tag:blogger.com,1999:blog-88702102655017821482024-03-08T06:01:55.634-08:00stevegoldadastevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.comBlogger78125tag:blogger.com,1999:blog-8870210265501782148.post-12192565867559508272014-12-16T13:07:00.002-08:002014-12-16T13:07:12.384-08:00More than 5% Accessible Housing Units. Information Bulletin #396 (12/2014)
Under Section 504 of the Rehabilitation Act of 1973, recipients of “federal financial assistance” were prohibited from discriminating. It took nearly 15 years for HUD to finally promulgate what nondiscrimination meant in the housing arena. Then in 1988, HUD’s federal regulations set a floor – 5% of federally funded housing had to be mobility accessible for people with mobility disabilities (and another 1% for hearing and visual disabilities).
For a number of years, the disability community could not enforce the 5% minimum, even though we believed it was grossly too low and inadequate. Even with the 1990 and 2000 census, we did not have a handle to push higher than 5%.
Now, with the 2010 census we can. The primary federal financial assistance housing programs that the 2010 census impacts are the HOME Investment Partnership, Project Based Housing Vouchers, and Public Housing.
HUD’s federal regulation 24 CFR § 8.22 (c ) states that HUD “may prescribe a high percentage … upon request … based upon demonstration … based on census data….”
Disability Advocates – here’s a suggested battle plan. First, you must use the Census’s “American Fact Finder” and determine for your county the percentage of persons “with an ambulatory difficulty” whose incomes are under the poverty levels. It is critical to remember that this data does NOT include persons institutionalized in nursing homes. Second, you must contact your local HUD FHEO office and request at the least that prospectively HUD enforce the increased percentages.
To wet your interest, here are some preliminary results: Philadelphia, PA, 13.2%; Washington county, PA.15.3%, Chicago, Ill, 9.4%; Baltimore, 13.8%; Orleans Parish, New Orleans, 10.65%; El Paso, TX 9.8%; Lafayette Parish in Louisiana, 9.46%.
No more excuses! The data is now available. It’s up to you, the advocates, to make it happen.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/ Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-33427811513597700512014-07-17T07:44:00.001-07:002014-07-17T07:44:52.343-07:00<b><i>Medicaid Expansion: Real People, Real Lives, Real Injuries.</i><i></i></b> Information Bulletin # 395 (7/2014).
Too often, advocates get bogged down with “policy” formulations and do not focus on the people who are affected by these policies. Here is what is at stake for non-elderly people with incomes below 133% of the poverty level in the 24 States that have not opted to receive 100% federal reimbursement for Medicaid expansion since January 1, 2014. Chart #1 below lists the 24 States.
On July 2, the White House Council of Economic Advisers (CEA) issued a report, Missed Opportunities: the Consequences of State Decisions Not to Expand Medicaid, which details the impact of states’ decisions to not expand Medicaid under the Affordable Care Act.
We are talking about a lot of people whose health care needs are put at risk because the 24 States have refused to expand Medicaid:
1. Preventive health care will not occur each year -
a. for 214,000 women between the ages of 50 and 64 who would have received mammograms;
b. for 345,000 women who would have received pap smears, and
c. for 829,000 men and women who would have received cholesterol-level screenings.
2. Also, 651,000 people who would have received “all needed care” they felt they needed during the year.
3. If Medicaid had been expanded in every State, an additional 1.4 million people would likely have had a primary care visit at a physician’s office. See Chart #2 below for a breakdown by State.
Real people, real lives, real injuries.
Becausee these 24 States have not accepted Medicaid expansion, 255,000 people risked facing catastrophic out-of-pocket medical expenses which would have otherwise been covered with Medicaid. Even without catastrophic medical expenses, there would have been 810,000 fewer people who had trouble paying rent and utilities because they had to pay for medical bills.
Medicaid expansion thus helps people to have greater financial security in addition to improved access to health care.
Finally, in addition to individuals receiving health care, let’s not forget the impact on your States’ economies because your State has opted not to have Medicaid expansion. The impact on State economies is stark: those 24 States that have not expanded since July 1, 2014 will lose $88 million in Federal payments through calendar year 2016. Those 26 States that have expanded will receive $84 million over that period.
Because Medicaid expansion is funded through our federal taxes, tax-payers in the 24 States that have not opted to expand Medicaid are subsidizing the 26 States that have expanded.
The federal government pays 100% of the health costs for Medicaid expansion for three years – 2014 through 2016. Thereafter, the federal government pays about 90%.
It is really hard to believe and understand why any State would not accept 100% federal funds for health care for the lowest income people, other than a real enmity toward low-income people, especially when a State could opt out of Medicaid expansion for whatever reason.
Advocates in the 24 States that have not expanded Medicaid should think about whether your State accepts federal highway and other infra-structure funds for bridge repairs. We bet none of these 24 States turn down those funds. Does your State turn down federal special education funds? Maybe we should not mention food stamps for fear that the apparent hatred toward low-income people would be extended to those federal funds too.
Chart # 1 -
Number of people denied health care
in States without Medicaid xpansion
Alabama 235,000
Alaska 26,000
Florida 848,000
Georgia 478.000
Idaho 55,000
Indiana 262,000
Kansas 100,000
Louisiana 265,000
Maine 28,000
Mississippi 165,000
Missouri 253,000
Montana 38,000
Nebraska 48,000
North Carolina 377,000
Oklahoma 123,000
Pennsylvania 305,000
South Carolina 198,000
South Dakota 26,000
Tennessee 234,000
Texas 1,208,000
Utah 74,000
Virginia 210,000
Wisconsin 120,000
Wyoming 16,000
Chart #2 States Without Medicaid Expansion and
People who gave had
No Mammograms No Pap Smears No Cholesterol Screening
In Past 12 months In Past 12 Months In Past 12 Months
Alabama 9,300 14,200 34,200
Alaska 900 1,500 3,800
Florida 35,300 52,000 123,000
Georgia 17,000 28,900 69,600
Idaho 2,300 3,300 8,000
Indiana 9,000 15,200 38,200
Kansas 3,100 5,800 14,600
Louisiana 10,400 16,000 38,600
Maine 1,300 1,700 4,100
Mississippi 6,200 9,700 24,000
Missouri 9,400 14,900 36,900
Montana 1,600 2,400 5,500
Nebraska 1,600 2,900 7,000
North Carolina 13,900 23,000 54,900
Oklahoma 4,800 7,300 17,900
Pennsylvania 11,100 17,600 44,400
South Carolina 8,000 12,000 28,800
South Dakota 900 1,500 3,800
Tennessee 9,500 14,000 34,100
Texas 44,100 75,200 176,000
Utah 1,900 4,500 10,800
Virginia 8,000 1,300 30,600
Wisconsin 3,800 6,700 17,500
Wyoming 700 1,100 2,300
Real people, real lives, real injuries.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com1tag:blogger.com,1999:blog-8870210265501782148.post-16774578241449279912014-07-14T06:37:00.002-07:002014-07-14T06:37:18.606-07:00People With Disabilities Institutionalized in Nursing Homes, Information Bulletin #394 (7/2014).
Think about the warmth and coziness conjured up by the term “nursing homes.” Much of the public and as well as the press think that “nursing homes” are the places where people must go in order to receive intensive nursing care. Let’s take a look at the extremely effective branding of a product: nursing homes.
As of December 2013, 69.4% of the nation’s 15,666 nursing homes were classified as “for profit,” only 24.7% were classified as “nonprofit,” and 5.9% were classified as “government/public facilities.” In Alabama, Arizona, California, Connecticut, Louisiana, Ohio, Oklahoma, Oregon, Texas and Utah, more than 80% of the nursing homes are “for profit.”
More than 55% of these 15,666 facilities were owned by multi-nursing home chains and corporations, with each corporation having two or more nursing facilities under one ownership or operation. Nursing homes have not been “mom and pop” operations for many years.
Nursing homes are a $74 billion Medicaid funded industry. Medicaid certifies about 90% of the nursing facilities. Most of these facilities are BIG BUSINESS funded by public taxes and dollars. Think BIG LOBBIES using people with disabilities as cash cows to make profits.
Most of these are large institutions – not “homes,” not even “group homes” of only a few people. This is not surprising since “for profit” means making money for the owners. That means meeting the interests of the owners and not the residents in terms of size and scale.
The “nonprofits” are really not that much different from the “for profits” with regard to their size. They are not “homes.” Don’t be fooled by the label “nonprofit.” Executive Directors’ salaries in nonprofit nursing homes can be hundreds of thousands of dollars or more. Senior staff in “nonprofits” also make a lot of money.
What about the residents in Medicaid funded-nursing homes? They are all people with disabilities. Regardless of their age, in order to be eligible for Medicaid funded nursing homes, people must meet the State’s criteria disability consisting of physical and/or cognitive impairments that limit activities of daily living.
Elderly people cannot just decide that they want to enter a Medicaid-funded nursing facility, like they would a hotel. They must have a certain number of impairments, just like younger people with disabilities.
With regards to the alleged doctors, let’s examine their affiliations with the facilities. Most people in nursing homes do not know they can have their own doctors continue to treat them there. Rather, the nursing homes have an understanding or deal with certain doctors who “care for” all the residents. The result is that the doctors in nursing homes are beholden to the nursing facility, and the residents/patients in these facilities are cash cows for the doctors.
These doctors do not view the residents as their patients because in order for the doctors to continue to be reimbursed, they must cater to the nursing home proprietors. We have seen the “drive by” medical care that these alleged medical professionals provide. They bill Medicaid for hundreds of alleged patient visits, as well as care and treatment for all the nursing home patients just in a few hours. In reality, they rarely even see the patients but just sign hundreds of charts.
What about the “nursing” part of “nursing homes”? The general public, the press, and elected officials must think that people with disabilities, regardless of their age, really need to be in a nursing facility because they need direct care that can be provided only from well-trained health care staff in a nursing facility. Hmm.
Let’s look at how much time measured in hours per patient per day residents actually receive “nursing” care and services. Nationally, the average of “total direct care” staff hours provided per patient per day is 3.71 – that a total for registered nurses (RNs), licensed practicing nurses (LPNs), and aides. However, of this average 3.71 hours per nursing home, less than half an hour is provided by a RN and about three quarters of an hour is provided by an LPN, who generally have only one year of training.
Does anyone really think that a “visiting nurse” in one’s home could not provide the same patient care in the same amount of time, but much more cheaply?
Who is providing this “direct care if not the RNs or LPNs?” It is the “aides.” These are the people who provide the assistance with residents’ daily living needs – transferring them from their beds, assisting them with toileting, showering, dressing, and other such needs. Yes, the assistance personal attendants provide in the nursing homes is the same assistance with activities of daily living that people with disabilities receive in the community.
So why has the nursing home industry been so successful in deceiving the public?
First, the nursing home industry is well-funded; they are active lobbyists and contributors to your State legislators and Governor. They play this system much better and more effectively than the community-based community-care providers.
Second, advocates for the elderly and non-elderly disabled people have not developed or engaged in effective activism and advocacy. There have not been the press or television stories that were produced about institutions for people with intellectual or mental disabilities, showing how absolutely terrible they were.
Third, once people with disabilities enter nursing homes, especially if they are elderly, they give up hope that they can live in the community. Their families do not know about or believe they can receive appropriate or the same services in the community that they think nursing facilities provide, and they do not fight for those services.
We need a new Frederick Douglass. He knew that power concedes nothing without struggle. Where are you?
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-28644457429188038402014-06-20T06:49:00.001-07:002014-06-20T06:49:09.169-07:00<b>Olmstead 15th Anniversary [Part Four] - How Much Progress Has Your State Made?</b> Information Bulletin # 394 (6/2014).
In the previous three Olmstead 15th Anniversary Information Bulletins, we focused entirely on Medicaid-funded nursing homes and community-based programs. We have looked only at programs for people of any age with primarily physical disabilities of any age and who would meet the eligibility criteria for nursing homes.
We saw that between Fiscal Years (FY) 2000 and 2012, there was a significant national increase in Medicaid community-based expenditures from 18.7% to 38.8%. That is an increase from $9 billion to $22 billion – not chopped liver!
People with developmental disabilities also benefit from the Olmstead decision and the ADA’s “most integrated setting” regulation requirement. People with developmental disabilities do not meet the eligibility criteria for nursing homes and should not be in those institutions. We can make an independent comparison of institutional versus community spending for people with developmental disabilities. Historically, the two systems – one for people with developmental disabilities and the other for the aged and people with primarily physical disabilities – have responded to Olmstead and the ADA’s mandate quite differently.
For example, for people with developmental disabilities between FY 2000 and FY 2012, there was a significant national increase in Medicaid community-based expenditures from 49.0% to 69.6%. That 20% jump is about the same as the increase in community spending for people with physical disabilities. Chart One presents 2012 Developmental Disabilities (DD) data by State in the community.
What is particularly impressive is that 14 States in FY 2012 spent more than 90% of their total Long Term Services and Supports (LTSS) (i.e., the combined institutional and community expenditures) for DD in the community. See Chart One – 2012 % of LTSS Medicaid Expenditures Went to ID Community Programs.
It is also fascinating is to compare by State the FY 2012 expenditure of LTSS for people with non-DD disabilities with the expenditure for people with DD. See Chart Two.
