JFActivist

New Housing Program for PWD Takes Shape

From AAPD (4.14.11):

HUD’s building in Washington, DC

Housing Update: New Section 811 Housing Program Should Lead to More Housing for Low Income People with Disabilities

By Jenifer Simpson, Government Affairs, AAPD

On April 14, 2011, AAPD attended a briefing by the U.S. Department of Housing and Urban Development (HUD) on the status of the new Section 811 housing program for very low income people with disabilities. This new program is authorized under the Frank Melville Supportive Housing Investment Act of 2010, another piece of legislation enacted in 2010. This new law -- that AAPD supported along with many other advocates -- should facilitate more independent living in the community for people with disabilities. The new program, referred to as a “Project Rental Assistance” program modernizes and updates the existing “Supportive Housing for Persons with Disabilities Program (Section 811)” that began in 1990. The discussion was led by Carol Galante, Deputy Assistant Secretary for Multifamily Housing at HUD.

Background: Over the past 20 years, HUD has supported about 30,000 “housing units” for households whose income is 15% below poverty level. These households served include people with developmental disabilities, people with physical disabilities, people with HIV/AIDS, and people with mental illness. The Section 811 program provides funds in the form of capital advances to non-profit organizations to develop rental housing with support services for people with disabilities. The program also provides rent subsidies to tenants. Projects funded have included group homes, independent living complexes and sponsored condominiums or cooperative units.

Section 811 Modernization: While maintaining support for group homes and independent living complexes, the new program targets multi-family housing, i.e., apartment buildings, to encourage non-profit sponsors to set-aside up to 25% of the units for people with disabilities. The new program also creates a new Project Rental Assistance program where HUD will give funds to state housing agencies that can demonstrate strong collaboration with state health and human services agencies to deliver the services and supports needed by people with disabilities.  Households served must include one person with a disability and be extremely low income (30% of area median income level or less.)  Projects funded must operate for 15 year terms and cannot use Section 811 funds for development costs. At the briefing AAPD attended it became apparent that a key component of this new rental assistance program will be how well and in what ways the housing agency works with the Medicaid services agency in the state to deliver the support services. For instance, whether the two agencies would sign Memorandums of Agreement and how well detailed they would be for purposes of implementation.

Policy Concerns: Attending the HUD briefing were representatives from non-profit housing entities, from state housing finance entities and federal staff from HUD, OMB, HHS, ASPE and CMS. Discussion covered topics such as landlord-tenant relationships, “disruption when someone doesn’t take their medication,” “it’s not the owner’s job to market to tenants,” “reasonable accommodations to disability,” “need for flexibility,” state HCBS and other Medicaid waivers, and how the “new program might support the Olmstead Act.” Advocates from Access Living (Chicago, IL), AAPD and Lutheran Services of America raised topics such as non-discrimination in housing and the need for assurances from the state Medicaid services agency to deliver supportive services to make the program work.

During the coming year, HUD expects to release a proposed rule – likely in September -- about these and other concerns. HUD expects to finalize the rules for the program before the end of 2011 or early 2012. The new Frank Melville Section 811 program is expected to start and be funded in 2012.

Action step:

To stay on top of this program, such as for the purpose of commenting into proposed rules, and to ensure your state housing and federal agencies know about the new program next year, contact Ben Metcalf at of the HUD Office of Multifamily Housing programs at [email protected]  Ask to be put on mailing list for any Notices about the program, about the rules development and any HUD Field Informational Hearings they will hold on this new Section 811 program.

Housing Discrimination: Charles Schwab Settles with HUD

From HUD (3.30.11):

CHARLES SCHWAB BANK TO PAY $30,000 TO SETTLE DISCRIMINATION COMPLAINT INVOLVING BORROWER WITH DISABILITIES IN METARIE

WASHINGTON - The U.S. Department of Housing and Urban Development today announced that Charles Schwab Bank has agreed to pay $30,000 settling allegations that the bank refused to accept a loan application from the adult son of a Metairie, Louisiana woman with disabilities. The son, who was acting with his mother's power of attorney, tried to apply for a loan on his mother's behalf, but was told that the bank did not accept powers of attorney for "incapacitated borrowers."

