Arizona's CHIP Plan Spared Elimination

Arizona's Children's Health Insurance Program plan (CHIP), which was slated for elimination on June 15, will no longer be cut due to the federal health reform law that President Obama signed into law March 23. According to the Arizona Health Care Cost Containment System, the reprieve came in the form of a maintenance-of-effort provision applicable to children's health care through 2019. It prevents states from changing eligibility requirements in such a manner that would force individuals off existing rolls.

The Legislature now must repeal the action that eliminated the KidsCare program, AHCCCS spokeswoman Monica Coury told BNA April 7. It is expected to do so before the June 15 sunset date.

But the restoration of the program means the state's budget falls out of financial balance, and now must be reconciled either by additional spending cuts or tax increases, something Arizona's legislators have been opposed to doing.

No agreement has been reached on how the fiscal hole may be patched. Arizona's budget must be balanced, under the state's constitution.

The maintenance-of-effort requirement applies to Medicaid generally and was included in the federal stimulus bill, but was scheduled to expire at the end of 2010, according to the AHCCCS website.

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HUD Releases Notice of Funding Availability (NOFA) for Rental Assistance for Non-Elderly Persons with Disabilities

On April 7, 2010 the U.S. Department of Housing and Urban Development (HUD) announced the availability of $30 million in funding for approximately 4,000 Section 8 Housing Choice Vouchers (HCV) for non-elderly disabled households. Funds unobligated under previous HUD NOFAs will also be made available as part of this NOFA, bringing the total funds available to $40 million for approximately 5,300 vouchers. Go to http://portal.hud.gov/portal/page/portal/HUD/program_offices/administration/grants/fundsavail/nednofa.pdf for a complete copy of the NOFA. Applications are due July 7, 2010.

For more information click here.
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Secretary Sebelius Announces Five New HHS Regional Directors

Secretary Sebelius Announces Five New HHS Regional DirectorsHHS Secretary Kathleen Sebelius today announced the appointment of five new regional directors of the U.S. Department of Health and Human Services.

* Christie Hager, Region I - Boston (CT, ME, MA, NH, RI, VT)
* Jaime R. Torres, Region II - New York City (NY NJ, NY, PR, VI)
* Joanne Grossi, Region III - Philadelphia (PA DE, DC, MD, PA, VA, WV)
* Marguerite Salazar, Region VIII - Denver (CO, MT, ND, SD, UT, WY)
* Herb K. Schultz, Region IX - San Francisco (AZ, CA, HI, NV, Guam, PI, AS)

"I am very pleased to welcome Christie, Jaime, Joanne, Marguerite, and Herb to HHS," said Secretary Sebelius. "They will play a vital role in our department's effort to effectively implement the Patient Protection and Affordable Care Act. I look forward to working with them in the months and years ahead to achieve HHS's mission to protect the health of all Americans and provide essential human services."

As HHS regional directors, they will serve as key representatives of Secretary Sebelius in working with federal, state, local, and tribal officials on a wide range of health and social service issues.

Biographies:
Christie Hager, JD, MPH is currently an Adjunct Lecturer on Health Policy at the Harvard School of Public Health. Her research and teaching focus on state regulation of health care and public health, health care access, and the legislative process. From 2004-2009, she served on the staff of the Massachusetts House of Representatives, as Chief Health Counsel in the Office of the Speaker during the development, enactment and first three years of implementation of the health reform law passed in 2006. She previously served as Deputy Director of the Division of Public Health Practice at the Harvard School of Public Health. She was appointed Senior Fellow at the Schneider Institute for Health Policy at Brandeis University's Heller School, where she served as Director and Principal Investigator at the Massachusetts Health Policy Forum, from 1999-2002. She also previously worked on the editorial staff of the New England Journal of Medicine. Ms. Hager received an AB from Smith College, a MPH from the Boston University School of Public Health, and a JD from the University of Connecticut School of Law.