Why, for example, does Alabama allocate 96.4% in the community for persons with developmental disabilities, but only 15.2% in the community for the aged and people with physical disabilities? Further, Michigan and Maryland each allocate 100% in the community for persons with developmental disabilities, but spend only 23% in the community for the aged and people with physical disabilities. Similarly, New Hampshire allocates 98% in the community for people with developmental disabilities but only 19% for the aged and people with physical disabilities, and Rhode Island spends 96% for people with developmental disabilities in the community but only 19% for the aged and people with physical disabilities in the community. We could go on and on – see Georgia, Connecticut, but you see the discrepancy.
However, there are several big differences that may explain this discrepancy.
First, in 2000, the institutional side (Intermediate Care Facilities/MR) and the community side (MR Waivers) each expended about $10 b. On one hand, $49b (80% of the entire LTSS) of Medicaid spending for the aged and people with physical disabilities went to the institutional side. On the other hand, institutions and community Medicaid spending for people with developmental disabilities started off nearly equal. It’s like a hundred yard dash with some folks starting at the mid-point and others starting far behind.
Second, the institutional component of ICF/ID (Intellectual/Developmental Disabilities) in 2012 is quite different from nursing homes, the institutional component for people with physical disabilities regardless. That is, 58% of the institutions for developmental disability community were publicly owned in comparison to the nursing homes of which only 6% are publicly owned and nearly 70% are for profit. This difference results in political differences because, unfortunately, money and contributions to state-elected officials play an important role in how Medicaid funds are expended between the institutions and the community.
Third, the exact opposite occurs on the community side for people with developmental disabilities. Since 2000, most people with developmental disabilities have moved from public institutions to primarily private provider-based group homes and most people with physical disabilities have moved from private institutions (nursing homes) to their own apartments and homes.
The providers of community-based services are for developmentally disabled individuals very strong both financially and politically in the same way that institutional nursing homes proprietors are strong (regardless of whether the nursing home is “for profit” or allegedly “nonprofit”).
Fourth, advocates actually need to go into institutions to encourage and help people transition out of the institutions. I am regularly amazed when I ask advocates for the aging and people with physical disabilities community about people in institutions who want to reside in the community and am told they do not know those people.
Advocates should also encourage people to stay in their own homes and communities. “Closing the front door” before a person is institutionalized is an effective strategy to which your State Medicaid administrators should be receptive – if you push them.
Neither the Olmstead decision or the ADA are self-executing. They are enforced only when advocates act.
<b>Chart One -2012 % of DD LTSS in the community</b>
Alabama 96.40%
Alaska 98.10%
Arizona 100%
Arkansas 50.40%
California 74.70%
Colorado 89.60%
Connecticut 74.20%
Delaware 69.80%
Florida 71.50%
Georgia 90.30%
Hawaii 92.10%
Idaho 73.60%
Illinois 47.80%
Indiana 62.30%
Iowa 56.10%
Kansas 84.10%
Kentucky 72.50%
Louisiana 48.30%
Maine 80.80%
Maryland 100%
Massachusetts 98.50%
Michigan 100%
Minnesota 86.00%
Mississippi 14.00%
Missouri 59.80%
Montana 88.60%
Nebraska 79.50%
Nevada 79.90%
New Hampshire 98.30%
New Jersey 51.70%
New Mexico 91.80%
New York 62.00%
North Carolina 56.90%
North Dakota 58.00%
Ohio 62.10%
Oklahoma 71.10%
Oregon 100%
Pennsylvania 76.70%
Rhode Island 95.70%
South Carolina 65.30%
South Dakota 77.60%
Tennessee 72.80%
Texas 50.00%
Utah 74.90%
Vermont 99.20%
Virginia 66.90%
Washington 83.80%
Dist. of Columbia 68.00%
West Virginia 82.80%
Wisconsin 79.90%
Wyoming 82.60%
United States 69.60%
<b>
Chart Two - 2012 % of A/PD LTSS in the community</b>
Alabama 15.2%
Alaska 62.4%
Arizona 42.0%
Arkansas 31.7%
California 57.1%
Colorado 45.5%
Connecticut 25.8%
Delaware 21.3%
Florida 23.0%
Georgia 29.0%
Hawaii n/a
Idaho 43.5%
Illinois 31.9%
Indiana 18.7%
Iowa 26.6%
Kansas 31.5%
Kentucky 14.4%
Louisiana 30.0%
Maine 32.3%
Maryland 23.4%
Massachusetts 44.7%
Michigan 23.6%
Minnesota 65.4%
Mississippi 22.2%
Missouri 37.4%
Montana 36.2%
Nebraska 23.6%
Nevada 33.5%
New Hampshire 18.8%
New Jersey 15.7%
New Mexico n/a
New York 45.9%
North Carolina 39.8%
North Dakota 14.0%
Ohio 32.4%
Oklahoma 30.8%
Oregon 60.7%
Pennsylvania 24.7%
Rhode Island 18.8%
South Carolina 26.2%
South Dakota 16.3%
Tennessee 31.3%
Texas 50.1%
Utah 21.9%
Vermont 44.7%
Virginia 43.9%
Washington 61.7%
Dist. of Columbia 54.1%
West Virginia 31.3%
Wisconsin 47.9%
Wyoming 20.0%
United States 38.8%
Again, thanks to Truven Health Analytics for the underlying data.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-73742355175502770032014-06-19T07:12:00.000-07:002014-06-19T07:12:01.330-07:00Olmstead 15th Anniversary [Part Three] - How Much Progress Has Your State Made? Information Bulletin # 392 (6/2014).
In this Olmstead 15th Anniversary Information Bulletin, we will compare the Medicaid expenditures State-by-State for Long Term Services and Supports (LTSS), including expenditures on both nursing homes (institutions) and community-based programs.
In Fiscal Year 2000, the first year after the Supreme Court held that “unnecessary isolation” was discrimination against people with disabilities.
States varied quite a lot in the percentage of their LTSS spending that went to the community-based programs. Nationally, only 18.7% of LTSS spending went to the community-based programs and the remainder went to programs that segregate people with disabilities in nursing homes. The worst States in 2000, those that expended less than 10% of their LTSS in the community were Illinois, Indiana, Louisiana (5.7%), Mississippi (6.7%), New Hampshire, North Dakota (3.4%), Pennsylvania (3.2%), Rhode Island, South Dakota, Tennessee (0.5%), Utah, and Wyoming. Chart One below lists the rates for each State.
By FY 2012, the percentage of Medicaid LTSS expenditures in the community had increased to 38.8%. There were only four States that had under 10% Medicaid community-based expenditures: Alabama, Indiana, Kentucky, and South Dakota. However, another four States were listed as having zero expenditure in the community: Arizona, Hawaii, Rhode Island and Tennessee. Chart Two below lists the rates for each State.
By FY 2012, many of the worst States from FY 2000 had made really significant progress in funding community-based services, including, Illinois, Louisiana, Mississippi, and Pennsylvania. The improvement in these States demonstrates a real commitment to changing their allocations to comply with Olmstead.
Obviously, there has been a lot of progress. However, it is important to understand that the spending on the institutional side of the leger has not been stationary between FY 2000 and FY 2012. In terms of total Medicaid dollar expenditures during these years, the institutional and community sides each increased by $12 billion. Chart three below lists the increases in each State.
What is particularly interesting about the total dollar expenditures is that some States that decreased their total combined institutional and nursing home expenditures between FY 2000 and FY 2012 were also able to increase their total community-based Medicaid expenditures. These States, which should receive exceptional kudos, include Minnesota (reduced institutional expenditures by $32 m and increased community by $1 b), Nebraska (reduced institutional expenditures by $21 m and increased community by $13 m), New Mexico (reduced institutional expenditures by $162 m and increased community by $7 m), Pennsylvania (reduced institutional expenditures by $231 m and increased community by $737 m), Tennessee (reduced institutional expenditures by $72 m and also decreased community by $6 m).
However, there were States that increased their total institutional expenditures and while actually reducing their community-based expenditures between FY 2000 and FY 2012. These States, were Connecticut (increased institutional expenditures by $273 m and decreased community by $16 m), Kentucky (increased institutional expenditures by $284 m and decreased community by $70 m), Rhode Island (increased institutional expenditures by $75 m and decreased community by $20 m).
We are very disappointed and surprised with those States that have actually decreased their total Medicaid expenditures for community-based programs. How can they be complying with the Olmstead decision? Are all of the people with disabilities who want to live in the community able to do so? Are there any people with disabilities still at risk of unnecessary isolation? What about those States that in FY 2012 still spent less than 10% of their LTSS on community-based services? How do they comply with Olmstead? How do they prevent unnecessary isolation?
What are the advocates for the aging and the advocates for physically disabled people doing in those States? It is difficult to believe that States are complying with the Olmstead and the ADA when they are spending such a small percentage of their LTSS on community-based programs.
It is difficult to reconcile a commitment to ending unnecessary isolation with many States’ increased spending on institutions that segregate people with disabilities. Advocates for the aging and physically disabled people regardless of their ages must speak up and demand full compliance with Olmstead and a real commitment to community-based programs.
<b>Chart One – % FY 2000 State Medicaid Expenditures In Community</b>
Alabama 11.0%
Alaska 28.8%
Arizona 14.1%
Arkansas 30.0%
California 22.6%
Colorado 26.9%
Connecticut 16.9%
Delaware 13.1%
Florida 10.1%
Georgia 14.2%
Hawaii 14.2%
Idaho 26.0%
Illinois 8.5%
Indiana 7.9%
Iowa 11.1%
Kansas 26.6%
Kentucky 22.6%
Louisiana 5.7%
Maine 17.1%
Maryland 12.4%
Massachusetts 17.3%
Michigan 11.3%
Minnesota 21.8%
Mississippi 6.7%
Missouri 20.9%
Montana 24.9%
Nebraska 16.9%
Nevada 17.1%
New Hampshire 9.9%
New Jersey 10.0%
New Mexico 11.4%
New York 29.9%
North Carolina 34.6%
North Dakota 3.4%
Ohio 11.7%
Oklahoma 16.3%
Oregon 48.0%
Pennsylvania 3.2%
Rhode Island 7.5%
South Carolina 22.5%
South Dakota 6.2%
Tennessee 0.5%
Texas 28.5%
Utah 8.3%
Vermont 23.1%
Virginia 17.0%
Washington 39.4%
Washington DC 11.4%
West Virginia 30.2%
Wisconsin 19.6%
Wyoming 9.0%
U.S. 18.7%
<b>
Chart Two -% FY 2012 State Medicaid Expenditures In Community</b>
Alabama 9.6%
Alaska 62.4%
Arizona 1.0%
Arkansas 23.5%
California 33.6%
Colorado 26.7%
Connecticut 12.8%
Delaware 13.9%
Florida 13.7%
Georgia 25.0%
Hawaii 0.0%
Idaho 42.8%
Illinois 30.6%
Indiana 7.6%
Iowa 14.8%
Kansas 29.7%
Kentucky 9.8%
Louisiana 27.2%
Maine 28.3%
Maryland 18.0%
Massachusetts 34.1%
Michigan 21.6%
Minnesota 61.9%
Mississippi 21.6%
Missouri 35.2%
Montana 31.2%
Nebraska 20.5%
Nevada 28.3%
New Hampshire 15.1%
New Jersey 13.3%
New Mexico 91.3%
New York 35.8%
North Carolina 35.1%
North Dakota 10.8%
Ohio 22.5%
Oklahoma 28.4%
Oregon 59.3%
Pennsylvania 19.4%
Rhode Island 0.0%
South Carolina 23.5%
South Dakota 9.8%
Tennessee 0.0%
Texas 46.3%
Utah 17.0%
Vermont 20.0%
Virginia 42.4%
Washington 60.6%
Dist. of Columbia 52.1%
West Virginia 25.9%
Wisconsin 44.4%
Wyoming 13.8%
U.S. 38.8%
<b>
Chart Three – Dollar Increases Between Between 2000 and 2012 in Nursing Homes and in Community</b>
Nursing Homes Community
Alabama $255,754,231 $16,285,283
Alaska $69,148,946 $189,789,166
Arizona $475,688,312 $2,662,490
Arkansas $360,783,181 $74,068,697
California $1,998,500,869 $1,478,460,824
Colorado $257,127,331 $91,947,814
Connecticut $272,916,597 (-$15,486,259)
Delaware $7,535,638 $2,118,904
Florida $1,220,177,047 $268,218,703
Georgia $462,313,596 $280,885,524
Hawaii (-$147,584,084) (-$24,655,070)
Idaho $102,276,230 $120,753,121
Illinois $187,080,589 $611,247,113
Indiana $705,632,599 $54,927,012
Iowa $73,325,212 $37,289,090
Kansas $92,238,026 $59,833,671
Kentucky $284,788,789 (-$70,531,195)
Louisiana $346,159,432 $291,254,656
Maine $25,352,670 $47,704,797
Maryland $509,910,527 $160,185,965
Massachusetts $429,138,089 $650,078,374
Michigan $116,400,288 $269,903,742
Minnesota (-$32,379,189) $1,091,003,677
Mississippi $373,034,866 $181,099,249
Missouri $213,203,966 $317,567,671
Montana $33,015,318 $30,784,373
Nebraska (-$21,419,330) $13,345,040
Nevada $105,515,937 $57,853,840
New Hampshire $110,248,344 $33,967,631
New Jersey $177,204,426 $98,487,894
New Mexico (-$161,591,525) $7,211,233
New York $620,173,358 $1,181,029,041
North Carolina $390,328,061 $222,000,788
North Dakota $22,665,290 $18,278,558
Ohio $274,931,768 $421,962,758
Oklahoma $185,939,465 $136,516,642
Oregon $90,763,291 $260,920,140
Pennsylvania (-$231,182,111) $737,149,759
Rhode Island $75,641,677 (-$20,073,338)
South Carolina $195,064,443 $66,138,140
South Dakota $31,717,171 $7,781,163
Tennessee (-$72,734,458) (-$5,487,090)
Texas $959,781,368 $1,493,636,696
Utah $80,111,282 $27,157,320
Vermont $39,090,314 $5,830,447
Virginia $332,358,019 $504,163,948
Washington $4,179,217 $553,176,628
DC $76,178,032 $217,231,477
West Virginia $259,072,260 $67,828,539
Wisconsin $113,425,426 $587,263,336
Wyoming $52,403,886 $11,347,656
U.S. $12,401,404,687 $12,922,115,638
Thanks again to Truven Health Analytics for compiling the data.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-49408399395430143842014-06-17T06:54:00.000-07:002014-06-17T06:54:18.160-07:00<b><b>Olmstead 15th Anniversary [Part Two] - How Much Progress Has Your State Made? </b> </b>Information Bulletin # 391 (6/2014).
