Governmental Affairs Action Alert ~ March 21, 2017
BACKGROUND: On Thursday 3/23, the House of Representatives will vote on the American Health Care Act (AHCA). The Senate is expected to vote sometime before the end of March.
The AHCA in its current form extinguishes Medicaid’s Home and Community-Based Services (HCBS) program. HCBS are “optional services” that enable your son or daughter to live and work in the community. It is virtually the only choice for adult support services. It also includes waiver services that allow families to get the health services they need to keep their son or daughter in the home.
This will be done by imposing per capita caps/block grants as the method of reimbursement to the states instead of the current fee for service model. The plan is expected to reduce federal expenditures by $880 billion over the next 10 years. To read more about these methods of reimbursement, go to: http://www.c-c-d.org/fichiers/CCD-MedicaidLeaveBehind_Final03012017.pdf
The NDSC is up on Capitol Hill speaking with Members of Congress and their staffers. They need to hear from you, their constituents, directly.
The ARC of the United State has developed the following points about the impact of these reductions:
People with disabilities will get slammed by Medicaid cuts. $880 billion would get cut from the Medicaid program over the next decade. This cut comes from 1) changing the financing structure of the program to a per capita cap model, and 2) phasing out the “Medicaid expansion,” which incentivizes states to cover people up to 138% of the federal poverty level (income of $16, 642 per year) for an individual.
The result is a cost shift to states that would likely force states to choose among options such as:
Cutting eligibility. People with disabilities, low-income adults, children, pregnant women, and seniors could be cut from the rolls.
Cutting services. Current “optional” services such as in-home services, assistive technology, transportation, supported employment, and much more could be up for grabs.
Cutting quality. If federal Medicaid regulations are lost, it could be cheaper for states to warehouse people with disabilities in institutions rather than provide quality home and community-based services.
Call your Representative with the following message:
The current bill moving through the House of Representatives is unacceptable because it will limit or eliminate the Home and Community-Based Services and is devastating to people with disabilities who rely on the services.
Then call your Senators with this message:
The AHCA bill is unacceptable because it will limit or eliminate the Home and Community-Based Services and is devastating to people with disabilities who rely on these services.
Tell your personal story. Congressional members need to hear what the impact will be on your son or daughter’s ability to live and work in the community. Even if you are not currently receiving HCBS, you need to act now to preserve this for your family’s future.
Act Now to Stop Drastic Cuts to Medicaid and Health Care for People with Disabilities – Congress is Moving Fast!
NDSC is an active member of the Consortium for Citizens with Disabilities (CCD), the authors of this alert. This bill is moving quickly and would result in deep cuts in children’s waiver services, adult employment, and residential support services.
Congress is on a fast track to repeal major portions of the Affordable Care Act (ACA) related to people with disabilities and to make drastic cuts to the Medicaid program. The level of cuts over time would decimate the Medicaid program.
When will this happen? It is happening now! The House of Representatives is moving quickly to push the bill through Committee this week and vote by the end of March. The Senate is planning to vote on the House bill before the mid-April recess.
People’s health, services, and lives are at stake. We urgently need advocates to reach out to their Senators and Representatives and tell them to stop the repeal of the ACA provisions related to people with disabilities and the cuts to Medicaid. Advocates need to explain why the ACA and Medicaid are essential to people with disabilities and their families.
Message 1: Do not cut and cap Medicaid
Medicaid is a jointly funded program with matching state and federal funds. Under a Medicaid per capita cap, the federal government would set a limit on how much to reimburse states based on enrollment in the Medicaid program. Unlike current law, funding would not be based on the actual cost of providing services. Much like the proposed block grants, the intent of the per capita caps is to restructure the program and save the federal government money. Inevitably there will be cuts in funding in the states. The negative impacts to Medicaid recipients could include:
Losing home and community-based services and supports. Waiting lists would quickly grow.
Losing other critical services such as personal care, mental health, prescription drugs, and rehabilitative services. If funds become scarcer, states may decide to stop providing these services altogether.
Being forced into unnecessary institutionalization. States could return to the days of “warehousing” people with disabilities in institutions.
Shifting the costs to individuals or family members to make up for the federal cuts. The costs of providing health care and long-term services and supports will not go away, but will be shifted to individuals, parents, states, and providers.
Call the U.S. Capitol Switchboard at (202) 224-3121 and ask to be connected to your Senators’ and Representatives’ offices today. You can also use https://www.senate.gov/senators/contact/ and http://whoismyrepresentative.com/ to get contact information.
Now is the time for action; remember every call matters. Don’t let Congress take away health care and long-term support services for millions of people and replace it with a plan that cuts Medicaid.
What to Say:
I am your constituent.
I am a person with a disability (or I am a family member of someone with a disability or I am a professional in the disability field).
Do not allow restructuring and cuts to Medicaid to be part of a replacement bill.
Medicaid helps me/my family member to have health care and community-based services.
