Iowa State Budget Update

Thursday, October 8, 2009 Governor Chet Culver of Iowa announced a 10% across the board cut. Up until now, Medicaid providers in Iowa had been exempted from the two previous cuts due to the federal stimulus dollars.

Most Medicaid eligible recipients in Iowa have their local match paid by their county of legal settlement rather than the state. The only savings to the state would be for persons who are state cases and do not have a determined county of legal settlement. The estimate for ICFs/MR is that with a 10% rate cut the state would forfeit $12M in federal funding to save only $400,000 in state dollars, or a loss of $30 for every dollar saved.

It is unsure at the point whether Iowa may require legislative action for cutting Medicaid. That would mean the Governor Culver would have either to call for a special legislative session or wait until the next session convenes in January.

Thank you to Rod Braun from Christian Opportunity for this update.
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Call Your Senate Offices; Ask Them to Include Long Term Services and Supports in Health Reform

As reported in last week’s WICs Live, several important provisions regarding long-term services and supports backed by ANCOR are included in Senate health reform proposals. Senate Finance Chairman Baucus modified his original health care mark by including additional federal assistance to states for Medicaid’s HCBS waiver services, changes in Medicaid’s 1915(j) HCBS state plan option, and a new Medicaid personal attendant state plan option with a 6% enhanced FMAP. The Senate HELP Committee has included the CLASS Act in their version of Health Reform. ANCOR staff made Capitol Hill visits on these and other long-term services’ issues this week in addition to its ANCOR grassroots alert posted in the Action Center. We are asking the Senate to include Long Term Services and Supports in the final version of Health Reform. ANCOR members are encouraged to respond to the alert if they have not already. Read more!

Senate Finance to Vote Tuesday on $829 Billion Health Reform Bill

Senate Majority Leader Harry Reid (D-NV) and Finance Chairman Max Baucus (D-MT) agreed to wait until Tuesday, in order to allow Members to review the Congressional Budget Office’s (CBO) analysis that was released late Wednesday afternoon. Once the committee votes, Reid is expected to begin meeting immediately with White House officials, including Chief of Staff Rahm Emanuel, Baucus, Sen. Chris Dodd (D-CT), and other Members of the Democratic caucus to merge the Finance package with a measure passed out of the Health, Education, Labor and Pensions Committee. Dodd shepherded the HELP bill through the committee in July in the absence of Chairman Kennedy (D-MA).
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New Co-Sponsor for Direct Support Professionals Fairness and Security Act

Rep. Steven Rothman (D-NJ) signed on as a co-sponsor to the Direct Support Professionals Fairness and Security Act (H.R. 868). Thank you to everyone who contacted their members urging them to sign on. Read more!

H1N1 Definitition of "Health-Care Personnel"

During phone calls with CDC, ANCOR requested clarification as to whether direct support professionals are included under “health-care personnel”. CDC stated that they could not clarify that as they are only writing guidelines. CDC emphasized that state health departments execute these recommendations and make the final decisions as to who receives the vaccines first.

ANCOR strongly recommends that everyone contact their state health department and urge them to include direct support professionals in the “health-care personnel” category. Read more!

Florida Nursing Home Residents Win Suit Against the State

A class action lawsuit brought in 2008 on behalf of 8,500 Floridians by AARP Foundation, the Southern Legal Counsel, and National Health Law Program and others, said the state illegally forced residents to live in nursing homes instead of their communities, has been settled with the state agreeing to spend up to $27 million to resolve the lawsuit. The agreement calls for the improvements to be made during the fiscal year ending June 30, 2010. A federal court will monitor the settlement that requires the Florida Agency for Health Care Administration and the Department of Elder Affairs to improve the way they inform Medicaid nursing home residents about making the transition from nursing homes to community-based programs.
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President Obama Announces New Initiatives During National Disability Employment Awareness Month

President Obama announced the Administration is taking steps to ensure that there is fair and equal access to employment for all Americans, particularly the 54 million people in this country living with disabilities.

The following are some of the steps the Obama Administration will take:

•The Office of Personnel Management (OPM) and Department of Labor's Office of Disability Employment Policy (ODEP) will collaborate to sponsor and organize a day long Federal Government-wide job fair for people with disabilities. The Fair will take place in early spring 2010. In addition to the Job Fair, OPM, ODEP, the Equal Employment Opportunity Commission (EEOC) and the Department of Defense's office on Computer and Electronic Accommodations Program (CAP) will provide workshops throughout the day on a variety of topics including the Schedule A hiring waiver and the right to the provision of reasonable accommodations including information on assistive and communications technology
•OPM will develop training on Schedule A for federal Human Resources specialists, hiring managers and selective placement coordinators that will be easily accessible and includes on line training.
•EEOC and the Department of Justice's Civil Rights Division will hold four Town Hall meetings throughout the nation to share information about the ADA Amendments Act proposed regulations and to gather comments on them. All Town Hall meetings will consist of two sessions - one for disability advocates and one for the employer community. These sessions will be completed by November 20th. The four locations are Philadelphia, Chicago, San Francisco, and New Orleans.
•The Department of Justice will release a video that will identify and respond to a number of common myths held by employers about workers with disabilities.
•OPM will create and lead a task force comprised of representatives from key Federal Departments and Agencies that have developed and implemented model practices for recruiting, retaining and advancing employees with disabilities. The task force will report on the innovative practices agencies use to encourage the employment of individuals with disabilities. The report will identify and promote successful practices for conducting outreach, recruiting, hiring qualified candidates, successful accommodations, and providing opportunities for career advancement at all levels.