In the previous Information Bulletin, Olmstead 15th Anniversary [Part One] - How Much Progress Has Your State Made? we provided a State-by-State breakdown of Medicaid Long Term Services and Supports for both institutional expenditures and community-based Medicaid expenditures, comparing Fiscal Years 2000 and 2012.
In this Information Bulletin, we will look at the biggest institution for people with disabilities – nursing homes. The 2000 census reports that there were 1,720,500 persons of all ages with disabilities residing in nursing homes. [Remember, “aged” people must be disabled in order to receive Medicaid reimbursement for nursing home care; they do not qualify based on age alone.] How much progress have we made? By March 31, 2013, the number had been reduced to 1,414,957 – an 18% reduction in the population of institutionalized disabled people. [See Chart One below for a State-by-State breakdown.]
June 22, 2014 is the Fifteenth Anniversary of the Supreme Court’s Olmstead decision. In accordance with that decision and with the ADA’s “most integrated setting” requirement, people with disabilities should free from being unnecessarily isolated or at risk of unnecessary isolation in nursing homes.
While there has been an 18% reduction in the nursing home population of people with disabilities nationwide, rates vary among the States. Hawaii had a 28% increase and Nevada had a 4% increase in nursing home population from 2000 to 2013; however, these were the only two states that increased their institutional populations. A few States had small reductions of less than by 5% (Georgia had only a 1% reduction and Maryland had only a 5% reduction, which was followed closely by Texas and New Jersey’s reductions at 7% and 9% respectively.
On the positive side, Oregon was the most effective State at reducing its nursing home population with a reduction of 47%, second was Alaska at 36% and the following States all reduced these populations by at least 30% (Idaho, Maine, Minnesota, Oklahoma, Vermont, D.C., and Wisconsin). Kudos to those States.
While we do not have current comparison data for average Nursing Home occupancy rates, we do have it for 2011, when the national average occupancy rate was 83%. One might think that a State that had low nursing home occupancy rates would also be reducing its Medicaid expenditures on nursing homes. After all, it seems that reduced numbers of persons with disabilities in the nursing homes and many unused/unoccupied nursing home beds should result in less total Medicaid funds going to keep people with disabilities unnecessarily isolated or at risk of such isolation. [See Chart Two below.]
Are you surprised to learn that between 2000 and 2012 there was a 31% increase in the total amount of Medicaid funding for nursing home residents? There was a $12.4 billion increase in Medicaid funding for nursing homes during those years despite both an 18% reduction in number of residents and only an 83% occupancy rate. [See Charts Three and Four below.]
Sometimes I know I am in the wrong business.
What is amazing given these reductions and relatively low occupancy rates between 2000 and 2012 is that the national average of Medicaid nursing home expenditures actually increased by 31%! There was a total of $12.4 billion more Medicaid expenditures over that period. Here are the States that increased their Medicaid nursing home expenditures by more than 80%: Arizona, Arkansas, California, Idaho, Indiana, Maryland, Mississippi, Nevada, Utah, Virginia. Although Delaware, Michigan and D.C. had less than a 10% increase, there were a few States that acutally reduced the percentage of their nursing home expenditures, including Hawaii, Minnesota, New Mexico, Pennsylvania, and Tennessee.
It is hard to believe that the community of disability advocates cannot make the cost savings argument to your State legislatures and your Governors. We can and must make arguments newspapers, TV, and social media outlets that will result in real outrage.
We know that more than 90% of aged and younger people with disabilities do not want to be institutionalized and would prefer to reside in their own homes and communities. We also know that it is cost effective to provide these services in the community and that they have actually been provided for people exactly like those residing in nursing homes.
This is a shame. So what’s happening? The nursing home industry is ripping off your State budgets. (In the next Information Bulletin, we’ll discuss what’s going on in those nursing homes.)
Here are four State-by-State Charts: the first is the decrease in nursing home populations from 2000 – 2013, the second is the nursing home occupancy rates in 2011, the third is the % increase in nursing home Medicaid expenditures between 2000 and 2012, and the fourth is the actual Medicaid dollar increase in nursing home expenditures between 2000 and 2012.
Chart One - % decrease in nursing home populations from 2000 – 2013.
Alabama -1-13%
Alaska -36%
Arizona -8%
Arkansas -16%
California -12%
Colorado -10%
Connecticut -21%
Delaware -10%
Florida -14%
Georgia -1%
Hawaii 28%
Idaho -30%
Illinois -18%
Indiana -18%
Iowa -24%
Kansas -26%
Kentucky -20%
Louisiana -18%
Maine -31%
Maryland -5%
Massachusetts -23%
Michigan -18%
Minnesota -32%
Mississippi -12%
Missouri -21%
Montana -26%
Nebraska -24%
Nevada 4%
New Hampshire -25%
New Jersey -9%
New Mexico -12%
New York -12%
North Carolina -25%
North Dakota -21%
Ohio -15%
Oklahoma -32%
Oregon -47%
Pennsylvania -28%
Rhode Island -11%
South Carolina -18%
South Dakota -18%
Tennessee -17%
Texas -7%
Utah -16%
Vermont -31%
Virginia -24%
Washington -24%
DC -30%
West Virginia -17%
Wisconsin -31%
Wyoming -17%
U.S. -1-18%
Chart Two - nursing home occupancy rates in 2011
Alabama 85.40%
Alaska 91.30%
Arizona 70.40%
Arkansas 72.80%
California 84.90%
Colorado 80.50%
Connecticut 88.70%
Delaware 86.10%
Florida 87.60%
Georgia 85.30%
Hawaii 91.40%
Idaho 69.80%
Illinois 78.50%
Indiana 78.50%
Iowa 79.70%
Kansas 82.70%
Kentucky 89.60%
Louisiana 72.50%
Maine 91.00%
Maryland 87.60%
Massachusetts 88.30%
Michigan 85.00%
Minnesota 90.60%
Mississippi 88.20%
Missouri 71.80%
Montana 69.50%
Nebraska 78.30%
Nevada 81.60%
New Hampshire 89.70%
New Jersey 87.90%
New Mexico 82.70%
New York 91.80%
North Carolina 86.20%
North Dakota 90.30%
Ohio 85.30%
Oklahoma 67.30%
Oregon 61.40%
Pennsylvania 90.40%
Rhode Island 92.20%
South Carolina 89.50%
South Dakota 100.00%
Tennessee 84.90%
Texas 69.90%
Utah 66.30%
Vermont 87.60%
Virginia 88.20%
Washington 80.40%
DC 93.40%
West Virginia 88.10%
Wisconsin 83.10%
Wyoming 81.60%
U.S. 83.0%
Chart Three - % increase in nursing home Medicaid expenditures between 2000 and 2012
Alabama 39%
Alaska 115%
Arizona 3068%
Arkansas 119%
California 90%
Colorado 71%
Connecticut 28%
Delaware 8%
Florida 77%
Georgia 61%
Hawaii -99%
Idaho 92%
Illinois 12%
Indiana 92%
Iowa 15%
Kansas 26%
Kentucky 51%
Louisiana 67%
Maine 13%
Maryland 82%
Massachusetts 31%
Michigan 7%
Minnesota -4%
Mississippi 97%
Missouri 29%
Montana 26%
Nebraska -6%
Nevada 123%
New Hampshire 51%
New Jersey 11%
New Mexico -98%
New York 10%
North Carolina 47%
North Dakota 13%
Ohio 13%
Oklahoma 60%
Oregon 38%
Pennsylvania -6%
Rhode Island 31%
South Carolina 54%
South Dakota 31%
Tennessee -7%
Texas 67%
Utah 85%
Vermont 50%
Virginia 68%
Washington 1%
DC 54%
West Virginia 94%
Wisconsin 13%
Wyoming 108%
U.S. 31%
Chart Four - actual Medicaid dollar increase in nursing home expenditures between 2000 and 2012
Alabama $255,754,231
Alaska $69,148,946
Arizona $475,688,312
Arkansas $360,783,181
California $1,998,500,869
Colorado $257,127,331
Connecticut $272,916,597
Delaware $7,535,638
Florida $1,220,177,047
Georgia $462,313,596
Hawaii (-$147,584,084)
Idaho $102,276,230
Illinois $187,080,589
Indiana $705,632,599
Iowa $73,325,212
Kansas $92,238,026
Kentucky $284,788,789
Louisiana $346,159,432
Maine $25,352,670
Maryland $509,910,527
Massachusetts $429,138,089
Michigan $116,400,288
Minnesota (-$32,379,189)
Mississippi $373,034,866
Missouri $213,203,966
Montana $33,015,318
Nebraska (-$21,419,330)
Nevada $105,515,937
New Hampshire $110,248,344
New Jersey $177,204,426
New Mexico (-$161,591,525)
New York $620,173,358
North Carolina $390,328,061
North Dakota $22,665,290
Ohio $274,931,768
Oklahoma $185,939,465
Oregon $90,763,291
Pennsylvania (-$231,182,111)
Rhode Island $75,641,677
South Carolina $195,064,443
South Dakota $31,717,171
Tennessee (-$72,734,458)
Texas $959,781,368
Utah $80,111,282
Vermont $39,090,314
Virginia $332,358,019
Washington $4,179,217
DC $76,178,032
West Virginia $259,072,260
Wisconsin $113,425,426
Wyoming $52,403,886
U.S. $12,401,404,686
Special thanks to Truven Health Analytics and Kaiser Commission for background data.
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-62050382760412884352014-06-16T09:39:00.000-07:002014-06-16T09:39:01.390-07:00Olmstead 15th Anniversary [Part One] - How Much Progress Has Your State Made? Information Bulletin # 390 (6/2014)
On June 22, 1999, the Supreme Court held in Olmstead held that “unnecessary isolation is properly regarded as discrimination based on disability.” In this decision, the Court upheld the ADA’s regulation that “[a] public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.”
Happy Anniversary! What a 15 year ride it has been. We’re going to look State-by-State at how much progress has been made and where advocates might focus in the future. As you know from numerous previous Information Bulletins, the total Medicaid Long Term Services and Supports (LTSS) includes expenditures both in the institution and in the community. Since the largest institution for people with disabilities is the nursing home, we’ll focus in this Information Bulletin there.
Fiscal Year 2000 started on July 1, 1999. In FY 2000, the national average for community-based Medicaid funded programs and services was 18.7% of the total LTSS. Therefore, the remaining 81.3% went to keep older and younger people with disabilities “unnecessarily institutionalized” in nursing homes. These FY 2000 expenditures are the Olmstead/ADA base for comparison.
In FY 2000 dollars, only $9 billion Medicaid funding was spent to keep people in the community, while $49 billion was spent to institutionalize them in nursing homes! Quite a spread.
By FY 2012 (the latest year for which we have reliable national data), the national average for community-based Medicaid funded programs increased to 38.8% of the total LTSS and the institutional expenditures decreased to 61.2%.
In FY 2012, $22 billion in Medicaid funding was spent in the community (up from the $9 billion in FY 2000) but $74 billion was spent to keep people in “unnecessary isolation” (up from $49 billion in FY 2000).
Let’s now compare States by focusing on the 38.8% increase in the national average of Medicaid funding for community-based programs in FY 2012. This comparison looks only at the percentage increase in funding going to community-based programs from 2000 to 2012.
We believe that a State’s commitment to end discrimination against people with disabilities and to enforce the Olmstead decision and the ADA is reflected in its increase in community expenditures.
Here’s a State-by-State comparison of community-based expenditures as a percentage of their entire LTSS from FY 2000 to FY 2012. Remember - to compute the percentage of Medicaid institutional expenditures, just subtract the %s displayed from 100.