"Lenders must ensure that their policies take into account the needs of all borrowers and do not discriminate against persons with disabilities," said John Trasviña, HUD Assistant Secretary for Fair Housing and Equal Opportunity. "HUD will continue to work with lenders to make sure that their policies and practices make lending opportunities available to everyone."

The settlement follows a HUD investigation of a complaint against the San Francisco-based bank from a woman with disabilities who said the bank rebuffed her son's attempt to submit a loan application over the phone on her behalf. The son alleged the bank advised him that it does not accept a power of attorney for "incapacitated borrowers" during the application process and refused to accept the loan information the son offered, despite the fact he had power of attorney for his mother. The Fair Housing Act makes it unlawful to have policies that discriminate or have a discriminatory effect against persons with disabilities.

According to the voluntary agreement in this case, Charles Schwab Bank agrees to: pay the borrower $25,000, $10,000 of which will go to St. Francis Xavier Church, as a charitable donation on behalf of the borrower; $5,000 to the borrower's son; permit persons with disabilities, where necessary, to use a power-of-attorney, at no additional cost; update the mortgage education section of its website to include questions and answers regarding powers-of-attorneys; and provide fair lending/fair housing training for its employees.

The conciliation agreement can be found online.

>>> For the original release

Urgent Alert: Advocate for Medicaid During Congressional Recess

                    Urgent Action Alert!

 

Contact your Representative and Senators during the Congressional Recess (Monday April 18- Friday April 29) to advocate against current House proposals to slash funding for Medicaid. Talking Points, Action Steps and Contact Information for Senators and Representatives is below.

Background:  The recent budget proposal in the U.S. House of Representatives would seriously undermine the Medicaid program. Medicaid provides critical health coverage to 8 million Americans with disabilities who rely upon Medicaid for long term services and support, including prescription drug coverage, durable medical equipment, and  facilities and services which  permit them to live and work in the community, avoiding costly institutional care.

This proposal would reduce Medicaid funding for the next ten years by a total of $772 billion below the level of a status quo program. This is a reduction of about 35%. In addition, the proposal would make the reduced funding a cap on the program (the so-called block grant). By contrast, the existing program does not have a cap and is an entitlement program in which federal funding will cover a share (averaging 57%) of the expenses of a state’s approved Medicaid program. If enacted, the States would have the burden of limiting their programs to deal with the reduced federal support. The reductions made by the state could take the form of curtailing covered services, capping enrollment, and imposing high premiums and co-payments for beneficiaries.

Policy Considerations: The Congressional process for this proposal is likely to be drawn out. At this time there is no definite scenario for how and when Congress will consider proposals to cut Medicaid. There are a number of possibilities.

1. Medicaid cuts are now in issue in the Congressional Budget resolution that, if passed, would establish dollar limits for Medicaid funding.  If limits are set, the details, such as converting the program from an entitlement program to a program of capped blocked grants, would be dealt with in subsequent legislation. At this time, there is a good possibility that the House and Senate will not be able to agree on a budget resolution, as has happened in the past.  Even if no budget resolution is adopted Congress is still able to go forward with legislation to fund the government.
2. The next opportunity to impose general spending caps is likely to be when legislation is considered to raise the debt ceiling on the amount of the debt the federal government can issue. The federal government’s debt is expected to reach the current ceiling by May 16. The Administration has stated that if the ceiling is not raised by July 18, the government will be unable to make payments on existing debt.  This would have catastrophic effects on interest rates in domestic and international markets. Unlike the budget resolution, the debt ceiling bill is “must pass” legislation.

Outlook: There is speculation that conservatives will refuse to support legislation to raise the debt ceiling unless accompanied by legislation requiring limits on federal spending.  Possible limits on spending could take many forms, but most likely they will be general and the battle will continue over follow-up legislation to develop detailed proposals for individual programs such as Medicaid. On another track, President Obama has announced a plan for bi-partisan negotiations between the Administration and the Congress, with the goal of reaching an agreement on the overall budget by June.