Jaime R. Torres, DPM, MS, is currently Associate Director of Consultative Services at Coler-Goldwater Specialty Hospital, part of New York City's Health and Hospital Corporation--the nation's largest public hospital system. He is the founder and President of Latinos for National Health Insurance, a national coalition working for equality in healthcare. He is on the Board of Directors of the National Hispanic Council on Aging and served on the Advisory Board of the National Hispanic Medical Association (NHMA) from 2000-2006. For eight years he represented the NHMA in the National Diabetes Education Program (NDEP), which is sponsored by the National Institutes of Health and the Centers for Disease Control. As vice-chair of NDEP's Hispanic/Latino Work Group, he was instrumental in creating bilingual health campaigns for people with diabetes. In 2006, he was a spokesperson for the American Podiatric Medical Association's campaign "Descubras sus pies" (Discover Your Feet) which educated the Latino community on how to prevent foot ailments related to diabetes. Dr. Torres received his Doctorate of Podiatric Medicine from the New York College of Podiatric Medicine and a master's degree in Community Health from Long Island University.

For the past seven years, Joanne Grossi has served in the administration of Governor Edward G. Rendell, first as Deputy Secretary of Health and later as the first- ever Director of the Office of Women's Services. During her five-year tenure as Deputy Secretary for Health Promotion and Disease Prevention at the Pennsylvania Department of Health from 2003 to 2008, Ms. Grossi oversaw all the public health programs for the Commonwealth, including tobacco cessation and prevention; obesity prevention; drug and alcohol programs; and maternal and child health programs. As Director of the Office of Women's Services at the Pennsylvania Department of Public Welfare from 2008 to 2010, Ms. Grossi administered statewide programs that provide assistance to women, including family planning/reproductive health; domestic violence; sexual violence; and the breast and cervical cancer treatment program.Before joining the Governor's Administration, Ms. Grossi served for 13 years as a Senior Technical Advisor in the Bureau of Global Health at the United States Agency for International Development, where she oversaw international health programs in developing countries.Earlier in her career, Ms. Grossi served on the staffs of Congressman Peter Kostmayer and Ambassador Millicent H. Fenwick at the American Embassy in Rome, Italy. Ms. Grossi earned her master's degree in International Public Policy at the Johns Hopkins University's School of Advanced International Studies and completed additional graduate education at the Johns Hopkins University's School of Public Health and Hygiene. She earned her B.A. in journalism at Temple University.

Marguerite Salazar has served as President/CEO of Valley Wide Health Services, Inc. (VWHS) since 1989. VWHS is one of the largest rural Community Health Centers in the country, providing primary care to over 40,000 residents of the San Luis, Lower Arkansas and Upper Arkansas Valleys in Southern Colorado. VWHS is recognized for exceptional outcomes with prenatal care and reducing ER utilization through Convenient Care in some of the poorest areas of Colorado. Previously, Ms. Salazar directed Access Social Work Service, a firm that contracted with local public health departments, hospitals and nursing homes to provide social work services. Ms. Salazar is a Fellow in the National Hispana Leadership Institute as well as a Livingston Fellow in the Bonfil Stanton Foundation, a Trustee for the Temple Hoyne Buell Foundation and was appointed by Governor Bill Ritter, Jr. to the Board of Governors for Colorado State University. She was appointed by Governor Bill Owens to serve as a Policy Board Member for the Colorado Children's Basic Health Plan. In 1999, she was awarded the Bernie Valdez Award for Excellence in Health from the Latin American Research and Service Agency (LARASA). She holds a Master's degree in counseling psychology from Adams State College in Colorado.