% of Total LTSS Medicaid Expenditures In The Community for People with Disabilities
2000 2012
Alabama 11.0% 5.2%
Alaska 28.8% 62.4%
Arizona 14.1% 42.0%
Arkansas 30.0% 31.7%
California 22.6% 57.1%
Colorado 26.9% 45.5%
Connecticut 16.9% 25.8%
Delaware 13.1% 21.3%
Florida 10.1% 23.0%
Georgia 14.2% 29.0%
Hawaii 14.2% n/a
Idaho 26.0% 43.5%
Illinois 8.5% 31.9%
Indiana 7.9% 18.7%
Iowa 11.1% 26.6%
Kansas 26.6% 31.5%
Kentucky 22.6% 14.4%
Louisiana 5.7% 30.0%
Maine 17.1% 32.3%
Maryland 12.4% 23.4%
Massachusetts 17.3% 44.7%
Michigan 11.3% 23.6%
Minnesota 21.8% 65.4%
Mississippi 6.7% 22.2%
Missouri 20.9% 37.4%
Montana 24.9% 36.2%
Nebraska 16.9% 23.6%
Nevada 17.1% 33.5%
New Hampshire 9.9% 18.8%
New Jersey 10.0% 15.7%
New Mexico 11.4% n/a
New York 29.9% 45.9%
North Carolina 34.6% 39.8%
North Dakota 3.4% 14.0%
Ohio 11.7% 32.4%
Oklahoma 16.3% 30.8%
Oregon 48.0% 60.7%
Pennsylvania 3.2% 24.7%
Rhode Island 7.5% 18.8%
South Carolina 22.5% 26.2%
South Dakota 6.2% 16.3%
Tennessee 0.5% 31.3%
Texas 28.5% 50.1%
Utah 8.3% 21.9%
Vermont 23.1% 44.7%
Virginia 17.0% 43.9%
Washington 39.4% 61.7%
Dist. of Colum 11.4% 54.1%
West Virginia 30.2% 31.3%
Wisconsin 19.6% 47.9%
Wyoming 9.0% 20.0%
U.S. 18.7% 38.8%
Disability advocates of aged and younger people, at this time of celebration, many of you should recognize that these increases are extremely important and represent your real efforts.
These changes do not come about by magic but by hard grass roots organizing and efforts. These changes directly impact hundreds of thousands of people with disabilities.
Some states have significantly turned the balance and to them we offer real congratulations; some have made some progress but still have a ways to go.
Steve Gold, The Disability Odyssey continues
Special thanks to Truven Health Analytics for data.
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-12678885431909370032014-05-21T08:12:00.001-07:002014-05-21T08:12:03.022-07:00State by State Medical Assistance FY 2012 LTSS Data for Aged and Disabled. Information Bulletin #389 (May 2014)
For the past eleven years, we have tracked Medicaid funds by State by comparing community versus institution expenditures for people with disabilities. The FY 2012 data is now available. This Information Bulletin will focus only on Older Adults and People with Physical Disabilities from both a six year (FY 2007-2012) perspective with a more detailed look at FY 2012.
It was reported that “Federal Fiscal Year (FFY) 2012 marked the second consecutive year with little or no growth in national Medicaid spending for long-term services and supports (LTSS) [which includes both institutional and home and community-based services (HCBS)]… Average annual growth from FFY 2010 to FFY 2012 was 0.4 percent, compared to 6.2 percent from FFY 2000 to FFY 2010.”
Some good news: the “total LTSS spent on home and community-based services (HCBS) increased from 48.7 percent in FFY 2011 to 49.5 percent in 2012. The shifting balance was attributable to both an increase in HCBS spending of 2.4 percent and a decrease in spending for institutional services of -2.3 percent.”
However, this national average significantly “masks differences across population groups. HCBS accounted for 70 percent of spending in programs targeting people with developmental disabilities,” but only “39 percent of spending in programs targeting older people or people with physical disabilities.” That means for people with ID, only 30% of the entire MA LTSS went to institutionalize people, but for people with A/PD 61% went to nursing facilities.
Yes, once again the ID advocates and ID community continues to spend a significantly higher percentage of their LTSS in the community and not institutions, as compared to the PD/A advocates.
Focusing on the LTSS for people with physical disabilities, including aged people with disabilities [yes, the “aged” group is counted only if they have a disability that would qualify for nursing facility care], there is some encouraging data.
The “good” news is that in FY 2006, the national average of community versus institutional Medicaid expenditures was 29.6% to the community and 70.4% to the nursing homes. In FY 2012, it was 38.8% to 61.2%. Yes, it’s a slow, incremental change. And yes, inherent in the lethargy and pace are people being discriminated against in violation of the ADA. Without a serious national attack, the arc of history will continue to bend, but very, very slowly.
We all know why this imbalance is so slow to change: the nursing home industry is very powerful and contributes a lot of money to Governors and State legislators, and they set your State budgets. Given that most people want to live in the community and not nursing homes, the quid pro quo is obvious. The nursing home industry “contributes” to your elected State officials, who in return continue to raise the per diem nursing home reimbursements and continue to allocate Medicaid funds with an institutional bias.
Unlike the for people with Developmental Disability, where 28 States spend more than 75% of their Medicaid expenditures in the community and only 3 States spend less than 50% in the community, for the Older Americans and People with Physical Disabilities no States spent more than 65% in the community and 48 spent less than 50% in the community. Quite a difference!
Here are the States that spent the least in the community in FY 2012 for A/PD, and therefore spent the most in the nursing homes. The worst/least Medicaid expenditures in the community was North Dakota, followed by Kentucky, Alabama, New Jersey, South Dakota, Indiana, New Hampshire, Rhode Island – all spent less than 20% of their MA LTSS in the community for people with A/PD, and by definition therefore spent more than 80% in nursing homes.
Six of these “worst” A/PD states either have an exceptionally strong nursing home industry or the State elected officials have a particular dislike of Old Adults and People With Physical Disabilities. Compare their community-based Medicaid expenditures for people with Developmental Disabilities versus Older Adults and People with Physical Disabilities. The following five states spent more than 70% of the Medicaid funds in the community for people with DD, while spending less than 20% in the community for people with A/PD: New Hampshire, Alabama, Rhode Island, South Dakota and Kentucky. Quite a difference!
Here are the States that spent the most in the community in FY 2012 for A/PD, and therefore spent the least in the nursing homes: Minnesota, Alaska, Washington, Oregon, California, District of Columbia, Texas and Wisconsin. These States are the winners – virtually the same as in 2011. What are advocates in these States doing right? Tell us.
Advocates for Older Adults and people with Physical Disabilities should sit down in your State with the advocates for people with Developmental Disabilities to discuss their successful strategies.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-1606644228839724162014-04-28T06:55:00.001-07:002014-04-28T06:55:21.025-07:00A Victory! Information Bulletin # 388 (4/14)
In the previous Information Bulletin, we pointed out that the disability community had been extremely dissed by the LBJ conference on Civil Rights. What follows is from the American-Statemen. There are lessons to be learned……
Texas disability rights groups launch voter effort, push for more clout
By Andrea Ball - American-Statesman Staff
When disability rights activists discovered they’d been left out of one of the highest-profile civil rights events in decades, the group came out swinging.
The country’s 57 million people with disabilities — 3 million of them in Texas — deserved to be represented at the three-day Civil Rights Summit at the LBJ Presidential Library, advocates said. Two-thirds of them are unemployed. Accessible housing is in short supply. More than 100,000 Texans are on a waiting list for services to help them live independently.
But people with disabilities have not been able to muster the kind of political clout claimed by other groups, such as the gay or women’s rights communities. That’s why the omission from the summit stung.
“We are too infrequently a part of the conversation,” said Lex Frieden, one of the chief architects of the 1990 Americans With Disabilities Act.
Summit organizers ultimately invited Frieden to speak on a panel about social justice. But disability rights supporters say the episode was a wake-up call to mobilize in bigger numbers and stop being an afterthought. Advocates have launched a voter registration and education effort. They’re inviting candidates for top political offices to speak at a September conference on disability issues. They’re planning events to celebrate the upcoming 25th anniversary of the Americans with Disabilities Act.
“Disability rights are civil rights,” said Bob Kafka of the advocacy group ADAPT of Texas. “We thought it was a given. This whole thing highlighted that we still are late being invited to the party.”
For decades, Texas advocates have been a strong force behind many reforms affecting Texans with disabilities. Supporters have pushed for millions of dollars in curb cuts for people with wheelchairs, helped secure wheelchair lifts on Austin buses, championed wage increases for professional caregivers and pushed for more community services that let people live independently.
But that work has mostly happened outside the spotlight. Now and then, ADAPT, generally considered the most radical of Texas advocacy groups, makes headlines for its protests or mass turnout at meetings. ADAPT members have been arrested for protesting budget cuts at the Capitol, outside the Governor’s Mansion and in other public places. Kafka has been arrested dozens of times for such civil disobedience.
“We think it’s so important, people are literally willing to go to jail for it,” he said.
People who have disabilities vote at lower rates because of transportation problems, inaccessible polling places and other barriers. If it could get people to the polls, the disability community would be a powerful voting bloc, Kafka said. Together, organizations across the state — including nonprofits, schools and state agencies — work with hundreds of thousands of people. The Arc of Texas alone has a mailing list of 20,000 people.
The Americans with Disabilities Act — which outlaws discrimination in areas such as public transportation, employment and access to public facilities — was a huge step in the battle for civil rights, Frieden said. Disability parking placards and wheelchair ramps have become the norm. The less visible obstacles are the ones members of the disability community say they continue to face.
Although employers are required to make “reasonable accommodations” for people with disabilities — such as adaptable work spaces or computer technology for people with visual impairments — millions of employable Americans with disabilities remain out of work. That’s because they are often seen for “what they cannot do, when, in reality, there are many, many more things that they can do,” Frieden said.
Advocates also say that professional caretakers are poorly paid, that a shortage of funding for community services unnecessarily forces people to live in nursing homes or institutions and that the dearth of accessible housing in the community limits where people can live.
People with disabilities say these barriers infringe on their civil rights. That’s why they were so offended when they were not invited to the LBJ summit, said ADAPT organizer Cathy Cranston.
“It was like, ‘Wait a minute, guys; what about us?’” she said. “It seems like, somehow, we’re always forgotten.”
The Civil Rights Summit was a national event that drew President Barack Obama, three former presidents and national experts to discuss racial equality, immigration, gay marriage and other issues.
Summit organizers had planned to feature civil rights issues in which Johnson had played a role, such as the Civil Rights Act of 1964. They also wanted to focus on issues that are still in the courts.
When asked why disability rights was not on the agenda, LBJ Presidential Library Director Mark Updegrove told the media, “There is little lingering legislative debate about ADA — it is unquestionably the law of the land.”
Disability rights advocates disputed that, citing ongoing lawsuits accusing states of violating the ADA. Supporters across the country launched a campaign to be included in the summit, writing and calling the LBJ library, the media and the offices of Obama and former Presidents Bill Clinton, Jimmy Carter and George W. Bush.
Updegrove said one of the reasons he didn’t initially include disability rights in the program is the issue was already being addressed at a conference hosted by the George Bush Foundation scheduled for a few days before the LBJ summit — an event Updegrove himself planned to attend. When he went, he met Frieden, who explained that the community didn’t want its civil rights battle to be treated differently from the others.
“I realized that I was wrong and asked Lex if he would be kind enough to participate,” Updegrove said.
Advocates praised the decision.
Mobilizing the vote
This spring ADAPT of Texas is working on the Disability Voting Action Project, a statewide effort that uses the Internet and other advocacy groups to help register people to vote and find ways to get them to the polls.
In June, ADAPT will send a survey to all of the candidates running for governor, lieutenant governor and attorney general. Those answers will be shared with the disability community. Multiple disability advocacy groups also plan to host a conference in September in which candidates for those same state offices will be invited to speak. It’s not a debate or a partisan event, Kafka said. It’s an effort to get the candidates on the record about what they plan to do to help people with disabilities, he said.
“We hope they will be wise enough to come,” he said.
Gubernatorial candidate and current Attorney General Greg Abbott, a Republican, has met several times with disability advocates since beginning his campaign, said Abbott spokesman Matt Hirsch.
“Greg Abbott is running an inclusive campaign and will continue to reach out and directly engage with all voters across Texas,” Hirsch said.
The Democratic candidate for governor, state Sen. Wendy Davis, did not respond to a request for comment.
No matter who wins the upcoming elections, advocates say they’ll continue to emphasize that disability rights are civil rights and that their community deserves to be heard.
“When you include us, we’ll blow your mind,” said Joe Tate of the advocacy group Community Now. “We do have insight that’s important.”
******
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/2013 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-20294699962079715502014-04-01T09:53:00.003-07:002014-04-01T09:53:35.509-07:00Hoisted on Our Own Petards? Information Bulletin #387 (4/14)
“The Civil Rights Summit: 1964 We Shall Overcome 2014” conference takes place at the LBJ Library in Austin, Texas from 4/8 thru 4/10. Presidents Carter, Bush 41, Clinton, Bush 43 and Obama will speak. Big shing dings.
The Civil Rights topics include “Heroes of the Civil Rights Movement” and “LBJ and MLK Fulfilling a Promise, Realizing a Dream.” Pretty heady – no?
But the focus is not only race. Other civil rights topics include: “Women: How High is the Glass Ceiling?”; “Gay Marriage: A Civil Right?”; “Pathway to the American Dream: Immigration Policy in the 21st Century;” and “Education: the Ultimate Civil Right.” No dispute with those groups and issues.
Also, we should not forget “Sports: Leveling the Playing Field” and “Music and Social Consciousness.” No idea how they squeezed in.
Is something missing? Waldo?
Yes, NOTHING about disability. Let’s be clear. Disability is NOT considered a disability on civil rights par with race, gender, gay marriage, or immigration. Forget the ADA’s 25 anniversary in 2015. Will these Presidents attend? Will the LBJ Foundation arrange for Sports for the disabled – oh, fear not, the national TV networks will cover it.
Unreal? Outrageous? Depressing?
Maybe the organizers thought Austin is too far for Lex Frieden to travel from Houston. After all, Lex was at the ADA’s signing with the President in 1990, as was Justin Dart, another Texan. Probably too far for Bob Kafka and Stephanie Thomas, two leading ADAPT organizers, to drive across I-30 from the east side of Austin. That’s probably why no person with a disability was not invited to be a speaker.
