Kathleen Sebelius and Vice President Joseph Biden taking turns introducing each topic. While the "bipartisan health care summit" takes place Thursday, the defining moment will come the day after, when Democrats decide once and for all whether they can "go it alone" or try for Republican support to pass a bill.

House Democratic participants include House Majority Whip Clyburn (SC), Speaker Nancy Pelosi (CA), Majority Leader Steny Hoyer (MD), and Representatives Rangel (NY), Miller (CA), Waxman (CA) and Dingell (MI). Republicans include House Minority Leader Boehner (OH), Minority Whip Cantor (VA.) and Representative Camp (MI.), Barton (TX) and Kline (MN).
Senate Democratic participants include Majority Leader Reid (NV), Majority Whip Durbin (IL) and Senators Baucus (MT), Dodd (CN) and Harkin (IA).

Republicans include Minority Leader McConnell (KY), Senate Minority Whip Kyl (AR) and Senators Grassley (IA) and Enzi (WY).

In addition, House and Senate leaders from both parties were each allowed to bring four lawmakers to represent their chamber. House representatives include Representives Becerra (D-CA), Cooper (D-TN), Slaughter (D-NY), Andrews (D-NJ), Boustany (R-LA), Ryan (R-WI, Blackburn (R-TN) and Roskam (R-IL). Senate representatives include Schumer (D-NY), Murray (D-WA), Rockefeller (D-WV), Coburn (R-OK), Alexander (R-TN), John McCain (R-AR), Conrad (D-ND) and Barrasso (R-WY).
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Senate Passes $15 Billion Jobs Bill--First in Series of Job Creation Agenda

After waiving a Republican point of order, the Senate Wednesday morning  passed a $15 billion jobs bill, by a vote of 70-28. The bill which includes  payroll tax breaks, bond-financing for state and local infrastructure projects, a small-business expensing provision, and an extension of federal highway programs, will be sent to the House for a vote.  The House passed a more comprehensive $154 billion jobs bill in December which included a six-month extension of FMAP. 

Before leaving for their week-long President's Day recess, Majority Leader Reid (D-NV) scrapped a larger, bipartisan jobs bill draft by Senate Finance Chair Baucus (D-MT) and Ranking Member Grassley (R-IA) in favor of a series of smaller jobs bills.  Majority Leader Reid is working on several other jobs bills as part of a jobs creation agenda.  A six-month extension of FMAP, as well as extensions of unemployment insurance and COBRA, are being considered for the next jobs bill. However, timing has not been set for the series of bills or content.  Reid must first determine what items must be costed out under new "pay-go rules" and what combination in each package will bring sufficient support to muster a 60-vote cloture rule to end any filibuster efforts, before proceeding.

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Forty-Seven Governors Urge FMAP Extension

A bipartisan group of 42 governors of states and five governors of U.S. territories sent a letter on February 22 urging House and Senate leaders to extend for at least six months the enhanced federal match for Medicaid included in the American Recovery and Reinvestment Act of 2009. The following governors did not sign the letter: Janice Brewer (R-AZ), C. L. Otter (R-ID), Bobby Jindal (R-LA), Tim Pawlenty (R-MN), John Hoeven (R-ND), Mark Sanford (R-SC), Rick Perry (R-TX), and Gary Herbert (R-UT).
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New HCBS Participant-Directed Services Clearinghouse Online Website

The HCBS Clearinghouse has added a new theme page maintained by the National Resource Center for Participant-Directed Services at Boston College regarding information and resources on participant-directed services (self-directed services). The new site includes an online manual for developing and implementing participant-directed services; CMS guidance on the DRA Section 6087, the “Optional Choice of Self-Directed Personal Assistance Services (PAS) Medicaid state option; and state experiences with managing rebalancing efforts.
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Go Direct - Social Security

Millions of Americans still receive their Social Security and other federal benefit payments by paper check, which can be vulnerable to delays, loss or theft. By supporting the U.S. Department of the Treasury's campaign to encourage the use of electronic payments for federal benefits, you can help senior citizens, people with disabilities and others in your community choose a safer, easier way to get their money. Treasury suggests the use of two electronic payment options:

The U.S. Department of the Treasury encourages the use of two safer, easier alternatives to paper checks for federal benefits: Go Direct and the Direct Express card.