Herb K. Schultz, MPP, is currently Senior Advisor to Governor Arnold Schwarzenegger, and since January of this year, also the Director of the California Recovery Task Force. In this role, he is responsible for the oversight and implementation of the American Recovery and Reinvestment Act of 2009. As Senior Advisor to the Governor from 2008-2010, he represented the Governor on major domestic policy issues, which included serving as a principal advisor on health care reform. Previously, he served as the Senior Health Policy Advisor to the Governor during California's 2006-2008 state debate on comprehensive health care reform. From 2005-2006, he served as Vice President of Government Programs for McKesson Health Solutions, where he oversaw the company's disease management and nurse advice programs for Medicaid and Medicare beneficiaries. During the first year of Governor Schwarzenegger's Administration, Mr. Schultz served as Acting Director of the California Employment Development Department. He also previously served as a member of former Governor Gray Davis' Cabinet as Acting Secretary for the Labor and Workforce Development Agency. He served as the Agency's Undersecretary before his Cabinet-Level appointment, and remained in both roles until the end of the Davis Administration. Prior to that, he was Deputy Director of External Affairs for the California Department of Managed Health Care, and served as Director of the Advisory Committee on Managed Health Care. Mr. Schultz received his BA in Political Science and International Studies from The American University in Washington, DC and has a Masters Degree in Public Policy from Georgetown University, also in Washington, DC.

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HHS Community Living Initiative Upcoming Stakeholder Dialogues

As part of The Community Living Initiative, HHS is holding dialogues with State and local officials as well as other critical stakeholders with diverse opinions on issues related to community living. These dialogues will help your public officials develop and/or refine their policies and practices to better meet the needs of people with disabilities and older adults, and provide information useful to achieving the goals of the Initiative to improve community living options.

For more information click here.

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Congress Enters Spring Recess

Congress begins their district work period on March 29 and it will run through April 9. Use this opportunity to meet in person with your members of Congress. Meeting with them in their local, district offices or having them visit your organization is the most effective way to educate your Members and their staff on issues important to you. While health care reform has passed the jobs bill with the FMAP extension is still up for debate. Also use this opportunity to ask for co-sponsors for the Direct Support Professionals Fairness and Security Act of 2009 (H.R. 868).
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Harvard Professor to Be Named CMS Head

Donald M. Berwick, a professor at the Harvard School of Public Health, is expected to named head of the Centers for Medicare & Medicaid Services. The announcement is expected during the congressional two-week April recess that begins on March 29.

Berwick is a clinical professor of pediatrics and health care policy at the Harvard Medical School and the Harvard School of Public Health, according to the school. He is also president and chief executive officer of the Institute for Healthcare Improvement, a Cambridge, Mass.-based, a not-for-profit organization that promotes the improvement of health care.

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House and Senate Pass Reconciliation Package

The Senate passed the reconciliation package 56 to 43 and sent it to the House where it was also passed.The bill will go to President Obama's desk where he is expected to sign it on Tuesday. Read more!

Arizona 1st State to Drop CHIP Program

Arizona Gov. Jan Brewer (R) has signed budget legislation that removes the statutory authorization for the state Children's Health Insurance Program (CHIP), thus making Arizona the first state to do so amid fiscal constraints. Brewer and Republicans who control the Arizona Legislature said the elimination of the program, known here as KidsCare, was necessary to help close the state's budget deficit, which is pegged at $2.7 billion in fiscal 2011 beginning on July 1. KidsCare would lose funding June 15.

Meanwhile, Arizona House Democrats, led by Minority Leader David Lujan and Assistant Leader Kyrsten Sinema, are working to head off the program's demise.
They asked House Speaker Kirk Adams (R) in a letter dated March 22 that the authorization be reinstated, and that funding be provided through repeal of a sales tax exemption on retail warranties.

The elimination, Democrats argue, may also have consequences beyond children's health, jeopardizing an estimated $7 billion in federal Medicaid matching funds to the state.
The federal health overhaul plan signed March 23 by President Obama requires states to continue “maintenance of effort,” or providing health care at the same funding level as when the legislation was signed. Elimination of KidsCare would put Arizona in violation of that new law, Democrats argue.

Other states, including California, have considered eliminating their CHIP programs, but none has done so.