Is it really believable that the organizers of the LBJ Library did not think about disability? No way, since Texas ADAPT is in the face of the legislature and city officials all the time. The Texas press covers it.
How about something simpler? In the organizers’ minds, disability is not a civil right worthy of being, and not in fact, on par with race, gender, immigration, or sexual orientation. Disability is not as important or powerful as the other civil rights.
As depressing as those thoughts may be, why have our “national disability leaders” been so publicly quiet? Why haven’t they publicly demanded the same respect as people with disabilities and the disability movement gives other civil rights groups? Can you imagine how John Lewis, Julian Bond, Andrew Young would have publicly reacted if they were as dissed as disability leaders have been?
Oh well, maybe a pat on the head is all we deserve. Hmmmmmmm.
Power concedes nothing without a struggle. Where is the disability POWER?
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins posted after 10/2013 can be found only at http://stevegoldada.blogspot.com/
Information Bulletins before 10/13 are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-33691641258696947542014-03-06T08:31:00.001-08:002014-03-06T08:31:55.210-08:00How Many Elderly and Disabled People Have to Be Injured and Die Before Advocates Act? Information Bulletin # 386 (3/2014)
Here’s a surprise for elderly and disabled advocates: nursing homes are really dangerous places for people who live in them. For a number of years, there have been numerous federal government reports of injuries, physical abuses, and deaths of residents of nursing homes.
We have reported on these reports quite often. See for example Information Bulletins “How Many more Disabled People Must be Injured in Nursing Homes;” “Disabled People and Physical Restraints in Nursing Homes;” “Abusing Drugs in Nursing Facilities;” “States ‘Miss’ (i.e., Fail to Report or Protect” People in Nursing Homes Who Are in Active Harm or Immediate Jeopardy.”
Guess what? Another HHS Report, this one from the Office of Inspector General, and it’s entitled “Adverse Events in Skilled Nursing Faculties….” (OEI-06-11-00370).
If anyone really cares, and sometimes we are not sure, here are some of the Findings:
• 22% of the residents experienced “at least one adverse event during their stays.”
• 79% were serious enough to require either prolonged nursing facility stay or hospitalization for acute level care.
• 14% required “intervention to sustain the resident’s life.”
• 6% “contributed to or resulted in resident death.”
These total 22% “adverse events” include a shocking array: 37% related to medication (e.g., medication-induced delirium, excessive bleeding due to medication, hypoglycemia related to medication); 37% related to ongoing resident care (e.g., falls or other trauma with injury, dehydration, acute kidney injury, exacerbation of preexisting conditions resulting from an omission of care, pressure ulcers); and 26% related to infections (e.g., aspiration pneumonia, urinary tract infections).
An extraordinary number of these “adverse events” are acknowledged to be “clearly preventable” or “likely preventable.”
Even if our public officials do not care about these “adverse effects” to elderly or disabled people, they should (maybe) care about, at the least, financial costs of these “adverse events.” Here’s a quick breakdown – an additional $58 m in hospitalization costs for “adverse medication events,” $67 m in hospitalization costs for “adverse resident care events,” and an additional $83 m in hospitalization costs related to “adverse infection events.”
Do our State and federal officials care that these costs for these hospitalizations were “clearly preventable” or “likely preventable”?
The public reaction, your State’s reaction and especially the elderly and disabled advocates’ reaction sounds like “ho hum:” another report confirming the valueless lives of elderly and disabled people.
KY, LA and SC had the largest number of “serious deficiencies per nursing home.” Some other big winners include AR, FL, GA, Il, IN, MI, MS, NC OK, WI, which had a large number of “total serious deficiencies.”
What about the nursing facilities paying, at least, monetary fines for these “adverse events”? The “average fine” varied from a low of $1,559 to a high of one State at $38,851 and a major outlier of $70,872. Quite a number of “average fines” were in the range of under $10,000 (21 States). That’s chump change for nursing homes, far lower than even Medicaid reimbursement.
Yes, despite the enormous progress we have made to increase home and community-based services, advocates for the elderly and disabled people have done a terrible job ending nursing home institutionalization. We know nearly all nursing home residents could be cared for in their homes with appropriate services. Get that word out!
We’ve been afraid to point out how really dangerous nursing homes are! We need to post signs that say “Beware. Nursing Homes May Be Dangerous to your Health and Life. Avoid at ALL Cost.”
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-89627435560331856892014-02-25T11:38:00.001-08:002014-02-25T11:38:23.954-08:00
Medigap Discriminates against PWDs under 65. Information Bulletin # 385 (022014).
Did you know that the federal Supplemental Insurance for Medicare Part B (called Medigap) is required to be offered, by States, only to people 65 or older? For disabled people under 65 who receive Social Security Disability Insurance and Medicare, States are not required to offer Medigap.
Even the nondiscrimination requirement in the Affordable Care Act for people with disabilities and preexisting conditions does not cover those individuals under 65 who receive Medicare only (i.e., people who do not also receive Medicaid as a “dual eligible”). It does not matter if they want to purchase a Medigap/Supplemental Insurance policy but live in a State that does not offer it.
To summarize, States are allowed to discriminate if you are on Medicare only, under 65 and want to purchase a Medigap/Supplemental insurance policy.
80% of most Medicare Part B services are paid for by the federal government and the remaining 20% is paid for by the individual. People over 65 purchase a Supplemental insurance policy called Medigap to cover the 20%.
Because there is no federal Medicare requirement for states to offer Medigap insurance to people under the age of 65 who are on Medicare, disabled people under 65 must pay the Part B noncovered 20% out of their own pockets. That can really be expensive and a deterrent to obtain health care.
21 states and the District of Columbia do not require and offer no Medigap insurance to people with disabilities under 65 on Medicare only. These are:
Alabama, Alaska, Arizona, Arkansas, Idaho, Indiana, Iowa, Kentucky, Montana, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Rhode Island, South Carolina, Utah, Virginia, Washington, Washington D.C., West Virginia, Wyoming
29 states however have decided to offer some type of Medigap insurance to people under 65. The amount they charge for this Medigap insurance may be significantly higher than the amount they charge for the same policy to people 65 or older.
These States are: California*, Colorado, Connecticut, Delaware**, Florida, Georgia, Hawaii, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts*, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont*, Wisconsin (* A Medigap policy isn’t available to people with End Stage Renal Disease (ESRD) under 65 ** A Medigap policy is only available to people with ESRD.)
PEOPLE ON MEDICARE ONLY UNDER THE AGE OF 65 – WE NEED YOUR HELP!
The Institute for Disability Access (1640A East 2nd St, Austin, Texas 78702, 512/442-0252) wants to find out if you have attempted to purchase a Medigap policy and have been denied or you have been charged an amount per month for insurance significantly higher than people 65 or older!
If you have had to pay the 20% out of your own pocket or are in debt because of the 20% copay, they want to have that information too.
The Institute is trying to ascertain the extent of the discrimination for people with disabilities under the age of 65 and on Medicare only
in receiving insurance because of a PRE EXISTING CONDITION (now prohibited by the Affordable care Act).
If you are willing to share your story please contact the Institute at the above address.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-10474620501443097472013-10-09T11:51:00.001-07:002013-10-09T11:51:40.951-07:00State by State Data for Aged and Disabled: Institutional Bias? Information Bulletin #383 (October 2013)
For the past ten years, we have tracked Medicaid funds by State by comparing community versus institution expenditures for people with disabilities. The FY 2011 data is finally available. This Information Bulletin will focus only on Older Adults and People with Physical Disabilities from both a six year (FY 2006-2011) perspective with a more detailed look at FY 2011.
The “good” news is that in FY 2006, the national average of community versus institutional Medicaid expenditures was 29.6% to the community and 70.4% to the nursing homes. In FY 2011, it was 38.1% to 61.9%. Yes, it’s a slow, incremental change. And yes, inherent in the lethargy and pace are people being discriminated against in violation of the ADA. Without a serious national litigation attack, the arc of history will continue to bend, but very slowly.
The nursing home industry is very powerful and contributes a lot of money to State elected officials. Given that most people want to live in the community and not nursing homes, the quid pro quo is obvious. The nursing home industry “contributes” to your elected State officials, who in return continue to raise the per diem nursing home reimbursements and continue to allocate Medicaid funds in a discriminatory manner.
Unlike the for people with Developmental Disability, where 23 States spend more than 80% of their Medicaid expenditures in the community and only 7 States spend less than 50% in the community, for the Older Americans and People with Physical Disabilities only 1 State spent more than 80% in the community and 44 spent less than 50% in the community. Quite a difference!
Here are the States that spent the least in the community in FY 2011 for A/PD, and therefore spent the most in the nursing homes. The worst/least Medicaid expenditures in the community was Rhode Island, followed by North and South Dakotas, Alabama, Delaware, Kentucky, New Hampshire, Mississippi, Indiana, Utah, and Pennsylvania.
Six of these “worst” A/PD states either have an exceptionally strong nursing home industry or the State elected officials have a particular dislike of Old Adults and People With Physical Disabilities. Compare their community-based Medicaid expenditures for people with Developmental Disabilities versus Older Adults and People with Physical Disabilities. The following six states spent more than 72% of the Medicaid funds in the community for people with DD, while spending less than 22% in the community for people with A/PD: Alabama, Kentucky, Delaware, New Hampshire, Utah, and Pennsylvania. Quite a difference!
Here are the States that spent the most in the community in FY 2011 for A/PD, and therefore spent the least in the nursing homes. New Mexico was far and away the best, followed by Minnesota, Washington, Alaska, Oregon, California, Texas and Wisconsin. These States are the winners.
Advocates for Older Adults and people with Physical Disabilities should sit down in your State with the advocates for people with Developmental Disabilities to discuss their successful strategies.
Advocates should ask their attorneys why they are not banging down the courthouse doors with lawsuits under the ADA and Olmstead.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-36214376695167922132013-08-07T10:28:00.002-07:002013-08-07T10:28:27.635-07:00
DOJ’s ADA Lawsuit Regarding Children in Nursing Homes. Information Bulletin #383 (8/2013)
The U.S. Department of Justice, Disability Rights Section, filed a very important ADA/Olmstead lawsuit against the State of Florida on behalf nearly 200 children with disabilities. USA v. The State of Florida http://www.ada.gov/olmstead/olmstead_cases_list2.htm#fla. These children “entered nursing facilities as children and grew up in these institutions” and were “unnecessarily segregated from their communities.”
This lawsuit also claimed that “children with significant medical needs who reside in the community” face “serious risk of unnecessary institutionalization” because of “repeated service reductions and lengthy and unduly burdensome recertification processes.”
While the lawsuit focused on children, DOJ’s legal claims apply as well to adults in nursing facilities and at risk of institutionalization. Also, because many States have very similar ADA/Olmstead issues, we will point out some very important handles you might want to consider.
1. “Denial or Reduction of Medically Necessary Services.”
DOJ asserted that Florida “in recent years unduly restricted the availability of many in-home services … through a state regulation that requires Medicaid services to ‘be furnished in a manner not primarily intended for the convenience of the recipient or recipient’s caretaker.”
DOJ asserted that there were children in nursing facilities as a result of Florida’s limits on in-home services and/or a failure to provide such services.
2. “Stagnant Reimbursement Rates for Home Health Services.”
DOJ noted that many people were unable to access home health services due to the low Medicaid rates paid for such services. One comparison that is very helpful was DOJ noting that the rate paid to nursing homes for these children increased in the last 9 years by 28%, but home health rates have not increased comparably.
3. “Insufficient Capacity in HCBS Waiver Programs.”
After pointing out that most of these children are eligible for Waiver services in the community, due to lengthy waiting lists children have been forced to enter nursing homes. Even with additional State Waiver funds in 2013, more than95% of the people on waiting lists will not receive community-based services.
4. “Lack of Sufficient Community-Based Alternatives.”
DOJ stated there were “very few providers of care to children with significant medical needs” in non-institutional settings.
5. “Failure to Offer Meaningful Opportunities to Move to the Community.”
DOJ stated that “many of the Institutionalized Children remain in facilities for very long periods of time, even when it is apparent that their medical conditions would permit return to the community with appropriate supports. The continued stay of most of these children is the direct result of the State’s failure to actively identify more integrated service options for them.”
Related to the ADA/Olmstead arguments and claims, DOJ noted that “providing services in integrated settings can be accommodated through reasonable modifications to the State’s existing services.”
These five problems exist in many other States and cause adults (and children) to be unnecessarily segregated in nursing homes and other institutional settings, as well as to be at serious risk of institutionalization.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-47932164206399590542013-06-10T11:22:00.001-07:002013-06-10T11:22:10.032-07:00HUD Issues Olmstead Guidance – Let’s Use It! Information Bulletin #382 (6/2013)
On June 4, 2013 HUD released a “Statement … on the Role of Housing in Accomplishing the Goals of Olmstead.” Here is the link to HUD’s Statement: http://portal.hud.gov/hudportal/HUD?src=/press/press_releases_media_advisories/2013/HUDNo.13-086 Then click on “Read HUD’s new guidance” for the full Statement.
This Information Bulletin quotes some points and suggests what advocates should look for and what can be done if your local and State recipients of HUD funds do not comply.
HUD emphasizes the critical role housing plays in implementing the Olmstead and the ADA’s “most integrated setting” mandate by “increasing the housing opportunities for individuals with disabilities who are transitioning from, or at serious risk of entering, institutions, hospitals, nursing homes, adult care facilities, and other restrictive, segregated settings.”