• Treasury's Go Direct® campaign offers Americans with bank accounts a fast, easy way to sign up for direct deposit. For more information about Go Direct and how to sign up please visit http://www.godirect.org/ or call the toll-free Go Direct campaign helpline at (800) 333-1795
  
• The Direct Express® Debit MasterCard® card is designed as a safer, more convenient alternative to paper checks for Social Security and Supplemental Security Income (SSI) benefit recipients who don't have a bank account. For more information about the Direct Express card or how to sign up please visit http://www.usdirectexpress.com/ or call toll-free (877) 212-9991
  
  

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Kaiser Examines Medicaid and Managed Care

The Kaiser Commission on Medicaid and the Unisured issued a policy brief Monday, February 8th which provides an overview of the Medicaid program’s increasing reliance on managed care to deliver services. Medicaid provides health and long-term care coverage to nearly 60 million low-income individuals, or roughly 1 in 5 Americans. About 70 percent of Medicaid enrollees receive some or all of their services through managed care. Adopting managed care also gives states more cost predictability and control over their Medicaid programs, and contracts with managed care plans offer states a mechanism, through quality measurement and improvement requirements, for holding plans accountable for the quality of care they provide to Medicaid enrollees. Read more!

Senate To Move on First Jobs Bill Week of February 8th

Provisions of a Senate $80 billion jobs bill expected in Thursday's Democratic press conference with Majority Leader Reid (D-NV), Durbin (D-IL) and Baucus (D-MT) were not forthcoming as Senators said details for a bill would be unveiled Friday or Monday. Reid expects to vote on the first jobs creation bill by end of next week before the Congressional week-long Presidents' Day recess that begins February 12th.

Senate leaders continued to negotiate a bipartisan package of tax incentives and safety-net spending for laid-off workers Thursday, but the must-pass nature of the bill meant it was beginning to attract unrelated legislative freight. The House-passed jobs bill costs $154 billion heavily focused on infrastructure and FMAP extension. However, the Senate jobs bill is to focus on tax credits and tax payroll relief for small businesses, highway funding, and possibly extension of unemployment insurance and COBRA. At this point, it is not expected to include FMAP extension. See related brief on Reid and Rockefeller bill and push to get FMAP in this jobs bill. Read more!

Senate and House Democratic Leaders Continue to Move Health Reform Process Forward

The leadership of both chambers are negotiating a pathway to resume passage of comprehensive health reform that includes significant provisions related to long-term services' issues. House Democrats remain reluctant to pass the Senate bill without assurances of changes.

In order to avoid an expected 60 vote cloture to end a filibuster Democratic leaders are still pursuing a path in which the House would agree to the Senate bill, but make changes through "the reconciliation process" that would require only 51 votes. Given the level of mistrust between the two chambers, the House wants the Senate to vote first on a reconciliation package that would modify the Senate bill's provisions including the so-called "Cadillac tax" on insurance plans costing more than $8,500 for individuals and deeper subsidies for low-income beneficiaries.

Meanwhile the Senate is pivoting to job creation bills while substance and process are worked out. Read more!

Reid and Rockefeller Introduce Senate Bill to Extend FMAP--Push Next Week to Avert More Job Losses Without FMAP Extension

Senate Majority Leader Reid (D-NV) and Senator Rockefeller (D-WV) introduced legislation Thursday to extend by six-months the temporary federal funding for FMAP in last year's Recovery Act (ARRA). With states expected aggregate budget shortfall at $180 billion and only $40 billion covered by ARRA's FMAP through 2010, the $140 billion expected shortfall would cost a job loss of 900,000 jobs nationally.

ANCOR sent a letter to all Senators Tuesday urging immediate extension of ARRA FMAP funding. In a meeting with Rockefeller's staff last night, ANCOR was told that the bill (yet to have a bill number) has 33 Democratic sponsors. ANCOR asked if the legislation mirrors the House provision included in its job bill passed in December. Senate Finance staff confirmed that it was the same except for adding a provision regarding county pass-throughs. Rockefeller staffer has confirmed that she will be a part of ANCOR's free audio conference on FMAP on Thursday, February 11th.