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President Obama Signs Underlying Health Reform Legislation into Law

The President signed shortly before noon today into law the underlying Senate-passed health reform legislation--The Patient Protection and Affordable Care Act of 2010 (H.R. 8590). The President signed the bill on behalf of his "mother that while struggling against cancer, she still fought her insurance company;" on behalf of several specific individuals present at the White House ceremony who were uninsured or whose family members struggled in face of inadequate coverage; and on behalf of Presidents since Teddy Roosevelt, countless Congressional leaders, and Senator Ted Kennedy. The Senate will immediately take up the companion "sidecar" reconciliation package passed by the House late Sunday evening. The Senate is expected to finalize the reconciliation package--The American Health Reform and Education Affordability Act of 2010 (H.R. 4872) that makes "fixes" to the underlying Senate bill--by Saturday before joining House members for a two-week recess to work in their states. See ANCOR's health care website for ANCOR's first Issue Brief explaining many parts of the new legislation; text, summaries, and costs of specific provisions; and other timely information.
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House Passes Health Reform Sending Reconciliation Package to Senate

A divided House of Representatives voted March 21, 2010 on historic health reform by way of a two-track process: voting 219 to 212 to clear the Senate bill passed December 24th by a 60-vote super-majority and voting 220 to 211 pass a reconciliation package of fixes. The Senate-passed bill was sent immediately to the President who is expected to sign the legislation into law on March 23rd. However, the Senate must also pass the same reconciliation legislation. It begins floor consideration on March 23rd, where it faces an endless number of amendments and challenges to the Senate “Byrd rule” under reconciliation rules before the bill is required to be passed by a simple majority vote (51). If passed without any changes, the reconciliation package goes immediately to the President for his signature. See ANCOR’s March 9th Issue Brief on Reconciliation for discussion of the reconciliation procedure. See ANCOR links to legislative text and impact on entities.

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Conferencing of “Tax Extenders Act” with FMAP Extension Likely After Health Reform

Last week the Senate passed the American Workers, State and Business Relief Act, also known as the Tax Extenders Act, which includes a six month extension of the temporary increase in states Federal Medical Assistance Percentage (FMAP) through June 10, 2011. Because there are differences between the Senate-passed measure and the version approved by the House in December that must be worked out, ANCOR staff learned this week that the bill will likely be “conferenced” after health reform legislation is wrapped up. At this time, neither chamber has appointed conferees. ANCOR is urging Congress to work quickly to seek agreement on a final bill to ensure the vital FMAP extension.
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Disability Provisions Included in Health Reform

Long Term Services and Supports

• Strengthening long-term services and supports through a two pronged approach:

1. Taking pressure off of the Medicaid program: The Community Living Assistance Services and Supports (CLASS) Act would create a national long term services insurance program which assists eligible individuals and their families to meet long term needs with a cash benefit and without forcing them into poverty to receive Medicaid benefits.
2. Improving the Medicaid program: The Community First Choice Option would help to eliminate the institutional bias by encouraging state states to cover personal attendant services under the state’s optional service plan instead of through the waiver system by offering a 6% increase in the federal share of Medicaid for these services.

• Increasing the federal share of Medicaid, known as the Federal Medical Assistance Percentage (or FMAP), for home and community based services (HCBS) and during periods of economic downturn.
• Allowing states to offer additional services under the 1915(i) Medicaid HCBS Waivers State Plan Option.
• Providing spousal impoverishment protections for HCBS Beneficiaries.

Coverage

• Prohibiting private health insurance exclusions for pre-existing conditions.
• Eliminating annual and lifetime caps in private insurance policies.
• Restricting the consideration of health status in setting premiums.
• Expanding Medicaid to cover individuals with incomes up to 133 percent of the federal poverty line (approximately $29,000 per year for a family of four).

Benefits

Ensuring that minimum covered benefits include products and services that enable people with disabilities to maintain and improve function, such as rehabilitation and habilitation services and devices.