Advocates throughout the country have repeatedly testified that the lack of affordable, integrated, accessible housing is and has been a very significant barrier for people institutionalized (who cannot afford or locate housing because they have no money or their money goes to the institution) and people at risk of institutionalization (who, to stay out of an institution, must have accessible units in the community).
Advocates know that HUD funded programs, in the past, have not focused on and have not required public recipients of HUD funds to focus on Olmstead and the ADA mandates for integration. The HUD Statement is intended to ensure compliance with Olmstead and the ADA.
HUD recognizes that “a critical consideration in each state is the range of housing options available in the community for individuals with disabilities and whether those options are largely limited to living with other individuals with disabilities, or whether those options include substantial opportunities for individuals with disabilities to live and interact with individuals without disabilities.”
HUD provides three examples of integrated housing:
1. “scattered-site apartments providing permanent supportive housing [that could be rented with Section 8 vouchers],
[2] tenant-based rental assistance [a housing voucher authorized in the HOME Investment Partnership program, administered nationally at both the State and local levels] that enables individuals with disabilities to lease housing in integrated developments, and
[3] apartments for individuals with various disabilities scattered throughout public and multifamily housing developments.”
HUD told “public housing agencies and other HUD-assisted housing providers to work with state and local governments to provide integrated, affordable and accessible housing options for individuals with disabilities who are transitioning from, or at serious risk of entering, institutions or other segregated settings.” (Let’s hope they will work also with advocates and people with disabilities.)
In another example [#4], HUD reminded both public housing agencies and other recipients of HUD assistance that “certain preferences [both with regards to actual housing and housing vouchers] that will enable individuals with disabilities … are permissible.” No more excuses that HUD-funded programs cannot establish preferences to assist institutionalized persons to return to the community or to prevent the institutionalization of people who are at risk of such institutionalization.
A fifth example focused on “reasonable accommodations/ modifications (e.g., increasing the payment standard for Housing voucher for accessible units, or an extra bedroom for equipment or live-in aide).
The Statement pointed out that “HUD requires recipients of HUD assistance [that includes public housing agencies, housing vouchers, the HOME tenant-based rental assistance vouchers, CDBG, and lots of other recipients] to take affirmative steps to further fair housing. The affirmative furthering fair housing (AFFH) obligation offers an opportunity for HUD and the recipients of HUD assistance to support Olmstead implementation by engaging in activities that will benefit individuals transitioning from institutions or at serious risk of institutionalization by providing integrated, affordable and accessible housing options in community-based settings.”
What advocates should do to find out if HUD really means it. Here are a few possible strategies:
1. Do your local and state Consolidated Plans show that all of the above five examples are being implemented? Or even planned for the future? For example, are there “preferences” in both actual housing and housing choice vouchers (aka Section 8) for people institutionalized or at risk?
2. Do your local and/or State recipients of HOME Investment Partnership federal funds provide for tenant-based rental assistance for people institutionalized or at risk? Have any been actually provided in the past to end institutionalization? Are they needed in your State?
3. Has your public housing authority provided for scattered-site accessible housing throughout your community? Are more needed? Planned for?
If there are people in institutions whom you, the advocates, know are institutionalized because of housing – either because they do not have funds for rent, security deposits, etc., or because they cannot locate accessible units they can afford, then your local and State recipients of HUD funds have failed to “affirmatively further fair housing.”
These local and State recipients of HUD funds are in violation of the federal Fair Housing Act. HUD should be notified of these violations so it can remedy the situation and ensure people are not unnecessarily institutionalized.
File a Complaint (be as specific as possible) with HUD Office of Fair Housing and Equal Opportunity in Washington, D.C. and send a copy of your Complaint to Jeanine Worden, Associate General Counsel, Jeanine.M.Worden@HUD.gov, or to Sara Pratt, Deputy Assistant Secretary for Enforcement, Sara.K.Prattt@HUD.gov.
All italicizations are added.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-65571031350871636282013-06-03T06:27:00.002-07:002013-06-03T06:27:09.081-07:00Managed Care Long-Term Services and Supports. Information
Bulletin #381 (6/ 2013)
The Center for Medicare and Medicaid Services, the federal agency that funds Medicaid on 5/20/2013 issued “Guidance to States using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs” (MLTSS). A copy of this important new federal guidance can be found at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/1115-and-1915b-MLTSS-guidance.pdf
We are quoting extensively from this CMS document because, for those States contemplating using Managed Care as the mechanism for Medicaid Expansion, as well as for those States that already include MLTSS, this document provides important advocacy handles.
Before a State can have a 1115 Demonstration or 1915(b) waiver, CMS must review and approve a State’s application. If your State does not include and really provide for the following, then advocates should let CMS know their opposition to MLTSS.
Here are some points that disability and elderly advocates might want to keep in mind.
1. CMS points out that LTSS includes “both home and community based services and institutional-based services.”
The guidance encourages states to include both home and community based services and institutional programs in the managed care capitation rate. If your State is contemplating MLTSS, make sure both home and community services as well as institutional services are included and are the responsibility of the Managed Care Organization (MC0). Make sure that institutional-based services are not “carved out” in any way.
Our assumption is if a managed care agency is financially responsible for institutional-based services, the MCO will figure out how to serve the person in the community, where on average it’s less expensive. If the MCO is not responsible for institutional services, the MCO will have a financial incentive to dump people with disabilities, especially with severe disabilities, into the institution.
2. The ADA and Olmstead requirements for services apply to MLTSS. CMS points out that “under the law [ADA], MLTSS must be delivered in the most integrated fashion, in the most integrated setting, and in a way that offers the greatest opportunities for active community and workforce participation.” Such a setting “enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible.” CMS writes that “States are encouraged to include in their benefit packages supports to enable workforce participation such as personal assistance services, supported employment and peer support services, as appropriate and desired by the participant.” If these kinds of supports are not included in your State’s managed care program, then you should advocate with CMS and State officials to get your State to include them. If CMS is not responsive to your concerns, please let us know asap!
3. Under “alignment of payment structures and goals,” CMS requires States “establish rates that support the goals and objectives of their MLTSS program… In keeping with the intent of the ADA and Olmstead decision, payment structures must encourage the delivery of community-based services and not provide disincentives, intended or not, for the provision of services in home and community-based settings.”
A number of advocates have voiced serious concerns that the more severely disabled persons will not be able to live in the community because the capitation rates (the dollar amount per person the MCO receives) are too low to cover all the community needs and supports. CMS requires that “State payment structures, systems and review mechanisms must ensure that participants at all levels of need and all types of disabilities have the opportunity to choose their MLTSS providers and have appropriate access to community-based services.”
There cannot be any doubt that “States must employ financial incentives that achieve desired outcomes, [such a] provision of services in the most integrated settings and consumer satisfaction.” It is a failure for States not to set rates that ensure the most severely disabled persons have a meaningful choice to reside in the community. States that fail will have “financial penalties… or return of a payment if a MCO does not achieve required outcomes for the provision of services in the most integrated settings.”
4. The State Medicaid agency has the legal duty to “evaluate whether payment rates and structures are adequate to achieve participant access to quality providers for covered services.”
5. “Person-centered” needs assessment, service planning and service coordination are required. CMS urges that MLTSS “should encourage participant self-determination and provide opportunities for self-direction of services.”
If your State provides self-direction in its existing fee for service Medicaid program, CMS states that the MLTSS “programs are expected to continue them,” and if your State does not currently offer self-direction, “it should consider providing the opportunity for self-direction within their MLTSS program.
6. “Stakeholders” [which includes us – disability and elderly advocates] must be formally involved, including cross-disability representatives, in the planning, implementation and oversight of the MLTSS.
You must be at the table when the State Medicaid agency is developing the contract for MLTSS. The contract sets the enforceable requirements. ALL of the above five points are just words if the contract does not require the provision of these points. In addition to these six points, the State’s contracts with managed care organization should include requirements that managed care staff working with MLTSS programs receive Olmstead training to understand the importance of serving persons outside of the institution.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-92072678756337144562013-05-21T08:58:00.001-07:002013-05-21T08:58:23.080-07:00Are Nursing Homes Referring People to the Community? Information Bulletin # 380 (May, 2013)
Several years ago, the disability and elder communities and the Centers for Medicare and Medicaid Services worked to revise the Minimum Data Set questionnaires. The MDS must be completed quarterly by each nursing home for each resident and then electronically submitted to CMS.
The famous “Q1a” was the focus of the revisions that very much concerned the disability and elder communities. One of the primary goals was to change the system to help people transition to the community.
Here are some national findings for the 1,322,697 people in nursing homes on 3/31/13. The following data is from what CMS collected from the nursing homes.
1. MDS Questions 100A-C report on the percentages of people in nursing homes who “Participated in the Assessment and Goal Setting”. Nationally, 84.48% of the residents participated. Nationally 31.73% of “family or significant others” participated, and 10.08% had a “guardian or legally authorized representative” participate.
2. MDS Questions 300A-B focus on “Residents’ Overall Expectation” and the “Goal Established During the Assessments.” The results show that nationally 27.63% of the residents “expect to be discharged to community.” That means 365,461 nursing home residents wanted to leave and expected to live in the community. While we do not have a breakdown, we know that residents themselves made up 62.27% of these respondents and another 30.23% were family or significant others.
3. Proceeding to question MDS 400A, nationally there were 84.85% of these 365,461 residents (that equals 310,093 people in nursing homes) had an “Active Discharge Plan” in place to return to the community. We have no idea why the 15.15% (55,367 people) did not have a plan since they wanted to leave the nursing homes and had an expectation they would leave.
But when asked in MDS 400 B, “What determination was made by the resident and the care planning team regarding discharge to the community,” no data is provided. CMS writes “please be patient. This may take a few seconds to load.” It never loaded.
It is not clear what “determination” had to be made for the 310,093 people who had an “active discharge plan.” Nor is it clear whether a nursing home “planning team” could trump a resident’s decision to move to the community. Are community advocates present when such a determination is made? Does the nursing home “planning team” have any knowledge of what community-based services could be provided?
4. When the MDS goes beyond the “Active Discharge Plan” stage, it asks if the “resident asked to return to the community?”(MDS 500 A). Again, no data was provided. Also, we do not understand why the resident, who had an “expectation” to return to the community (MDS 300 A/B) and who has an Active Discharge Plan, is then asked (how many times are necessary) if the resident asked to return to the community. What if a family member asks?
5. Here’s the real kicker. When the nursing homes completed the MDS 500 B question, the nursing homes concluded that 86.55% of the people had no “possibility of returning to community.” A death sentence imposed!
The nursing home concluded that only 5.75% of the residents - remember, this is according to the nursing homes – had even a “possibility’ to return to the community. What services did the nursing homes think could not be provided in the community?
6. As appalling as these numbers are, the nursing homes are supposed to refer people to a “local contact agency” which is supposed to come into the nursing home and is supposed to provide assistance for the nursing home resident to transition back to their homes and apartments with appropriate home and community-based services.
7. And now for the final blow: only 2.5% of the nursing home residents were actually referred to a “local contact agency” as reported on MDS 500B. We assume (and hope) that these 2.5% are from those residents whom the nursing home thought there was a “possibility” to return to the community.
Disability and Elderly Advocates:
Based on the above data, it might be hard to imagine but people in nursing homes are Not Dead Yet! What are advocates doing to help disabled and elderly in nursing homes move back into the communities?
1. Here is a link for the MDS data which is available by State. http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports/Minimum-Data-Set-3-0-Frequency-Report.html
2. There are a limited number of prizes for advocates who know the name of your “local contact agency.” There are more prizes for the local contact agency that has received the most such referrals. These prizes are time-limited so please send in your responses as soon as possible.
3. Can anyone explain why CMS’ nursing home office of “Surveys and Certifications” does not check on any of the above MDS questions? Is there any doubt that if CMS included these MDS questions in its annual surveys the percentages of people who wanted to leave would increase? Maybe even more people would transition back to the communities.
4. There is a very special prize for the advocates who can identify any person in a nursing home who could not reside and be cared for in the community with appropriate services.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-67039567198355771322013-04-19T10:33:00.002-07:002013-04-19T10:33:41.798-07:00“Premium Assistance,” People with Disabilities, and Medicaid Expansion Via Insurance Exchanges. Information Bulletin #379 (4/2013)
Do you reside in a State that has not agreed to expand Medicaid under the Affordable Care Act (ACA) to all persons whose incomes are under 138% of the federal poverty level?
Has your Governor talked about using Medicaid’s “premium assistance” plan to purchase a health plan via an “Exchange” for people under 138% – the “Arkansas model”?
This Information Bulletin attempts to clarify some of these concepts, particularly as they apply to people with disabilities.
1.The normal way most States are implementing the ACA Medicaid expansion is to provide all persons with incomes under 138% with defined Medicaid benefits delivered through one Medicaid system.
The “Arkansas model” is different and is the outlier. It uses Medicaid funds as “premium assistance” payments with which a State will purchase a private health plan, through the health insurance exchange being created for each state under the ACA (run either by the state or by the federal government).
This private health plan will be limited to specific covered health benefits and services. Based on the proposed federal regulations and guidance from the federal Medicaid agency, CMS, the additional benefits covered under Medicaid, and the cost-sharing protections under Medicaid, must still be provided, these are likely to be very difficult to access.
However, absent a special waiver, with premium assistance payments, a State cannot mandate that anyone under 138% receive Medicaid expansion services via the private insurance market; they must all be offered the choice of traditional Medicaid.
