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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