The battle over cuts in Medicaid is likely to be prolonged, and involve a series of critical decisions and votes. It is important that the opponents of Medicaid cut proposals express opposition early and often.  Even if all details of Medicaid are not an issue in proposals for general spending cuts, the structure of these general spending cut proposals will affect the likelihood that similar proposals will ultimately be adopted. At all times, Members of Congress need to be aware of the serious consequences to people with disabilities of drastic cuts in Medicaid.

The Congressional recess beginning the week of Monday April 18 to Friday April 29^th is a good time for advocates to educate their Congressman and Senators who will be in their home districts and states during the recess.

Suggested Talking Points:

• Medicaid is critical for the health care of 8 million people with disabilities.
• Medicaid pays for wheelchairs and prosthetic devices for people with disabilities such as spinal chord injury, cerebral palsy and other disabilities.
• Medicaid pays for prescription drugs for persons with mental illnesses and epilepsy and other medical conditions.
• Medicaid pays for programs to enable people with intellectual disabilities to live and work in the community.
• Medicaid’s Early and Periodic Screening Diagnosis & Treatment program helps identify disabilities early for children with disabilities and gets them the care they need.
• The proposal would undermine these important benefits by reducing funding for Medicaid for the next 10 years by $772 billion, compared to continuation of the status quo.
• The proposal does not establish specific reductions in Medicaid to enable the program to operate under reduced funding. States will have to make changes to afford to continue Medicaid with significantly less federal support and this proposal leaves it to the States to decide how to cut back on their programs. This could impact many of the current waivers that support community-based living for people with disabilities. Changes must be carefully considered to be certain they will not have a disproportionate impact on people with disabilities who rely on Medicaid to enhance their ability to live and work in the community.

Action Steps:

1. Call your Senators and House Representative today in their local state offices to set up a time to meet between Monday April 18 and Friday April 29th. To find your U.S. Senator, go to http://www.senate.gov/general/contact_information/senators_cfm.cfm  This list includes their Senate address and phone numbers.  To determine who is your U.S. Congressional Representative, please go to the official site at https://writerep.house.gov/writerep/welcome.shtml  To find out your U.S. Congressional Representative’s local address and phone numbers, go to http://www.house.gov/
2. If you can only get a meeting with a staffer person, do that too.
3. If you or someone you know with a disability benefits from Medicaid directly, be sure to mention that at the meeting.
4. Be sure to write a letter using the Talking Points above or organize a Medicaid Letter Writing event.
5. Be sure to include your name and address in the letter and state that you are a “registered voter.” 
6. If you are not a registered voter, go to your state election website at http://tinyurl.com/29x7g5a   and register today!
7. Let AAPD know what you hear or learn in your meetings or in mail response by sending an email to [email protected]
8. Please circulate this Action Alert to others and encourage them to enter this big budget debate.
9. Thank you for everything you do to keep disability programs well-funded and driven by good policy!

AAPD’s Action Alert is written by David Heymsfeld, AAPD Member and Jenifer Simpson, AAPD Senior Director for Government Affairs.

Urgent Action: Tell Congress the House 2012 Budget Proposal Hurts PWDs

From AAPD (4.14.11):

Urgent Action: Tell Congress the House 2012 Budget Proposal Hurts PWDs

The proposed House 2012 Budget slashes numerous services for people with disabilities and will be voted on THIS FRIDAY. 

Take Action!  Contact your Congressman today and tell them to vote no on the Ryan Budget Proposal

Call toll free: 1-866-922-4970 or Dial 202-224-3121 (TTY 202-225-1904) and ask for your Representative’s office.

What is at stake:

Medicaid - The proposed plan shifts the cost of Medicaid to low-income consumers, including people with disabilities, and cuts the program by a third over the next 10 years.  The proposed plan converts Medicaid to a block grant which will cap funding regardless of health care cost inflation over time. 

>>> For More on how the proposed Medicaid Block Grants will hurt PWDS 

Medicare - The proposed plan eliminates the current Medicare structure and transforms the program into a voucher system.  It shifts the cost of services to the beneficiaries, almost doubling amount that individuals pay out of pocket for their ongoing health care.

