The State of America’s Direct Support Workforce Crisis 2022

The longstanding direct support workforce crisis, exacerbated by the COVID-19 pandemic, has led to closures of critically needed services and a denial of access to community-based supports.
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Capitol Correspondence - 01.21.18

Your January Round-up of State Policy Updates Is Here!

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Governors: States Embrace Innovation

In their 2018 State of the State Address, the National Governors Association (NGA) focused on innovation at the state level and “opportunities for innovation, including autonomous and electric vehicle technology, drones, ridesharing, and more.”  Read more here.

 

States Focus on Improving Health Care in Rural America

The National Governors Association (NGA) has selected six statesAlabama, Arizona, Indiana, Louisiana, Missouri and Oregon—to participate in a project called Improving Health in Rural America: Addressing the Leading Causes of Death. Specifically, states will develop and implement specific strategies to address one of the five leading causes of death in rural areas.

 

Bill would allow Iowa’s disabled to avoid managed care in Medicaid

The Des Moines Register reports that tens of thousands of disabled Iowans who rely on Medicaid would no longer have to deal with private managed-care companies under a bill now being considered by state lawmakers. Senate File 2013 would create an exemption from the managed-care component of Medicaid for disabled and elderly Iowans who rely on long-term support services such as housing, meals, employment and transportation.

 

Care denied: How Iowa’s Medicaid maze is trapping sick and elderly patients in endless appeals

The Des Moines Register published a special report chronicling the challenges presented by the appeal process available through the Medicaid managed care program.

 

‘Can you help me get out of here?’ — Utah sued over ‘inadequate’ system of care for developmentally disabled adults

On January 12th, the Disability Law Center sued the state of Utah in federal court, saying health officials — who oversee the private care facilities — have needlessly segregated those with intellectual disabilities in the institutions, where they are sometimes trapped for years or even decades. As noted by the Salt Lake Tribune, the Disability Law Center demands that the state build a new plan that identifies and transitions more people with intellectual disabilities  to community-based services and reduces Utah’s reliance on institutional care.

 

‘It’s just a matter of time before someone else dies’: Report details trouble at Washington institution for disabled people

The Seattle Times reports that a report by the watchdog group Disability Rights Washington is the latest to raise questions about the Rainier School, which cares for adults with serious intellectual and developmental disabilities. Citing several issues with the facility, federal authorities have decertified part of the institution, which serves about 310 people. The Washington State Department of Social and Health Services (DSHS) runs the facility and is appealing that decision.

 

A government shutdown could affect state health programs

Politico reports that if Congress shuts down, several states could suffer as key health programs temporarily fold, warned Dr. Georges Benjamin, executive director of the American Public Health Association. When the government closed in 2013, for example, the CDC stopped monitoring flu outbreaks (as of January 20 with the shutdown, the CDC said they will maintain partial monitoring). Several states are now in the throes of widespread influenza, and lack of monitoring could hamper their efforts to combat the virus. The collection of other disease data, including opioid addiction, also could be put on hold, he said.

 

New York is taking matters into its own hands

Politico reports that Gov. Andrew Cuomo released his budget this week, and he intends to create a health care shortfall fund to make up for more than $2 billion the state may lose if Congress fails to reauthorize CHIP, fund the cost-sharing reduction program and roll back cuts in Medicaid’s Disproportionate Share Hospital payments. The fund is expected to have $1 billion and will be made up largely of money Cuomo wants to get from insurance companies. The governor is proposing a tax to raise $140 million from for-profit insurers, arguing they received a windfall from the recent Republican tax plan, H.R. 1 (115). The largest revenue raiser would be a move to capture some of the cash that not-for-profit insurance companies receive when they sell assets to for-profit companies — such as Centene’s $3.75 billion purchase of Fidelis. The bishops who run Fidelis had intended to use that money for charity.