This year’s theme for National Disability Employment Month is Expectation + Opportunity = Full Participation. This annual October celebration as designated by Congress is an opportunity to highlight the contributions and skills of Americans with disabilities to the workforce. For more information, see last week’s WICs Live article and the Department of Labor’s Office on Disability and Employment Policy web page on NDEM.

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WICS Live: Around the States

Iowa: State Creates New Prescription Drug Voucher Program. Under the new program, unveiled by the state Attorney general’s office September 22nd, eligible Iowans will obtain a voucher, present it to a participating pharmacy, and pay a $3 co-pay for a 90-day supply of medications for high blood pressure, high cholesterol, depression and other maladies. The program will use $420,000 from the state’s settlement with two drug management companies accused of consumer fraud. To be eligible for the program, individuals must be uninsured or under-insured or have an annual income less than 200% of the federal poverty level. More information is available at www.iowapdc.org. Read more!

WICS Live: Around the States

Florida: State Develops Website to Compare State, Federal Privacy Laws. The new web tool,launched September 17th, also helps providers and consumers compare laws and regulations related to electronic health records and health information exchange. The site is available at http://www.fhin.net/PSresourceCtr/index.shtml. Read more!

WICS Live: Around the States

California: Governor Signs Bill Preserving Healthy Families Program. After the state’s financial problems and steep budget cuts threatened to eliminate the Healthy Families Program, the state’s CHIP, as of October 1st, Signed by Governor Arnold Schwarzenegger (R) September 23rd, AB1422 would raise $194 million a year in part by imposing a temporary tax on health care insurers that participate in the state's Medi-Cal program. The bill also would raise the monthly per-child premiums by $4 to $7 for some program participants. The state will also receive $81.4 million from the First 5 California state commission, which oversees Proposition 10 tobacco tax revenue to promote early childhood development. Read more!

WICS Live: Around the States

Arizona: 10,000 Parents Lose Health Coverage As State Program Is Victim of Budget Cuts The KidsCare Parents program, which was an extension of the state’s SCHIP covering low-income working parents, ended September 30th after the state could not pay the $6 million cost to cover the program, following state budget cuts. The state will also lose $18 million in federal funds for administering the program. The state is facing an overall $3 billion budget shortfall. Governor Jan Brewer (R) said she was devastated by the program’s loss. Brewer is now concerned that KidsCare, which serves more than 50,000 children, could be cut in upcoming fiscal 2010-11 budget negotiations. Read more!

WICS Live: Around the States

Alabama: State Plans To Enroll Thousands More Under All Kids Expansion. A major program expansion to All Kids, the state’s CHIP program, beginning October 1st, is expected to enroll 10,000 additional children in the program. The program will be extended to children in families making up to three times the federal poverty level (FPL), or $66,165 for a family of four. The previous limit was two times the FPL. Read more!

WICS Live: Around the States

Pennsylvania: State Budget Impasse Enters Fourth Month. A delicate budget deal that Governor Ed Rendell (D) agreed to with lawmakers in his own party is now in jeopardy after the state House on Friday, October 2nd voted on a nearly party-line basis to swap out proposed taxes on arts and cultural events and on small games of chance and replaced them with new levies on cigars and other tobacco products as well as on natural gas drilling. The new tax provisions are in serious doubt in the Senate. On Saturday, the House passed a public welfare bill as part of state budget package. The Senate is expected to return to session Monday to consider various budget bills, and the bipartisan conference committee is scheduled to reconvene to consider the primary spending bill Monday. Read more!

WICS Live: Around the States

Michigan: A State Budget, Well…Almost. The state avoided a complete government shutdown October 1st, the start of its new fiscal year, with the signing of a 30-day temporary budget after Republican state lawmakers withheld several bills for Governor Jennifer Granholm’s (D) signature in order to force negotiations on several issues. Meanwhile, Granholm said Thursday, October 1st that she will veto portions of the budget sent to her for enactment because it cuts programs too deeply or eliminates them entirely. Granholm said she supports a new tax on physician services to raise $400 in Medicaid to avoid larger program cuts. Read more!