2. There is one possible way your State may try to get around this prohibition on mandatory enrollment in premium assistance. The State may apply to CMS for a section 1115 demonstration waiver to provide premium assistance to purchase a health plan on an Exchange and to make participation mandatory.
What is critical for people with disabilities to know is that, under such a waiver, “A State may not require an individual to obtain [Medicaid services and health care] benefits through enrollment” with premium assistance payments if the person fits into one of the following five categories.
If you are in one of these categories, the State cannot force you into a private health plan even through a 1115 waiver. Instead, the State must provide the traditional Medicaid benefits and services that current Medicaid recipients who are disabled are eligible for and receive, and deliver them in the traditional manner.
The exempted categories are:
1. Blind and disabled persons (or persons “being treated as being blind or disabled) without regard to whether the individual is eligible for supplemental security income benefits …on the basis of being blind or disable. Nationally, we estimated that 2,665,407 people with disabilities are in this category. See Information Bulletin #369 (1/2013) or http://stevegoldada.blogspot.com/ for a State-by-State breakdown.
2. Dual eligibles – i.e., persons who receive both Social Security disability and Supplemental Security Income benefits.
3. Persons institutionalized in a “nursing home, an intermediate care facility for the mentally retarded, or other medical institution, and required, as a condition of receiving services in such institution under the State plan, to spend for costs of medical care all but a minimal amount of the individual’s income required for personal needs.”
4. “Medically frail and special medical needs individuals,” (as identified in accordance with regulations of the Secretary).
5. Persons who qualify for long-term care services. “The individual qualifies based on medical condition for medical assistance for long-term care services,” including Home and community-based services furnished under a 1915 waiver.
These exempted categories are critical. These people are entitled to all of the Medicaid services and benefits currently available to existing Medicaid recipients who are disabled, through the existing delivery system.
3. Do you reside in a State that is considering using premium assistance payments for people on Medicaid?
If you do, please make sure your State is fully aware that it will have to run two separate programs for the Medicaid 138% expansion population, even with a waiver allowing it to force some Medicaid enrollees into premium assistance.
One Medicaid program will provide all the components in the State’s existing benefits and services for people in categories ## 1 -5 above, and for others who opt out of premium assistance if there is no waiver.
A second and separate Medicaid expansion program will use premium assistance payments for people not exempted under a waiver, or who have not opted out if there is no waiver.
We expect that most States using premium assistance without a waiver will try to convince people in categories ## 1-5 to receive services through private insurance in the Exchange paid with the premium assistance.
Don’t do it! You are exempted from mandatory enrollment.
Why are we so emphatic? There is no way a private insurance company that is paid to provide “Exchange” health services will provide the long-term care Medicaid services that people in categories ##1-5 need to live independent, integrated lives in their homes and apartments. Congress did not even require Exchanges to include long-term care services or benefits, and you can bet they will not.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-55878428278093363192013-04-01T08:41:00.001-07:002013-04-01T08:41:30.378-07:00What are the Religious Communities doing in your State Re Medicaid Expansion? Information Bulletin # 377 (4/2013)
Have the various religious communities in your State taken a public position with regards to Medicaid expansion for residents whose incomes are less than 138% of the federal poverty level?
Last week in Pennsylvania, 1,350 Roman Catholic nuns, priests, and brothers, representing 19 different religious congregations, were individually identified, by name and religious affiliation, in a letter written to the Pennsylvania Governor in which they urged him to accept federal Medicaid funds to expand coverage to nearly 700,000 residents who lack coverage.
These religious leaders noted that their “faith, tradition and justice teaching call us to advocate for the right of all human beings to have access to the basic necessities that enable them to live productive lives with dignity. Among those is the right to affordable health care.”
They stated that a failure to accept these funds by the Governor would “breach the moral duty to those who are on the margins of society.” They requested a meeting with the Governor.
These leaders pointed out the health benefits, cost savings on uncompensated care to hospitals, and economic stimulus which will occur with the Medicaid expansion.
These religious leaders concluded that their “faith calls us to respond to the needs of the disabled, the impoverished, and the downtrodden. The Medicaid expansion is an unparalleled opportunity to provide affordable health insurance for uninsured Pennsylvanians.”
In every State there are coalitions of religious congregations – Protestant, Evangelical, Jewish, Catholic, and others. Have they taken a public position regarding Medicaid expansion? Have they written to the Governor and state legislators? Have you asked them to?
What have they done in North Carolina, South Carolina, Georgia, Alabama, Mississippi, Texas, Oklahoma, Nebraska, Iowa, Tennessee, Virginia, West Virginia, Kansas and Utah? Surely there are religious leaders and coalitions who recognize Medicaid expansion as a “moral duty.”
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. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-57426181847617506032013-03-27T09:26:00.001-07:002013-03-27T09:27:26.467-07:00One Strategy to Increase Monthly Income for Disabled Persons – Corrected!!!!!!. Information Bulletin #376A (3/2013)
[Introduction – I apologize. In the above Information Bulletin, I made an error that a few people pointed out to me. The correction below regarding Medicare and Medicaid will significantly benefit people who apply, so I am rewriting this Bulletin with the corrections and thank all of you who pointed out my error. On a personal note, it is really gratifying that people actually read the Information Bulletin to the end. I must admit that I am never confident how many people read these, or do they float away in outer space. Thanks. Steve]
There are more than 7 million persons who are disabled and who receive Supplemental Security Income because they have a disability. This Information Bulletin is addressed to a subset those 7 million -- whose disability began before they were 22 years old and whose parents receive or were entitled to receive Social Security retirement benefits.
This Information Bulletin is to remind and or inform this subset of 7 million SSI recipients of a potential federal financial benefit that could increase their monthly incomes.
This subset of 7 million disabled persons’ living arrangements differ: some live independently on their own; some live in group homes or with roommates; some are married and live with their spouses; and some still reside with their aging nondisabled parents. Some have physical disabilities, some intellectual and some mental disabilities. Some were born with their disability and some acquired their disability before age 22.
If you are one of these 7 million or know people who are, you and they might be eligible to receive “Child’s benefits” – under the Social Security retirement system - based on the “earning record of an insured person,” your parent(s) Social Security retirement benefits, whether or not your parents are still alive.
What this means in nontechnical terms is:
1.Is either parent receiving Social Security retirement benefits, Social Security Disability benefits, or has either parent died? If one of your parents has died, you may be eligible to receive benefits on his/her account if s/he had a history of working.
2.Don’t be misled by the term “child.” It does not mean your age, but refers to your relationship to your parent. For example, a 45 year old recipient of SSI has a 67 year old parent who collects S.S. retirement benefits. The 45 year old may be entitled to “child’s benefits” based on his parent’s earning record.
3.Did your disability begin before you were 22 years old?
Here is concrete example of how this system works.
A.You became disabled before you were 22 years old. This could have been at birth or any time before you were 22.
B.You receive SSI (although that is not a requirement). It does not matter where you reside or with whom you reside.
C.What is important is that one of your parents receives Social Security retirement benefits (a/k/a Social Security “Old-Age” benefits), Social Security Disability Benefits, or if either parent has died and that parent had a work history that would have qualified him/her for Social Security retirement benefits.
The dollar difference between your SSI monthly benefits and the “child’s benefits” based on your parents earning record could be significant. You may receive up to one-half of your parent’s full retirement benefit or disability benefit while your parent is still alive, and up to 75 percent of your parent’s Social Security benefit when s/he dies.
You must apply to the Social Security Administration, which can be done in person, or by telephone or on-line. It is worth your effort to find out the monthly benefits you may be entitled to, whether or not you decide to actually apply, and compare that sum with your SSI.
Two additional points:
1.Normally “child’s benefits” end if the person marries. However, if a person with a disability marries another disabled person who receives disability benefits, then you are still eligible for “child’s benefits.”
2. A big issue is health care coverage and benefits. On SSI, you receive Medicaid. In many States – not all – if your “child’s benefits” are less than 138% of the federal poverty level ($1,285 a month), you will still be Medicaid eligible effective 1/2014. In many States, you can become eligible for Medicaid under “spend down” requirements.
If you start to receive your parent’s social security benefits because of your disability began before you were 22, you will also be eligible for Medicare benefits after you have been eligible for your parent’s benefits for 24 months.
Check out how this issue will specifically apply to you.
Also, in 1987, a federal law was enacted that says that if you are receiving Medicaid (maybe because you receive SSI on your own account), and then you start to receive Social Security benefits from a parent’s account, the amount of your parent’s benefit will not be considered when your State is deciding if you are financially eligible for Medicaid. For example, let’s say you are receiving $715 a month of SSI and also have Medicaid. Then your father dies and you become eligible for $1,000 a month in Social Security on your father’s account. Your State cannot count any of the $1,000 a month from your father’s Social Security when deciding if you are eligible for Medicaid. Here is the citation, 42 U.S.C. § 1383c, or http://www.ssa.gov/OP_Home/ssact/title16b/1634.htm (Determination of Medicaid Eligibility).
Is the Social Security Administration motivated to provide the maximum amount of income to which people with disabilities are entitled to receive? The SSA knows each of the 7 million SSI recipients, their age when they became disabled and their parents’ status. It cannot be too difficult to at least notify them of these potential rights. In fact the Social Security Administration requires that you apply for benefits on your parent’s account if there is a chance you might be eligible, in part because SSI is a “payment of last resort.”
There are a number of wrinkles which this Information Bulletin does not discuss. Telephone the Social Security 800 number and make an application.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-31999203384993111172013-03-25T06:45:00.001-07:002013-03-25T06:45:01.294-07:00One Strategy to Increase Monthly Income for Disabled Persons. Information Bulletin #376 (3/2013)
There are more than 7 million persons who are disabled and who receive Supplemental Security Income because they have a disability. This Information Bulletin is addressed to a subset those 7 million -- whose disability began before they were 22 years old and whose parents receive or were entitled to receive Social Security retirement benefits.
This Information Bulletin is to remind and or inform this subset of 7 million SSI recipients of a potential federal financial benefit that could increase their monthly incomes.
This subset of 7 million disabled persons’ living arrangements differ: some live independently on their own; some live in group homes or with roommates; some are married and live with their spouses; and some still reside with their aging nondisabled parents. Some have physical disabilities, some intellectual and some mental disabilities. Some were born with their disability and some acquired their disability before age 22.
If you are one of these 7 million or know people who are, you and they might be eligible to receive “Child’s benefits” – under the Social Security retirement system - based on the “earning record of an insured person,” your parent(s) Social Security retirement benefits, whether or not your parents are still alive.
What this means in nontechnical terms is:
1.Is either parent receiving Social Security retirement benefits or either parent died but would have been eligible to receive those benefits?
2.Don’t be misled by the term “child.” It does not mean your age, but refers to your relationship to your parent. For example, a 45 year old recipient of SSI has a 67 year old parent who collects S.S. retirement benefits. The 45 year old may be entitled to “child’s benefits” based on his parent’s earning record.
3.Did your disability begin before you were 22 years old?
Here is concrete example of how this system works.
A.You were became disabled before you were 22 years old. This could have been at birth or any time before you were 22.
B.You receive SSI (although that is not a requirement). It does not matter where you reside or with whom you reside.
C.What is important is that one of your parents receives Social Security “Old-Age” insurance benefits, a/k/a Social Security retirement benefits, or either parent received those benefits before s/he died and would have been eligible for them now, were your parent alive.
The dollar difference between your SSI monthly benefits and the “child’s benefits” based on your parents earning record could be significant.
You may receive up to one-half of your parent’s full retirement benefit, or 75 percent of the deceased parent’s basic Social Security benefit.
You must apply to the Social Security Administration, which can be done by telephone or on-line. It is worth your effort to find out the monthly benefits you may be entitled to, whether or not you decide to actually apply, and compare that sum with your SSI.
Two additional points:
1.Normally “child’s benefits” end if the person marries. However, if a person with a disability marries another disabled person who receives disability benefits, then you are still eligible for “child’s benefits.”
2. A big issue is health care coverage and benefits. On SSI, you receive Medicaid. In many States – not all – if your “child’s benefits” are less than 138% of the federal poverty level ($1,285 a month), you will still be Medicaid eligible effective 1/2014. In many States, you can become eligible for Medicaid under “spend down” requirements. Unfortunately, you are not eligible for Medicare benefits based on your parent’s earning record. Check out this issue as it will specifically apply to you.
Is the Social Security Administration motivated to provide the maximum amount of income to which people with disabilities are entitled to receive? The SSA knows each of the 7 million SSI recipients, their age when they became disabled and their parents’ status. It cannot be too difficult to at least notify them of these potential rights.
There are a number of wrinkles which this Information Bulletin does not discuss. Telephone the Social Security 800 number and make an application.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-57206263830239464112013-03-20T06:20:00.003-07:002013-03-20T06:20:34.952-07:00Why Private Employers Should Support Medicaid Expansion. Information Bulletin #375 (3/2013)
Medicaid expansion is obviously critical for people whose incomes are less than 138% of the federal poverty level.
However, the failure of States to expand their Medicaid program on January 1, 2014 will have disastrous impact on the private employers in your State.
The Missouri Hospital Association recently released a report entitled “The Hidden Health Care Tax – How NOT Reforming Medicaid Could Lead to Cost Shifting.” www.missourihealthmatters.com/wp-content/…/Cost-Shift_Report.pdf
This report presents data and arguments regarding how private employers will be negatively impacted if a State does not expand Medicaid and presents cogent arguments for advocates to use in urging Governors and State Legislatures to agree to Medicaid expansion.