>>> For More from the Congressional Budget Office on the effect on Medicare

Progress Made in Health Reform - The proposed plan repeals and defunds the Affordable Care Act (ACA) including programs that are vital for people with disabilities.  For example, the CLASS Program and and the Community First Choice Option are two ACA provisions targeted at expanding home and community based options for people with disabilities.

>>> For More on the ACA provisions for PWDs that are at risk

Call toll free: 1-866-922-4970 or Dial 202-224-3121 (TTY 202-225-1904) and ask for your Representative’s office.

What Should You Say?

• I am a constituent with a disability or parent/caregiver of a person with a disability.  (Briefly describe your situation, if you like.)
• The Ryan budget plan will take funding from programs that are critical to people with disabilities and will hurt me and/or my family.
• Please vote against the Ryan budget proposal.

 

Telerehab Conference, April 1, Register Today!

 

Save the Date!

WHEN: Date: Friday, April 1, 2011, 8:30 a.m. to 3:00 p.m.

What: “Where Rehabilitation and Broadband Technologies Intersect: A Policy Conference on New Approaches.” This is a Washington D.C. policy forum about what Telerehabilitation is and how it can enhance independent living and community integration for people with disabilities. Please mark your calendar for Friday, April 1, 2011, 8:30 a.m. to 3:00 p.m. and register today for this upcoming free conference intended for consumers, clinicians, researchers, policymakers, government agency representatives, industry, and providers. Lunch provided for registrants.

Where: The event is located in Room 333,  Hall of States, 444 North Capitol Street, NW, Washington, DC 20001  (nearest metro is Union Station, on the Red line)

Program:

Keynote speakers: Lynnae Ruttledge, Commissioner, Rehabilitation Services Administration and Jonathan Linkous, Chief Executive Officer, American Telemedicine Association.

Panels on: “Applications in Employment, Health and Wellness,” “Innovations for Community Living,” Funding & Support for Remote Delivery of Services,” Accessibility & Usability,” and “Comparative Effectiveness Research.”

Panelists and Lead Discussants include researchers from University of Pittsburgh, University of Illinois; policymakers from Agency for Healthcare Research & Quality (AHRQ),

Federal Communications Commission (FCC), U.S. Health & Human Services (HHS), and company representatives from AT&T, Qualcomm.

Don’t miss out on this first policy discussion on Telerehabilitation, where rehabilitation intersects with broadband technologies.

Register Today! Fax Form found online at http://www.rerctr.pitt.edu/PolicyConf.html  or contact Jenifer Simpson at email [email protected]

More information at http://www.rerctr.pitt.edu/PolicyConf.html

Project is funded by the U.S. Department of Education, National Institute on Disability Rehabilitation Research, Grant No. H133E090002.

 

Public Meeting on Employment of People with Mental Disabilities

From the EEOC (3.9.11):

Notice of March 15th EEOC Public Meeting on Employment of People with Mental Disabilities

On March 15th, 1-4 pm, the US Equal Employment Opportunity Commission (EEOC) will hold a public Commission meeting on the employment of people with mental disabilities. The focus of the meeting will be employment of people with intellectual disabilities and employment of people with psychiatric disabilities.

The meeting will explore barriers that have kept people with intellectual disabilities and people with psychiatric disabilities from getting and keeping jobs, and how those barriers can be successfully overcome.  It will also discuss how Olmstead enforcement dovetails with the EEOC's role of ensuring that people with disabilities can participate in their communities by getting and maintaining employment.

Speakers will include:

• Ruby Moore, Director of the Georgia P&A
• Sam Bagenstos, Principal Deputy Assistant Attorney General, DOJ Civil Rights Division
• Bill Kiernan, Director, Institute for Community Inclusion
• Gary Bond, Dartmouth Psychiatric Research Center
• Sharon Lewis, Commissioner of Administration on Developmental Disabilities

The meeting will take place at EEOC Headquarters, 131 M Street NE (NY Ave metro, M Street exit).

CART and ASL will be provided.

A web archive of the meeting will be available afterward.

Please contact Jennifer Mathis, [email protected], with any questions.