Senate staff from multiple offices expressed the urgency of immediately including an FMAP extension to avert deeper budget cuts that states are now planning in their 2011 budgets. The temporary extension would be through June 2011. The intention is to include the legislation immediately in the first jobs bill that the Senate is expected to take up next week. Both the National Governors Association and National Conference (NGA) on State Legislatures (NCSL) sent bipartisan letters this week to Congress urging immediate extension of ARRA FMAP funding. ANCOR will have an alert out early next week pending fact sheet being developed by Senate staffers today. Read more!

Administration Issues Paul Wellstone Mental Health Parity Interim Final Rule

The administration Wednesday issued interim final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to health care insurance coverage. These interim final regulations are effective on April 5, 2010. Read more!

CMS Issues Clarifying Letter on Ticket to Work Outcome and Milestone Payments to Employment Networks

On Thursday, January 28th, CMS issued a letter to State Medicaid Directors clarifying that Ticket Outcome and Milestone payments to Employment Networks (ENs) under the Ticket to Work program do not conflict with regulatory requirements and do not constitute an overpayment of Federal dollars for services provided because EN payments are payment for an outcome, rather than for a Medicaid service rendered. The letter indicates that State agencies and/or providers interested in participating in the Ticket to Work program as ENs are encouraged to do so.

We know that many organizations have been waiting for this policy clarification in order to make the final decision to become an EN or, if already an EN, to accept Ticket assignments and receive payments. To obtain the EN RFP, visit: http://www.ssa.gov/work/enrfp.html. For assistance with completing the application to become an EN, please contact a CESSI Account Manager at 1-877-743-8237 (v/tty) or visit www.cessi.net/ttw. Existing ENs should contact MAXIMUS at 1-866-949-ENVR (3687) or 1-866-833-2967 (tty) with any questions.

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President Obama Includes FMAP Extension in Budget

President Barack Obama's FY 2011 Budget endorses and includes a $28 billion six month extension of Enhanced Medicaid (FMAP). Without this provision, states would have been expected to make dramatic budget cuts this session to make up for the sudden loss of federal revenue that had previously sustained earlier recession budgets.

The FMAP extension had earlier been passed twice (most recently in December 2009) by the U.S. House of Representatives, but was stalled in the Senate with the aftermath of the demise of the current Health Care Reform bill.
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President Submits FY 2011 Budget Proposal with FMAP Extension, No Medicaid Cuts, and Freeze on Domestic Programs

President Obama submitted a $3.8 trillion budget request to Congress on Monday, while taking in $2.6 trillion in revenues in FY 2011.The budget submission kicks off the annual appropriations' processes in the House and Senate. The budget request includes for the first time federal spending on the wars in Iraq and Afghanistan as well as federal spending to cover the adjusted minimum tax. The administration's proposal includes $25.5 billion for a six month extension to the Recovery Act's federal FMAP funding to help cash-strapped states with their Medicaid budgets. No cuts to Medicaid are included in his budget.

The president will request $561 million in the 2011 budget, an 80 percent increase in discretionary funds to support identification of prevention, and enforcement of Medicaid and Medicare programs. The budget includes cuts in some discretionary spending as well as elimination or consolidation of some federal programs (e.g. VR programs, HUD programs) beginning in FY 2011. The proposal includes about $100 billion worth of policies intended to help create more jobs this year. ANCOR will provide a detailed analysis on its website and in WICs Live early next week.
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President Obama Taps Vice President to Lead Middle Class Task Force

President Obama announced Mondaythe formation of a White House Task Force on Middle Class Working Families that would target raising the living standards of middle-class, working families. In addition to regular meetings, the task force will conduct outreach sessions with labor, business, and advocacy communities. The President set out five goals for the task force. The announcement includes the creation of a new website at www.AStrongMiddleClass.gov that also solicits public comment. ANCOR will explore ways that its policy issues can be brought forward to the task force.