Access to Quality Care

• Improving training of physicians, dentists, and allied health professionals on how to treat persons with disabilities.
• Requiring the Centers for Medicare and Medicaid Services to collect data on beneficiaries with disabilities access to primary care services and the level to which primary care service providers have been trained on disability issues.
• Ensuring prevention programs include a focus on individuals with disabilities.

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Employer and Individual Mandates in Health Reform

The employer responsibility provisions have been altered so that employers who do not offer coverage and have 50 or more employees would have to pay $2,000 per FTE (up from $750), if even one full-time employee get subsidies in the exchange. However, the first 30 employees would be subtracted from the total. These provisions were in the President’s February 24th proposal.

The health reform bill bill encompasses part-time workers when determining whether an employer would be considered a “large employer” (50 or more workers) subject to the tax. Employers who do offer coverage and have a FTE in the exchange must may a penalty of $3,000 per employee.

For the purpose of calculation on whether an employer is a “large employer,” the legislation requires employers to divide the aggregate hours worked by all part-time employees in a month by 120, and that number would be a full-time equivalent. The provision now raises $52 billion over 10 years, up from $28 billion in the underlying bill.

Summary of Employer and Health Reform Benefits and Requirements

The individual mandate will now be phased in. By 2017, the fee for not purchasing coverage will be the greater of $695 or 2.5 percent of income. The provision will now raise $17 billion over 10 years, up from $15 billion.

Summary of Shared Responsibility of Health Reform

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State of Idaho Witholding Medicaid Payments to Providers for 30 Days

The Idaho Department of Health & Welfare plans to delay payment to all providers in the state for the entire month of June, 2010. They are doing this to meet budget cuts to the Medicaid appropriation for FY 2010. The state of Idaho’s constitution does not allow the state to end the fiscal year with a deficit, so their solution is to end the year paying for only 11 months of expenses with 12 months of revenue.

Thank you to Russ McCoy with the South Park, Inc. dba Developmental Options for bringing this to ANCOR's attention. Read more!

Two New Cosponsors Added to the Direct Support Professionals Bill

Representative Eliot Engel (D-NY) and Representative Bob Ethridge (D-NC) signed on as co-sponsors for H.R. 868, the Direct Support Professionals Fairness and Security Act of 2009. Thank you to everyone for reaching out to their members about this important legislation. Read more!

House to Vote Sunday Afternoon on Senate Health Reform Bill and Reconciliation

The House early Thursday afternoon unveiled a 153-page reconciliation package estimated to reduce the deficit by $138 billion in the first decade and $1.2 trillion in the second decade, a feat that has helped attract some Blue Dog “no” votes before an expected health reform vote after 2 PM on Sunday. The Reconciliation Act of 2010 (H.R. 4872), which costs $940 billion in the first 10 years (see CBO score), is very similar to President Obama's February 24th proposal.

Of the $940 billion, $434 billion over 10 years is new federal Medicaid money to cover Medicaid expansion, including newly eligible beneficiaries. In addition, the overall total includes $20 billion over 10 years in new state help. These additional Medicaid dollars do not include long term services dollars or disproportionate share hospital (DSH) payments. The cost of expanding coverage is shared between Medicaid and the new insurance exchange. For most states, only 4% of this Medicaid expansion will be state dollars, the rest will be federal Medicaid dollars for the next 10 years.

House and Senate staffers told ANCOR staff that if this bill does not pass, states will not see new money like this again.

The Senate bill and the reconciliation package will be combined, so the House only has to take one vote; however, Speaker Pelosi will not proceed on a vote until the Democrats reach 216 “yeas.” The Senate will then have to vote on the reconciliation package, which is likely to occur on Tuesday.

Related Summaries:
House Democratic Summary of Reconciliation Package
Health Reform Implementation Timelines
House Energy and Commerce Committee Benefits of Health Reform, District by District Impact Read more!