Say NO to Institutions: Tell ADD What They Should be Doing for PWD

From JFA Moderator:

Following the Envisioning the Future Summit, Sharon Lewis, Commissioner at the Administration of Developmental Disabilities (ADD), has opened a site for comment with your "vision for the future."  To read her invitation to participate, see below. 

Voice of the R#t@rded has used this platform to argue for maintaining institutions. Don't let them set ADD's agenda.  Numerous comments have been submitted to Preserve Residential Choice saying "ADD should not use its public funds to sponsor programs and promote policies which undermine and eliminate congregate care options (aka institutions), including intermediate care facility programs for persons with mental retardation (ICF/MR)."

Let Sharon Lewis know we do not want institutions.  The deadline is March, 4, 2011.  So Comment TODAY.

Example Comment: "I envision a world where people with disabilities are free to live, work, socialize, learn and pray in their homes and communities.  I want to see a future where people are not forced into institutions in order to receive supports.  The government should ensure that people are free to direct their own lives while receiving the supports they need in order to be productive citizens and community members.  Stop warehousing people with disabilities."

Please add your own priorities -

End the waitlists

Fully fund IDEA so that we have access to quality education

Allow PWD to get married without losing benefits, etc.

The website for writing your comments is:

http://www.envision2010.net/comment_submit.php

From Self-Advocates Becoming Empowered (2.24.11):

Say NO to Institutions

We need your help! Freedom to live in the community is at risk.

The group called VOR – Voices of the R#tarded - is telling the government to keep institutions opened. 

We need self-advocates and allies to speak up and say NO to institutions.

Go to ADD's web site – fill out the form. Tell people how you feel. You can write 1 sentence or 2 sentences or a whole page. Just Do It!

We know that filling out surveys on a computer can be a pain in the neck– so ask a friend for help you if you need it.

This is very important! Please do it before Friday March 4^th.

The website for writing your comments is:

http://www.envision2010.net/comment_submit.php

 

From Sharon Lewis, Commissioner of ADD:

As the Commissioner for the Administration on Developmental Disabilities, public outreach and strategic planning are critically important items on my agenda.

There are so many complex issues affecting people with disabilities across the country - implementation of the Affordable Care Act, the new economic reality of states, persistent unemployment, education reform efforts, and our aging population - these are only a small sample of the significant changes that are shaping the future.

Additionally, thanks to many years of hard work by advocates, families, and communities, the realities for people with developmental disabilities have positively evolved in recent decades, including:

• Options to live in homes and communities of their choosing, with self-directed supports and services;
• Moving beyond simple integration and participation, into community interdependence and meaningful belonging;
• High expectations in educational outcomes, including access to college;
• Technology that is changing the landscape and providing countless new opportunities;
• Employment and economic self-sufficiency as achievable hopes and dreams, including for people with significant disabilities;

… and many other cultural, programmatic, service and social changes.

Given this shifting landscape, I have been honored to hear how you - self-advocates, family members, allies, and professionals - describe your vision of the future for individuals with developmental disabilities. Thank you for collaborating with us throughout this process.

Sharon Lewis
Commissioner
Administration on Developmental Disabilities

Also check out Commissioner Lewis's moving introduction at http://www.envision2010.net/index.php (captioned video)

http://www.envision2010.net/captioning/Lewis_Welcome_Philadelphia.pdf (transcript)

AR: Institutionalization Debate Flares

From the Wall Street Journal (1.24.11):

Feud Over Best Setting for the Disabled
Justice Department Suit Against Arkansas Stirs Debate Over Housing People in Big Institutions Versus Small Group Homes.

By ANNA WILDE MATHEWS

The Justice Department in a lawsuit against Arkansas is reigniting an emotional fight over the role of residential institutions for people with disabilities.

The suit focuses on one of Arkansas's facilities for people with severe disabilities, the Conway Human Development Center. The state-run institution houses around 510 people off all ages, including children, who typically have intellectual disabilities as well as conditions such as cerebral palsy and physical handicaps.

The suit claims residents aren't being given enough of a chance to move to less-restrictive community settings—such as group homes or family dwellings with professional assistance—and alleges dangerous practices. Conway residents are generally placed in the center by their families, with the exception of a few who are wards of the state, such as children in foster care.

