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!