Contact Your Senators To Stop the Repeal of ESSA Accountability and State Plan Regulations
On February 7, 2017, the House of Representatives passed House Joint Resolution 57, to “disapprove” (repeal) the accountability and state plan regulations under the Every Student Succeeds Act (ESSA). ESSA is the law that replaced the No Child Left Behind Act and is supposed to hold states, districts, and schools accountable for the academic performance of ALL students, with a specific focus on historically underserved students like students with disabilities. Next, the Senate will vote on whether to repeal the ESSA accountability and state plan regulations.
If a disapproval resolution goes to a vote, it is expected that the Senate will repeal these regulations. Sources tell us the vote is expected to take place tomorrow. Senator Alexander recently introduced Senate Joint Resolution 25, which is identical to House Joint Resolution 57. However, it is still considered likely that the Senate will vote on House Joint Resolution 57, instead of its own disapproval resolution. If the resolution passes the Senate, the regulations will be gone and the U.S. Department of Education will not have the authority to issue any “substantially similar regulations.” The repeal of these regulations will have a devastating impact on federal oversight and state implementation of ESSA.
Regulations are critically important because they instruct the states on how to implement the law in a way that meets the purposes of the statute. This is particularly important under ESSA, which says that ALL students are to have a significant opportunity for a fair, equitable and high-quality education. Also, regulations clarify vague or confusing provisions in the law. For example, the ESSA accountability regulations outline acceptable options states can use in the development of their accountability systems, while also leaving the door open for states to define their own options that are equally rigorous.These regulations are essential to ensure that students with disabilities count in a meaningful way in the state accountability systems.
Main concerns about the repeal of these regulations:
A repeal will provide states with too much flexibility and too little oversight.
It will be harder for state advocates to ensure that their ESSA state plans address the needs of all students with disabilities and hold districts and schools accountable for their academic performance.
A successful effort to weaken ESSA accountability could encourage weakening of accountability under the Individuals with Disabilities Education Act (IDEA).
TAKE ACTION NOW!
Call the U.S. Capitol Switchboard at (202) 224-3121 and ask to be connected to your Senators’ offices. You can also use https://www.senate.gov/senators/contact/ to find out the name of your Senators and get contact information. If you have trouble getting through to the D.C. offices, contact your Senators’ local offices, which are listed on their websites. We will post any updates about a vote on the NDSC Governmental Affairs Facebook page!
Urge your Senators to:
Discourage a vote on the resolution to disapprove of (repeal) the ESSA accountability and state plan regulations. If there is fear that the resolution will be rejected, it might not come to a vote at all. The fact that the date for the vote is not yet certain may mean that there is concern about how certain Senators might vote.
Vote NO on the resolution to disapprove of (repeal) the ESSA accountability and state plan regulations, if the resolution is brought up for a vote.
Tell your Senators:
That Congress passed ESSA in a bipartisan manner and they should support these regulations, which are necessary to implement the law.
How states will still have much flexibility under the regulations, but we need to hold them accountable for students with disabilities.
That the U.S. Department of Education should use the normal regulatory process (which includes public review and input) to modify any parts of the regulations the Senators do not support, instead of repealing the entire set of regulations.
How a repeal of the regulations would affect your family.
Tell your story! Let your Representatives know how new legislation can impact HCBS.
Legislation that would severely impact community living and employment support services for adults will likely be introduced in the next few weeks that will include block grants and per capita caps. Home and Community Based Services (HCBS) are optional services made available through the Medicaid Program.Medicaid currently is a joint federal-state program that operates whereby the federal government pays a percentage of the costs (as high as 74% in some states). As spending increases, the federal government match rises. Under the per capita caps and block grants now being proposed, the government would set a limit on how much to reimburse states per enrollee.
The per capita growth amounts would be set below the projected rates of growth and would not be based on the needs of the individual.
A block grant would set a base amount of funding to the state that would only be increased by inflation and give the state the flexibility to decide who will get services what services they will get.
THE GOAL IS FOR THE FEDERAL GOVERNMENT TO REDUCE THE AMOUNT OF EXPENDITURES OVER TIME.
To read more about per capita caps and block grants, click here.
What Could Happen:
Home and Community Based Services that enable people with disabilities to have such services as employment support, assistance with medical appointments, cooking, cleaning, self-care, managing day-to-day planning could be reduced or the costs of services could be shifted to the individual or family. Families cannot bear the cost of such services.
Support services under the Medicaid proposal currently in the House of Representatives would put your child at risk for losing services that will allow him or her to live and work (earn wages) independently in the community.
Waiting lists to get funding for services would quickly grow
Children’s services such as in-home health care support and waiver services could be reduced or eliminated.
TAKE ACTION NOW!
Tell your personal story and how these changes would affect your family! Representatives need to hear from their constituents. There is great power in the grassroots. To find out who your Representative is, go to http://www.house.gov/.
Call or visit your Representative and tell him/her that per capita caps and block grants will wipe out the Medicaid program that provides virtually all funding for these services. Your calls and visits are important and have an impact. You can use the talking points above.