ANCOR Partners With the U.S. Census Bureau

ANCOR is partnering with the U.S. Census Bureau to spread the word about the 2010 Census. Conducted every 10 years, the census is much more than a population count. Census data are used to reapportion congressional seats to states, and directly affect how more than $400 billion per year in federal funding is distributed to state, local and tribal governments.

Because individuals with disabilities rely on many government and social service programs, accurate representation and funding is especially important. Census data influences the distribution of funding for Medicaid and Housing and Urban Development programs, such as Section 8 Housing Choice Vouchers and the Community Development Block Grant.

A Toolkit for Reaching People with Disabilities is available to help organizations that support people with disabilities communicate the benefits of census participation. Among the available documents are a toolkit overview and 2010 Census Fact Sheet. Questionnaire Assistance Centers (QAC) will be available to assist those unable to read or understand the census form. For those with visual impairments, Language Assistance Guides will be available in large print and Braille. Deaf and hard-of-hearing persons who do not have access to Video Relay Service (VRS) can call 1-866-783-2010 via FedRelay, a free and confidential federal government communications service. In addition to these options, Language Assistance Guides also will be available in 59 languages at all QAC locations.

By law, the Census Bureau cannot share respondents’ answers with anyone, including other federal agencies and law enforcement entities. All Census Bureau employees take an oath of nondisclosure and are sworn for life to protect the confidentiality of the data. The penalty for unlawful disclosure is a fine of up to $250,000 or imprisonment of up to five years, or both.

We will continue to share information with you about upcoming census events we are hosting, as well as those in our community. Below are key dates for the 2010 Census:

• March 2010: 2010 Census forms are delivered.

• April 1, 2010: Census Day – the official day of the population count. Information provided on 2010 Census forms should represent respective households as they exist on this day.

• April – July 2010: Census workers visit households that did not return the forms to take a count in person.

• Dec. 31, 2010: Census Bureau presents population count to the President of the United States.

Watch for additional details in the coming months, or visit 2010census.gov to learn more.


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Confused About All the Talk About "Reconciliation"?--Let ANCOR Help!

ANCOR has prepared a new Issue Brief on the concept of "reconciliation" as an expedited Congressional process to pass legislation that targets deficit-reduction. Read more!

U.S. District Court Judge in Louisiana Agrees to Continue Community Services Pending Final Court Judgment on Cuts

Louisiana has agreed to continue round-the-clock supports to a man with developmental disabilities who is suing state health officials over planned cuts in services. Following the use of a new assessment tool, a determination was reportedly made to reduce 24-hour-a-day assistance to three to seven hours per day. Brian Stein’s parents filed a federal lawsuit last month over cuts they claim would force their son to be institutionalized. They sought a preliminary injunction while the U.S. District Court decided the merits; however U.S. District Judge Ralph Tyson signed off on an agreement between the parties March 8th to continue services pending the court's ruling. According to state advocates, the Stein lawsuit could be the first of many similar actions as the state moves to a new system of assessing individual service needs for individuals living in the community at the same time budget cuts are being considered. Thanks to Joe Aniello of UCP South Florida for forward the information to ANCOR!
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Senate and House Take Formal Steps Toward Passage of Health Reform

In a letter Thursday afternoon to Senate Minority Leader McConnell (R-KY), Senate Majority Leader Reid (D-NV) stated formally for the first time that Democrats plan to use reconciliation. Meanwhile, House Majority Leader Pelosi (D-CA) told her Democratic rank-and-file members Thursday morning that it would have a week to review and discuss a final package of changes to the Senate-passed health care overhaul bill. Language for a health reconciliation bill could go to the House Budget Committee Monday or Tuesday. The committee is required to give 24 notice before taking up the reconciliation bill and a 48-hour wait period before the House Rules Committee takes action. Whether the House can meet the President's deadline for a vote on the Senate-passed bill by next Friday and completion of final passage by Congress by the Easter recess remains to be seen.
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