 

CMS Approves First 10-Year Section 1115 Demonstration Extension

On December 29th, CMS approved for Mississippi the first ever 10-year extension under the Medicaid program demonstration extension to provide further coverage of family planning services in the state. As reported by NAMD, this will extend eligibility for women and men ages 13 through 44, with income up to 194 percent of the federal poverty level (FPL) that are not enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) or other creditable health insurance coverage that includes family planning services. Mississippi’s waiver will be the 25th demonstration action approved by CMS since January 21, 2017. 

 

Kentucky Becomes the First State Allowed to Impose Medicaid Work Requirement

The Washington Post reports that a day after the Trump administration announced that it would allow states to compel certain populations receiving Medicaid to work or get ready for jobs, federal health officials on Friday granted Kentucky permission to impose certain Medicaid work requirements. Becoming the first-in-the-nation state to move forward with the profound change to the safety-net health insurance program is a victory for Kentucky’s Republican governor, Matt Bevin, who during his 2015 campaign for office vowed to reverse the strong embrace of the Affordable Care Act by his Democratic predecessor.

 

Here’s how states are trying to overhaul Medicaid — without Congress

CNN Money reports that mandating Medicaid recipients work in order to receive benefits is in the spotlight right now, but states are seeking to make a host of other changes to their programs. These include requiring enrollees to pay premiums, limiting the time they can receive benefits, testing them for drugs and locking them out if they fail to keep up with the paperwork.

 

Montana Labor Department: Medicaid Expansion Work Program ‘Fantastic’

Montana Public Radio reports on the results of Montana’s effort to encourage recipients eligible under Medicaid expansion to connect with the state Department of Labor. In touting the benefits, Department of Labor staff noted “The state is facing a labor shortage, and so having access to what would ordinarily be labeled non-traditional labor pools, this being one of those, that’s not some place that we have normally gone or done much with, and so for those reasons this has given us access to that population.”

 

Medicaid Home and Community-Based Services: Results From a 50-State Survey of Enrollment, Spending, and Program Policies

Kaiser Family Foundation released its Medicaid Home and Community Based Services 50-State Survey on January 19. Its key findings include:

  • Nearly 3.2 million people received HCBS through one of the three main Medicaid programs in 2014, a five percent increase from the prior year. 
  • The overall increase in enrollment across the three main HCBS programs from 2013 to 2014 is notable as many states also experienced enrollment increases from implementing the ACA’s Medicaid expansion in 2014. 
  • Total Medicaid spending on HCBS across the three main programs was $58.5 billion in 2014, an increase of three percent from the prior year.
  • Medicaid HCBS spending per enrollee averaged $18,458 nationally in 2014, with substantial state-level variation.
  • Most of the 24 states with capitated MLTSS programs in 2016 already were implementing key policies contained in the revised Medicaid managed care rule.
  • Three-quarters of states reported Section 1915 (c) or Section 1115 HCBS waiver waiting lists in 2016, totaling 656,195 individuals. 
  • The data do not support a relationship between a state’s Medicaid expansion status and changes in its HCBS waiver waiting list between 2015 and 2016. 
  • Over three-quarters (77%) of Section 1915(c) HCBS waivers set financial eligibility at the federal maximum (300% of SSI).
  • Nearly all states (49 of 51) offered self-direction as an option in their HCBS waivers.
  • States were further along in identifying policy changes necessary to comply with the home and community-based settings rule in 2016 compared to 2015.
  • The average home health agency reimbursement rate decreased slightly from 2015 to 2016, while the average personal care agency reimbursement rate increased slightly. 

 

After criticism, Maine lawmakers propose improving care for those with intellectual disabilities

The Portland Press Herald reports that in the wake of a critical federal audit last summer, lawmakers have introduced two bills that aim to address deficiencies in Maine’s system for caring for people with developmental disabilities. One of the bills, sponsored by state Rep. Jennifer Parker, D-South Berwick, would ensure that Maine Department of Health and Human Services records leading up to the death of a person with intellectual disabilities would be made available to an independent oversight board. The bill also would require that the Maine Developmental Services Oversight & Advisory Board ensure the confidentiality of the patients. Another bill would re-establish the Office of Advocacy, which was eliminated in 2011 shortly after LePage took office, as part of a consolidation of DHHS operations. The Office of Advocacy would investigate complaints from people who had family members with developmental disabilities who were receiving state services.