Vice President Bidgen will lead this initiative that will be comprised of top-level administration policy makers including the Secretaries of Labor, Health and Human Services, Education, and Commerce, and the Directors of the National Economic Council, the Office of Managemen and Budget, the Domestic Policy Council, and the Chair of the Council of Economic Advisors. President Obama has set the following goals for the task force: expanding education and lifelong training opportunities; improving work and family balance; restoring labor standards, including workplace safety; helping to protect middle-class and working-family incomes; and protecting retirement security. The first official meeting will be on February 27, 2009 in Philadelphia, Pennsylvania. The topic of the first meeting will be: "Green Jobs: A Pathway to a Strong Middle Class."
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Bipartisan Policy Center Launches Debt Reduction Task Force

Co-chairs of the Bipartisan Policy Center, former Senate Budget Chairman Pete Domenici (R-NM) and Former Office of Management and Budget and Congressional Budget Office Director Alice Rivlin announced Monday that they will lead a task force to develop a comprehensive, balanced and politically-viable budget plan for expedited consideration by the Administration and Congress.

The task force believes that the U.S. cannot simply rely upon economic growth to solve the federal fiscal imbalance and it plans to examine a broad range of spending and revenue options—with all options on the table. This effort is separate from failed Senate efforts this week to establish through statute a commission to make recommendations to Congress or President Obama’s plan to establish a commission via executive order. A listing is available of the Center’s Deb Reduction Task Force , as well as video and other activities on the Center’s website.
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President’s FY 2011 Budget to Include Freeze on Non-Security Discretionary Funds for Three Years

In conversations with Administration officials on Tuesday, ANCOR learned that the proposed freeze to be included in the President’s proposed FY 2011 budget submitted to Congress on February 1st will not affect mandatory programs (entitlements) such as Social Security, Medicaid, and Medicare. The proposal would not place a freeze on defense, homeland security, Veteran’s Affairs, or international/global funding. The proposed budget will seek to save $250 billion over 10 years to help address the $8 trillion deficit that this Administration said it inherited.

The freeze or cuts will not be equally borne across federal discretionary programs—some programs may get an increase, while others will be frozen or cut, and some eliminated. Officials stated that questions regarding specific programs would have to await the submission of the budget on Monday. As ANCOR members will recall, discretionary programs equal only 15 percent of the federal budget, with 85 percent spent on entitlement programs, interest on the national debt, and defense-related spending. Read more!

Reid Postpones Unveiling of Jobs Plan

Senate Majority Leader Harry Reid (D-NV) has postponed unveiling his plan for a series of jobs bills until next week in order to include proposals outlined by President Barack Obama during Wednesday’s State of the Union address. Obama’s State of the Union caused a “delay by a few days to incorporate a few of the president’s suggestions,” Senate Democratic Policy Committee Chairman Byron Dorgan (D-ND)said, including the president’s call for new small-business capital gains provision.

Earlier Thursday, Reid acknowledged that he is planning to move a series of smaller, targeted jobs bills this year rather than one large package. Democrats are hoping that by moving several bills throughout the year they can keep the issue on the front burner and lure some GOP support along the way.

The first bill, which could be introduced as early as next week with the intention of passing it before the Febrary 13 recess, could include provisions dealing with small businesses, infrastructure and taxes.

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ANCOR Offers Comments at Invitation-Only HHS/DOJ Summit on Fraud and Abuse

ANCOR participated Thursday in an all-day Summit on Fraud sponsored by HHS Secretary Sebelius and Attorney General Holder that brought together federal agencies, state officials, and some private providers and health care insurers. Both Sebelus and Holder emphasized that this administration has a top priority placed on the detection, prevention and enforcement of Medicare, Medicaid, and health care fraud, waste and abuse. Secretary Sebelius announced that President Obama's proposed budget to be released on February 1st makes an historic federal investment--$1.7 billion or 80% increase--in efforts to address fraud, waste and abuse.