The Justice Department has found itself squaring off not only against the state government, but also against well-organized and vocal groups representing families of residents of state-run institutions. They have prodded state officials to defend the facilities and intervened in the case with a brief defending Conway.

>>> For the Full Article

Groundbreaking Bill on Supportive Integrated Housing Passes!

From JFAAN (12.22.10):

 

Another Disability Legislative Win: Frank Melville Supportive Housing Investment Act Passes!

The Frank Melville Supportive Housing Investment Act of 2010 (S.1481) has passed the Senate and the House, and is now on its way to be signed by President Obama.  S. 1481 authorizes an innovative 811 demonstration program, which promotes integrated housing opportunities for people with disabilities. The new law, once implemented, creates 3,500 to 5,000  new affordable and accessible units every year without increasing Section 811 appropriations. During recent years, the program has produced fewer than 1,000 units annually.  Advocates are pleased that from FY 2011 to FY 2015, $300 million will be authorized for Section 811.
 
“Reasonably priced housing is a critical piece of the puzzle for disabled persons seeking to become independent,” said Senator Mike Johanns. “This bill will streamline efforts to provide them adequate and affordable homes and ensure no one slips through the cracks. I’m pleased my colleagues agreed that this bill is the right direction to provide stability for these vulnerable citizens.”  Congratulations, housing advocates!

Item provided by sister disability organization, National Council on Independent Living, a member of the Justice For All Action Network (JFAAN) coalition of disability groups.

From Consortium for Citizens with Disabilities (12.22.10):

Breaking News!

Congress Enacts Legislation to Reform HUD’s Section 811 Supportive Housing for Persons with Disabilities Program

December 22, 2010

The Consortium for Citizens with Disabilities Housing Task Force (CCD Housing Task Force) is pleased to announce that the Frank Melville Supportive Housing Investment Act of 2010 was passed by Congress yesterday and will soon be signed into law by President Obama.  

This groundbreaking legislation will reinvigorate and modernize the U.S. Department of Housing and Urban Development (HUD) Section 811 Supportive Housing for Persons with Disabilities program that provides critically important affordable housing linked with community-based supportive services for the most vulnerable people with disabilities.  By leveraging other sources of capital funding, such as federal Low Income Housing Tax Credits, the reformed Section 811 program will now fund thousands more units of supportive housing every year and – for the first time – create integrated supportive housing units within affordable housing properties.

The CCD Housing Task Force and the Technical Assistance Collaborative (TAC) led an intensive three-year advocacy effort that culminated yesterday in the House of Representatives.  On Friday December 17th, the U.S Senate passed this legislation – S 1481 – by unanimous consent.  The House passed a similar bill in 2009 and voted yesterday to adopt the bill passed by the Senate before final adjournment of the 111th Congress.

"This legislation is a significant accomplishment which will improve the lives of thousands more people with the most significant and long-term disabilities” said Andrew Sperling, CCD Housing Task Force Co-Chair.  “We are extremely proud to have been a part of this important effort.  We are also enormously grateful for the assistance TAC provided in helping to re-configure this important program.”

The CCD Housing Task Force also applauds the bipartisan leadership that made this legislation possible and extends its thanks to the Members of Congress who – along with their staff – helped make this important legislation a reality including: 

• Congressman Christopher Murphy (D-CT) and Congresswoman Judy Biggert (R-IL) who were the lead co-sponsors in the House;

• Congressman Barney Frank (D-MA) and Congressman Spencer Bachus (R- AL), Chairman and Ranking Member of the House Financial Services Committee;

• Senator Bob Menendez (D-NJ) and Senator Mike Johanns (R-NE) who were the lead co-sponsors in the Senate; and

• Senator Christopher Dodd (D- CT) and Senator Richard Shelby (R-AL), Chairman and Ranking Member of the Senate Banking Committee.