WICS Live: Around the States

New Mexico: State Medicaid Budget in the Red, and Could Reach a $300 Million Deficit in 2011. With more state residents enrolling in Medicaid due to the economy, the state could face a $300 million budget gap in its Medicaid program by next fiscal year. As of September 17th, the state is currently facing a $40 million shortfall in the program that is expected to grow to $60 million in the coming months. The state Human Services Secretary told lawmakers in mid-September that her Department is considering cutting optional Medicaid services, cutting provider payment rates, and eliminating the State Coverage Insurance program, which provides health insurance premium assistance to low-income workers. With the state also facing a general budget shortfall this year and next, Governor Bill Richardson (D) has said he is waiting to see what happens with health reform at the national level before making any decisions for his state. Read more!

WICS Live: Around the States

Montana: State Plans Swift Action to Implement Healthy Montana Kids Program. The program, which combines the state CHIP and Medicaid programs, began October 1st. The Department of Public Health and Human Services estimates that another 30,000 children could be added to the current 70,000 enrollees over the next two years. To help this along, the state September 24th announced a broad outreach effort in an effort to reach uninsured children and their families. The state has also cut the application in half, to 6 pages, and streamlined program administration. Under the new program, families earning up to $55,000 will qualify. Officials estimate there are 34,000 uninsured children in Montana, which ranks the state fifth in uninsured children. Read more!

WICS Live: Around the States

Louisiana: State Facing Mid-Year Medicaid Budget Shortfall. The shortfall is the result of a higher-than-expected health-care spending and delays delays in implementing cost-cutting strategies, the state Health and Hospitals Secretary told lawmakers during a special budget hearing September 22nd. In addition to costs associated with the H1N1 virus, the state also is spending more than anticipated on home-care services for individuals with intellectual and other developmental disabilities, and legislature-approved rate reductions have taken longer to implement. The exact amount of the shortfall must be reported to a House-Senate budget committee by November 1st. The state is already preparing for increasing financial hardship as of July 1st, when the state will see their federal Medicaid match fall from 80% to 63%, adding another $700 million to the budget deficit. A blue-ribbon panel is expected to recommend $802 million in program cuts in its report, due early next year. Read more!

WICS Live: Around the States

Florida: Pfizer Settlement Money Will Fund New Medicaid Fraud Informant Program. The state plans to use $1 million of its share of the multi-state settlement with the drug maker to reward informants who provide original information on Medicaid fraud violations that leads to recovery, civil or criminal penalties, or forfeiture of property. Reward money can be as much as 25% of the amount recovered, up to $500,000. The law authorizing the program also required all Medicaid beneficiaries to receive information annually on the program and how to report Medicaid fraud. Pfizer has agreed to pay a record $2.3 billion for illegally marketing Bextra, an anti-inflammatory drug, of which Florida is to receive $58 million, over $10 million which will go to the Medicaid program. Read more!

WICS Live: Around the States

California: Federal Judge Blocks Cuts to Adult Day Health Care Program, Says Cuts Violate ADA. A judge for the U.S. District Court for the Northern District of California issued a 24-page ruling September 10th, ordering the state to halt cuts to the Adult Day Health Care Program, unless and until the beneficiaries it serves are provided other Medi-Cal services to prevent institutionalization. The ruling came after a Department of Health Care Services lawyer argued that it was up to the individual providers who operate the more than 300 state centers to find alternative services for the beneficiaries. Judge Saundra Brown Armstrong ruled that the three plaintiffs who brought the suit would be high risk of institutionalization if their services under the program were scaled back, which could violate the plaintiffs’ rights under the Americans with Disabilities Act. The cutback is part of the budget agreement reached by the Legislature and Governor Arnold Schwarzenegger (R) and could be rescinded after the state finishes reviewing eligibility requirements. According to a spokesman for the Governor, the Administration is reviewing its legal options. Read more!

WICS Live: Around the States

California: Lawmakers Pass Bill Increasing Medi-Cal Hospital Rates So State Qualifies for Enhanced FMAP. The complex measure is designed to ensure the state continues to qualify for its temporary 11.59% enhancement in federal medical assistance percentage (FMAP), which is the state’s share of $87 billion allocated as part of the American Recovery and Reinvestment Act (ARRA). The bill, which is currently awaiting Governor Arnold Schwarzenegger (R) would increase the upper payment limit by imposing a “quality insurance fee” for outpatient and inpatient services at hospitals that quality for other state health funding other than Medi-Cal. The fee would be levied through December 31, 2010 and is projected to raise $2 billion annually. Revenue from the fee also would offset the impact of an April 6 emergency order by the U.S. Court of Appeals for the Ninth Circuit staying a 10% reduction in hospital Medi-Cal reimbursement rates. It is unclear if Schwarzenegger will sign the legislation; he has stated the bill is fatally flawed and will not receive federal approval.

In other news, lawmakers September 12th also approved legislation to temporarily unemployed Medi-cal beneficiaries with disabilities participating in the state’s Working Disabled Program to remain on Medi-cal for up to 26 weeks as long as federal funding is available. The extension would take effect 30 days after the temporary ARRA-funded increase in the state's Medicaid FMAP is no longer available. The bill was also sent to the governor for signature.
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