As you know from previous Information Bulletins, when Congress enacted the Affordable Care Act it significantly reduced the reimbursements that hospitals previously received uncompensated care the hospitals had been providing to low-income people. This reduction was because Congress had simultaneously mandated Medicaid expansion to all people who had been receiving this uncompensated care. With such expansion, the hospitals would receive regular Medicaid reimbursement for the newly Medicaid eligible people.
Unfortunately, the Supreme Court invalidated the mandatory expansion, leaving States, hospitals and insurance companies with significant reductions in uncompensated care and no increase in Medicaid eligible persons. It has been reported that the growth of “uncompensated care is alarming,” from 2002 to 2011.
Every State that does not expand its Medicaid program will suffer because the hospitals will continue to have high level of uncompensated care and no Medicaid dollars with which to pay for that care. Uninsured and uncompensated care account for a significant amount of costs hospitals must make up through other means.
How will hospitals make up the lost Medicaid costs? Private commercial insurance payers will eventually (sooner than later) have to subsidize the cost of the loss in Medicaid reimbursements. The costs will be shifted from the loss of Medicaid patients to the private businesses that currently provide health insurance to their workers. This will happen regardless of their employees’ incomes. The above “The Hidden Health Care Tax” report presents the data quite starkly.
The shifting of costs from uninsured/nonMedicaid low-income patients to employers of low-income workers are “hidden health care taxes” on commercial premiums and will increase what private employers will pay for the private health insurance of their employees. Otherwise, the hospitals will not be able to financially survive.
Advocates:
Has your State Hospital Association estimated the increase in costs to private employers’ health insurance premiums if your State does not expand Medicaid?
Has your State Hospital Association publicly stated this increase?
Has your Chamber of Commerce estimated this cost and the impact it will have on private employers’ insurance premiums?
Are your Governors and legislatures aware of this ramification and increased costs if they refuse to accept 100% of federally reimbursed Medicaid expansion funds?
Are your newspapers aware of these increased costs?
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. Information Bulletins
will also be posted on my blog located at
http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com<stevegoldada@cs.com>or
call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-23871191603892793102013-02-22T08:10:00.001-08:002013-02-22T08:10:11.282-08:00Florida Opts Into Medicaid Expansion, Religious Leader, and 10 Year Data. Information Bulletin #373 (2/2013)
This Information Bulletin deals with three aspects of the Medicaid expansion struggle: 1. Florida, 2. Religious leaders, and 3. Ten year data.
1.Another Republican Governor has announced his State will provide Medicaid services beginning January 2014 to all of its citizens with incomes under 138% of the federal poverty level. What should be a clear non-partisan issue, health care for the poorest people in a state, has unfortunately morphed into party politics. That’s one reason it is important that Florida’s Governor Rick Scott joined Republican Governors in Michigan, Ohio, Nevada, New Mexico, North Dakota and Arizona. Governor Scott had said quite emphatically that “Florida would not expand its program.” Why the reversal?
What makes Governor Scott’s announcement particularly important is that he understood two points that many non-participating Governors apparently have ignored.
First, Governor Scott said that “our options are either having Floridians pay to fund [Medicaid expansion] in other states while denying health care to our citizens or using federal funding to help some of the poorest in our state.” NYT, 2/20/13.
Yes, if your State does not opt-in, your State’s taxpayers will be paying for health care for low-income people in participating States that have agreed to the Medicaid expansion. That’s neither a very smart business decision nor a sound policy decision.
Second, “since Florida is legally allowed to opt out [of Medicaid expansion in the future], that’s the right decision for our citizens.” Yes, CMS has stated that a State that provides Medicaid expansion services can at any time decide to end its participation and there are no repercussions.
Have you contacted your Governor? Will other Governors see the importance of these two points for their States? Will advocates follow the Florida advocates’ success?
2. Religious leaders are realizing the moral implications in Medicaid expansion. For example, the “Roman Catholic bishops of Salt Lake City and Little Rock, Ark., have urged state officials to expand Medicaid. “ NYT, 222/13. Sorry to add another item to your plates, but have you contacted religious leaders in your State? Are they doing anything to encourage recalcitrant elected officials to do the right and smart thing?
3. A separate third Medicaid expansion issue. In previous Information Bulletins and individual State Fact Sheets, we have provided (thanks to the Kaiser Commission) six year out data from 2014 through 2019 to show the amount of federal funds would be received by Medicaid expansion and the amount of money a State would have to spend as a match over the six years.
A number of States are now arguing a longer time-frame, and they are suggesting/implying that over a longer than six years the federal funds may not be worth receiving. Therefore, we will provide for a period through 2022 (again thanks to Kaiser Commission) data for those states that have still not opted in to the Medicaid expansion. The results are the same as for six years. States make out like bandits!!!!! No business person in her or his right mind would turn down accepting the federal funds for the amount they must match over a ten year period. It makes no business sense. Isn’t it time that politics be put aside and rational business decisions take over?
INCREMENTAL IMPACT OF MEDICAID EXPANSION
2013-2022 Federal funds and state matches over 10 years.
Alabama
$14,371 billion of federal funds with only a $1,081 billion Alabama state match.
Alaska $1,458 billion of federal funds with only a $147 million Alaska state match.
Arkansas $12,465 billion of federal funds with only a $922 million Arkansas state match.
Georgia 33,711 billion of federal funds with only a $2,541 billion Georgia state match.
Idaho $3,280 billion of federal funds with only a $246 million Idaho state match.
Indiana $17,322 billion of federal funds with only a $1,099 billion In Diana state match.
Iowa $3,909 billion of federal funds AND a $534 savings in Iowa state funds!!!!!
Kansas $5,270 billion of federal funds with only a $524 million Kansas state match.
Kentucky $17,832 billion of federal funds with only a $1,297 billion Kentucky state match.
Louisiana $15,786 billion of federal funds with only a $1,244 billion Louisiana state match.
Maine $3,124 billion of federal funds AND a $570 million savings in Maine state funds!!!.
Mississippi $14,499 billion of federal funds with only a $1,048 billion Mississippi state match.
Missouri $17,795 billion of federal funds with only a $1,573 billion Missouri state match.
Nebraska $3,063 billion of federal funds with only a $250 million Nebraska state match.
New Jersey $15,366 billion of federal funds with only a $1,492 billion New Jersey state match.
North Carolina $39,638 billion of federal funds with only a $3,075 billion North Carolina state match.
Oklahoma $8,561 billion of federal funds with only a $689 million Oklahoma state match.
Pennsylvania $37,842 billion of federal funds with only a $2,842 billion Pennsylvania state match.
Rhode Island $2,935 billion of federal funds with only a $250 million Rhode Island state match.
South Carolina $15,827 billion of federal funds with only a $1,155 billion South Carolina state match.
Soth Dakota $2,110 billion of federal funds with only a $157 million South Dakota state match.
Tennessee $22,541 billion of federal funds with only a $1,715 billion Tennessee state match.
Texas $65,619 billion of federal funds with only a $5,669 billion Texas state match.
Utah $5,274 billion of federal funds with only a $364 million Utah state match.
Virginia $14,665 billion of federal funds with only a $1,326 billion Virginia state match.
West Virginia $8,744 billion of federal funds with only a $619 million West Virginia state match.
Wisconsin $12,263 billion of federal funds AND a $248 million savings in Wisconsin state match!!!!
Wyoming $1,353 billion of federal funds with only a $118 million Wyoming state match.
Ten year data from Kaiser Commission, “The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis,” at Table 6 (November, 2012).
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-44125181431307459202013-02-20T08:52:00.002-08:002013-02-20T08:52:26.069-08:00If Texas can organize to expand Medicaid, what about your State? Information Bulletin # 372 (2/2013)
Like many Governors, Texas’ Rick Perry has not committed to expand Medicaid for low-income people whose incomes are under 138% of the federal poverty level. However, Texas advocates have been doing their homework and are organizing the Trade Associations to explain to their Governor and elected officials why it’s essential that Texas agrees to Medicaid expansion. What follows is an excerpt from a newspaper article that explains what’s happening in Texas.
These same arguments in this article are applicable in every State that is still sitting on the fence. You have to get to your Trade Associations and form a coalition.
Trade Associations Lend Support for Medicaid Expansion by Becca Aaronson, February 5, 2013, in The Texas Tribune.
“Despite the resistance of Gov. Rick Perry and many other Republicans to expanding Medicaid in Texas under the Affordable Care Act, some momentum seems to be building from outside of the Capitol in support of the expansion.
“Texas’ two largest health care trade associations, the Texas Medical Association and the Texas Hospital Association, have announced support for extending Medicaid coverage to low-income adults. But both organizations also say that in order for the plan to work in Texas, lawmakers here also must implement reforms that will contain costs and bring more doctors into the Medicaid program to provide care for the additional patients.
“ ‘The most viable path is to try to work with [the federal government] to create a reformed program that does meet the needs of Texas better,’ said John Hawkins, senior vice president of government relations at the Texas Hospital Association. He said the plan to expand must be bipartisan. Democrats must be flexible in considering “personal responsibility” reforms, such as requiring some new patients under the expansion to pay co-pays. And Republicans, he said, must “play ball” because the current system is fiscally inefficient. “We’re still providing this care at the local government level, but we’re doing it in a fragmented way that actually costs more and has worse outcomes,” Hawkins said.
For an additional investment of $15 billion over 10 years, Texas could draw down $100 billion in federal funding to insure two million more Texans through the state’s Medicaid program, according to a report by Billy Hamilton, a nonpartisan consultant who was previously the state’s chief revenue estimator. [We can provide a 10 year comparison for your State. Just email me below and tell me what State.]
The Texas Medical Association, which represents physicians across the state, announced on Saturday that it would support the Medicaid expansion if lawmakers can devise a way to give Texas “the flexibility to change the plan as our needs and circumstances change.”
“You have the two major entities that represent the delivery of health care in Texas saying this is something that we definitely need to look at,” said Dr. Carlos Cardenas, vice president of the TMA board of trustees, adding the organization recognizes “there are issues within the present Medicaid program and that the Legislature is in a position to come up with some reforms to shore up the system.” ***
Perry, who has the power to veto an expansion plan approved by the Legislature, also reiterated in his state of the state address in January that Texas would not expand Medicaid. “Gov. Perry continues to believe that Medicaid is an unsustainable, broken program that needs to be reformed, and he does not support expanding it under Obamacare,” spokesman Josh Haven said in an email. ***
“The more people and organizations that come on board, the more likely there is to be a strings-attached proposition for the Medicaid expansion,” said state Rep. Garnet Coleman, D-Houston. As a proponent of expanding Medicaid coverage, Coleman said he would accept some reforms offered by Republicans, such as co-pays for expansion enrollees. “It’s hard to turn down $100 billion, so the question is what can be agreed upon to accept the $100 billion. And we have not gotten there yet.”
To work around Perry’s veto power, state Sen. Rodney Ellis, D-Houston, has proposed a constitutional amendment that would allow Texas voters to decide whether to expand Medicaid.
“There is a lot of political posturing going on, but the bottom line is that it makes no sense to reject additional federal health aid,” Ellis said in an email. “I believe we do millions of Texans a disservice — at a real financial and human cost — if we dither and delay implementing this common sense reform.”
Whether Medicaid expansion happens in your State is up to you. Sure, it is not easy, but its doable and its critically important.
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0tag:blogger.com,1999:blog-8870210265501782148.post-47334003646343227202013-02-13T07:31:00.001-08:002013-02-13T07:31:00.625-08:00HUD and HHS Award Housing Vouchers. Information Bulletin # 371 (2/2013)
Yesterday, HUD and HHS jointly announced the award of 3,530 housing vouchers for people with disabilities with extremely low-incomes, i.e., less than 30 percent of the median income.
These vouchers were competitive among States and are targeted to people transitioning out of institutional settings or at high risk of homelessness.
Each State housing agency had to partner with the State’s Medicaid agency in order to identify and coordinate the transitioning out of institutional settings, in order ‘to identify, refer and conduct outreach to persons with disabilities who required long-term services and supports to live independently.”
In announcing the vouchers, HUD noted that “today’s announcement reinforces the guiding principles of the Americans with Disabilities Act and the landmark 1999 Supreme Court ruling in Olmstead v. L.C., which require state and local governments to provide services in the most integrated settings appropriate to meet the needs of individuals with disabilities.”
For the 13 States that were awarded these vouchers, advocates can find the specific program targets, populations, and targeted areas HUD approved -http://portal.hud.gov/hudportal/HUD?src=/press/press_releases_media_advisories/2013/HUDNo.13-024
Advocates should be in contact with your State Housing Agency that won the vouchers and work to make sure the vouchers really go to the people with disabilities and are in the most integrated setting.
Here are the 13 States that won this competitive process.
State Housing Agency # of units
California Housing Finance Agency 335
Delaware State Housing Authority 170
Georgia Housing & Finance Authority 150
Illinois Housing Development Authority 826
Louisiana Housing Corporation 200
Massachusetts Dept. of Housing & Community Development 100
Maryland Dept. of Housing & Community Development 150
Minnesota Housing Finance Agency 95
Montana Dept. of Commerce 82
North Carolina Housing Finance Agency 562
Pennsylvania Housing Finance Agency 200
Texas Dept. of Housing & Community Affairs 385
Washington State Dept. of Commerce 275
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.
Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.
stevegoldadahttp://www.blogger.com/profile/16579404008497041276noreply@blogger.com0