Section 811 Reforms

The Frank Melville Supportive Housing Investment Act makes long overdue improvements to the Section 811 program by:

• Modernizing and simplifying the capital advance program for non-profit sponsors,

• Integrating supportive housing for people with disabilities into larger multi-family affordable rental housing developments,

• Protecting an existing tenant-based program targeted to people with disabilities, and

• Creating an innovative subsidy approach that will allow states to leverage additional capital funds for the creation of new units of supportive housing.

This important legislation is named in honor of the late Frank Melville, the first Board Chair of the Melville Charitable Trust.  Frank Melville and the entire Melville Charitable Trust family have been national leaders in promoting supportive housing as a highly successful and cost effective best practice that can prevent and end unnecessary institutionalization and homelessness among people with the most significant and long-term disabilities.

Help Your State Save Medicaid Funds and Comply with the ADA

From Steve Gold's Information Bulletin (12:1:10):

Help Your State Save Medicaid Funds and Comply with the ADA. 

 
Information Bulletin # 326 (12/2010)

Twenty-four states in FY 2009 spent less than 25% of their Medicaid Long Term Care expenditures for home and community-based services.  Yes, these twenty-four states in FY 2009 spent more than 75% of their Medicaid Long Term Care expenditures on nursing homes! [The list is below.]

Looked at another way, ten years after the Supreme Court in Olmstead declared unnecessary institutionalization in nursing homes as discrimination under the ADA, these twenty four states' Medicaid expenditures are still significantly biased toward nursing homes.

In the last Information Bulletin, "Are you ready for a real fight?" we discussed all the publicity and outcries about Medicaid expenditures.  We reminded advocates for elderly and disabled people that it was significantly cost effective to provide services in the community, instead of paying nursing homes.

We know the reason for the continued institutional bias by the nursing home industry contributes a lot of money to your Governors and state legislators. These political contributions are not acts of charity, but are the quid pro quo to keep the nursing home industry supplied with Medicaid cash cows - elderly and disabled people.

Isn't it time to point out to the press, friendly legislators and other advocates your state's hypocrisy -- complaining about Medicaid costs while at the same time refusing to reduce nursing home Medicaid expenditures by providing services in the community?

When Congress enacted the Affordable Care Act of 2010 (at section 10202), it offered these 24 states the opportunity to receive an increased Federal Medical Assistance Percentage (FMAP) of five percentage points if your state rebalances its LTC to be less institutionally biased. [There were another twenty-one states that spent between 25 % and less than 50% of their Medicad LTC on community-based services.  If these states rebalance, they will receive an additional two percentage FMAP points.]

That's five additional percentage points on what your State spends on its HSBC programs and services.  We're talking a lot of additional money from those five points!

Does your Governor want to increase the community-based expenditures by five percentage points for basically complying with the ADA?  It'll cost no additional money - just rebalancing the budget.

Under Section 10202 of the ACA of 2010, if your Governor is really serious about saving Medicaid funds, he/she must submit a plan to the U.S.
Department of Health and Human Services, and describe how the state will rebalance its program to increase its community-based expenditures and to decrease its nursing home expenditures.  Let's hope HHS really holds the States to a high standard.

This increased FMAP does require a state to have: (1)  a single entry point so that before a person goes into a nursing home, the person is really offered the choice of community-based services; (2) an assessment instrument used state-wide to determine what services a person needs to live in the community; and (3) case management services that are conflict free.  One might think that these three would already exist in every state, but obviously they do not.

Okay.  That's what your Governor has to do to increase federal Medicaid funds.  Now the issue is whether or not your Governor will submit a plan.
Write letters to the newspaper posing the question. Telephone supportive legislators. Find out if your state will submit a plan.

Here are the 24 States that in FY 2009 expended less than 25% of their Medicaid LTC on community-based services and, therefore, conversely spent more than 75% on nursing homes:

Alabama
Arizona*
Connecticut
Delaware
Florida
Hawaii*
Illinois
Indiana
Kentucky
Maine
Maryland
Michigan
Mississippi
Nebraska
New Hampshire
New Jersey
North Dakota
Ohio
Pennsylvania
Rhode Island
South Dakota
Tennessee*
Utah
Wyoming

 *   Data for these states does not include certain LTC expenditures within
managed care programs.

    Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/