Capitol Correspondence - 03.18.19

ANCOR Read Out of the President’s FY20 Budget – Administration Message to Providers

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Last week the President sent his budget proposal for 2020 to Congress. Having since analyzed the full proposal as well as a budget report specific to the Department of Health and Human Services (HHS), ANCOR is sharing key highlights relevant to people with intellectual / developmental disabilities (I/DD) and the supports providers who help them live life like everyone else.  The President’s budget is in many ways a messaging document, because Congress has the power of the purse and is the branch of government that ultimately decides how much money can be spent on what programs. Many aspects of the President’s proposal will require compromise between the now Democratic-led House and the Republican-led Senate.

However, the President’s messaging is still important to follow because it shows what are priority projects for the Administration. As such the budget serves as a signal of what the Administration might focus on through its executive powers if it cannot get what it wants from Congress. This includes rules and/or guidance from agencies, executive orders and other such initiatives that the Administration can issue without Congressional approval. It is through this lens that we look at what the President’s proposal contains regarding Medicaid, labor rules, and more – read our full readout here.

Key Proposals in FY2020 Presidential Budget:

On Medicaid, the President proposes:

  • Block grants including a revival of the 2017 Graham / Cassidy / Heller / Johnson legislative proposal, which ANCOR opposed as written because it would destabilize supports on which people with disabilities rely. See pages 43 and 128 of the full budget proposal for details.
  • Pre-payment controls to prevent fraud/abuse of the Medicaid program including
    • Prevent inappropriate personal care services payments, which ANCOR will be researching more in the coming weeks. See page 122 of the full budget proposal for details.
    • Grant the Centers for Medicare and Medicaid Services (CMS) the authority to collect overpayments from states that spend federal resources on ineligible or misclassified beneficiaries and streamlining the Medicaid provider termination process.
    • Deny “unusual personal care services claims.” The budget refers to unusual personal care services claims as duplicative services, services provided by personal care service attendants not meeting state qualification requirements, and services rendered to individuals no longer eligible for Medicaid. This provision was included in last year’s budget.
  • Continued cuts to the Medicaid Disproportionate Share Hospital allotment, from FY 2026 through FY 2029. These reductions were also included in last year’s budget and would be in addition to current law reductions between FY 2020 and FY 2025.
  • Implementing Medicaid “able-bodied” work requirements and additional option of state asset tests. Specific to the assets tests, it would be optional for states to require them for those eligible for Medicaid under Modified Adjusted Gross Income eligibility standards.
  • To “reform disability programs and test new approaches.” You can see more details of this on page 129 of the full budget proposal. It includes a mix of improving employment of people with disabilities while also restricting Social Security funds to families with multiple children with disabilities.

For the Department of Health and Human Services (HHS) overall, the President proposes:

  • Cutting the Department’s funding by twelve percent. The proposal would allot HHS $87.1billion in FY20.
    • This would include a $137million dollar cut to the Administration for Community Living (ACL), which administers disability grants and programs.

For the Department of Labor (DOL), the President proposes:

  • Cutting the Department’s funding by nine percent. The proposal would allot DOL $10.9billion in FY20.
    • This would include a $11million reduction for the Office of Disability Employment Policy.

For the Department of Education (DOE), the President proposes:

  • Cutting the Department’s funding by ten percent. The proposal would allot DOE $64billion in FY20.
  • This represents a mixed bag for disability supports:
    • Funding would be maintained at the same levels as last year for special education programs, disability-related training and grant programs (employment for people with disabilities, training for staff supporting people with disabilities).
    • Funding would be eliminated for Supported Employment State Grants, which the Administration views as redundant to vocational rehabilitation grants.

For the Department of Agriculture (DOA), the President proposes:

  • Cutting the Department’s funding by 15 percent. The proposal would allot DOA $20.8billion in FY20.
  • Creating a single work requirement for food stamps beneficiaries who are able-bodied adults ages 18 to 65, unless these adults qualify for specific exemptions. Additionally, as proposed last year, the budget promotes the America’s Harvest Box proposal, which converts a portion of SNAP allotments in order to provide low-income people with boxes of wholesale staple foods

ANCOR will keep members informed as the budget discussion continues and Congress starts developing its own proposals to send to the President for his signature. We will also examine materials expected to be released today (March 18), which are not yet available at the time of this writing – please stay tuned for those updates. The government runs out of funding in September, to give ANCOR members a sense of the timing on this process.