 

Budget Cuts Grow State Developmental Disability Workload By Six Times

Montana Public Radio reports that Montana’s state health department is getting ready to take over day-to-day help for 3,000 people with developmental disabilities this spring, after severing contracts with four private contractors. The department says it had no choice after state lawmakers and the governor cut $49 million out of its budget in November.

 

Oklahoma DHS Requests $2.5B Budget

Public Radio Tulsa reports that the Oklahoma Department of Human Services told lawmakers Wednesday it needs a $2.5 billion budget next year. The 4 percent increase would come largely from state appropriations to DHS climbing from $684 million to $749 million. DHS plans to put $4 million toward restoring developmental disabilities services provider rates cut in 2016. “The people that they rely on for the really core services provided to individuals and families are the very people who can go to 7-Eleven and get $2 more an hour there,” Lake said. “So, that’s who they’re competing against, and I think it’s worth our attention.” DHS said they saw a 7 percent drop in people served when the rate was cut.

 

Barber Institute CEO supports effort to raise support staff wages

As reported by GoErie.com, Barber National Institute CEO John Barber plans to call Gov. Tom Wolf on Monday and ask for his help in getting raises for about 1,270 institute employees. Barber will participate in a statewide campaign to encourage Wolf to include $60 million in his 2018-19 state budget proposal so that direct support professionals can receive wage increases. Monday is the day people in northwestern Pennsylvania are encouraged to call the governor’s office. ANCOR State Association Member PAR is organizing the statewide effort to contact Wolf and encourage him to fund raises for direct support professionals. The agency is encouraging anyone who is related to, or works with, someone with an intellectual or physical disability to call the governor’s office Monday.

 

Direct care workers, advocates push to speed up pay increases – Former assemblyman from Long Beach leads rally in Albany

The LI Herald reports that former state Assemblyman Harvey Weisenberg led a rally at the state capitol on Dec. 6 to call on legislators to speed up already approved wage increases for workers who care for people with disabilities. Weisenberg — who has a son with developmental disabilities and founded the Harvey and Ellen Weisenberg Foundation to support people with disabilities — joined dozens of direct care workers, state lawmakers and disabled people to urge Gov. Andrew Cuomo and the Legislature to speed up a plan to pay workers a living wage. The rally was organized by a statewide coalition called #bFair2DirectCare, which consists of tens of thousands of people across the state with developmental disabilities such as autism, Down syndrome, cerebral palsy, as well as their family members, advocates, non-profit providers and the direct care workforce – including many ANCOR members.

 

Minimum Wage Increases for 18 States in 2018 Minimum wage workers in 18 states will get a pay hike next week when higher wage floors go into effect around the country for 2018. With the federal minimum wage remaining just $7.25 per hour, more and more states  have opted to implement their own, higher rates that local employers must observe. Many of the bumps slated for New Year’s Day come courtesy of recent ballot initiatives approved by voters or bills passed by statehouses, in red and blue states alike. The states include Alaska, Arizona, California, Colorado, Hawaii, Maine, Michigan, Minnesota, Missouri, Montana, New Jersey, New York, Ohio, Rhode Island, South Dakota, Vermont, and Washington.

 

Wolf will seek dramatic revamp to overtime rulesThe Daily Item reports that Gov. Tom Wolf announced on Wednesday he plans to seek a dramatic revamp of the state’s labor rules to force companies to pay overtime to more workers. Wolf said the change is intended to reflect wage changes in the four decades since the last time the state’s overtime rules were updated. “Because the overtime rules have not been updated, employees are covered by an exemption to overtime that was intended for high-wage, white-collar employees more than 40 years ago,” Wolf said.