Top federal officials stressed that this first ever fraud summit would not be the last. The summit included comments from the HHS Inspector General (IG) and included CMS Medicaid and Medicare, Administration on Aging, HHS IG, and other federal officials along with federal and state law enforcement officials. One theme of the summit was to bring public and private stakeholders together to discuss solutions to address detection and prevention of fraud and abuse.

ANCOR was one of a few private providers along with private health insurers in attendance. ANCOR had the opportunity to comment in an afternoon breakout session on the duplication of multiple audits and reviews, and urged coordination of federal and state efforts. ANCOR also reminded officials--as they spoke about limited federal, state, and local resources--that providers are also facing an environment of severe cuts, the costs of multiple audits and reviews, and resources diverted from providing supports and services. In addition to better coordinating efforts and refocusing on suspicious trends in provider claims, ANCOR urged federal and state officials to better share information and engage providers in solutions.
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ANCOR Co-sponsors National Call-In Days and Roll Call Ad Urging Congress to Complete Health Care Reform That Includes Long-Term Supports

Working together with a group of aging and disability national organizations, ANCOR joined in sponsoring a Roll Call Ad that calls on Congress to pass legislation now that includes The CLASS Act and other important improvements to expand and increase funding options for home and community supports and services. Other efforts included national call-in days to Congressional offices this week. ANCOR thanks all members who responded to the National Call-In alert this week. Read more!

No Firm Strategy Emerges Yet for Congress to Complete Health Care Reform

House and Senate Democratic leaders January 28th said President Obama's State of the Union speech might help re-energize Congress in its push to pass health care reform legislation. Getting the House to pass the Senate bill, along with approval of a smaller measure making changes to the Senate legislation favored by House lawmakers via the budget reconciliation process, remains under serious consideration.

Under reconciliation, legislation in the Senate can be approved with just 51 votes. That package was expected to include new language on the makeup of health insurance exchanges, changes to the so-called Cadillac tax on high cost health insurance plans in the Senate bill, and more generous federal subsidies for low- and middle-income individuals seeking to purchase insurance than contained in the Senate bill. House Speaker Pelosi (D-IA) said House Democratic leaders would soon lay out the content of the smaller bills, but “right now, we want to see where the Senate will go on its legislation.“
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Grassley Introduces Bill to Fight Fraud, Waste, and Abuse in Medicaid, Medicare, and SCHIP

On the same day that the departments of Health and Human Services and Justice held a Summit on Health Care Fraud (see related article) Ranking Senate Finance Member Chuck Grassley (R-IA)Thursday introduced the “Strengthening Program Integrity and Accountability in Health Care Act." Grassley's legislation brings together "bipartisan initiatives to fight fraud, waste and abuse in taxpayer-sponsored health care programs, which all face serious budgetary challenges.” It includes many of the themes for fighting fraud addressed in the HHS/DOJ summit.

The bill would strengthen the Federal False Claims Act, strengthen provider screening requirements, establish provider compliance program requirements and increase disclosure requirements of entity and provider ownership, increase federal funding, strengthen reporting requirements for Medicaid and Medicare Integrity Programs, and improve collection and sharing of data. “As spending on these programs continues to grow, Congress should act quickly to pass these reforms out of respect for taxpayers and on behalf of program beneficiaries.”

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Senate Rejects Proposed Congressional Commission on Defict Reduction, President Obama Will Create Commission Through Executive Order

In a 53-46 vote Tuesday on Senate Budget Chairman Conrad's (D-ND) and Ranking Member Judd Gregg's (R-NH) bipartisan amendment to a bill to increase the debt ceiling to $14.3 trillion (H J Res 45), the Senate rejected creation of a congressional debt commission that would establish a fast-track process for placing the panel's future recommendations on the floor for an up-or-down vote. Some opposed the amendment because they thought it removed authority from Congress to do its job and make individual policy decisions regarding deficit-reduction. Democratic opponents feared it as a pathway to cuting Medicare and Medicaid, while Republican opponents feared it could be a way to enact tax increases. President Obama will issue an executive order to create a commission as the administration pivots its agenda to emphasize deficits and the economy. However, the creation of such a panel through executive ordert will lack the authority for fast-track consideration by Congress and only produce recommendations. Read more!

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!

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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.

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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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