State Disability News Highlights for Period ending 08/01/2014

By Diane McComb posted 08-01-2014 10:25 PM


State Disability News Highlights for Period ending 08/01/2014

Lead Story:  New York

Standing outside her sixth-floor apartment in the Bronx, Lissette Encarnacion says she sometimes forgets the place belongs to her. "I'm thinking I'm at somebody else's [house]," she says. "I'm ringing my own doorbell." Encarnacion used to have a career in banking, and lived in a real home with her son and husband. Then one night everything changed, she says, when her husband came home drunk and angry and threw her off a balcony. "He came home, pulled me from the hair, and just started beating the hell out of me," she says. Encarnacion suffered traumatic brain injury and was never the same. She and her sons moved in with her sister, but Encarnacion often wandered off. Eventually she became homeless, she tells NPR affiliate WNYC, and remained that way for a decade. She suffered from epileptic seizures, and was frequently picked up by paramedics and taken to emergency rooms. Then two years ago, she moved into The Brook, an apartment complex that provides supportive housing to its residents — more than half of whom are formerly homeless. “ You know, we as a society are paying for somebody to be on the streets. Now Encarnacion lives in a studio apartment, which she has decorated with stuffed animals and Christmas lights. And though the place is small, she likes to think of it as her "penthouse" apartment. And while these services don't come without a cost — an apartment at The Brook runs at about $24,000 a year — Rosen says they are cheaper than the estimated $56,000 per year that the city spends on the emergency room visits, and stays at shelters and jails, where many people with severe mental illness end up. "You know, we as a society are paying for somebody to be on the streets," says Rosen. Few people would dispute that Lissette Encarnacion is better off in her studio apartment than she was when she was living under the bridge. And it's far cheaper if she has a doctor downstairs than if she has to show up regularly in the ER. The question is, who pays for this kind of housing? New York now has about 47,000 supportive housing units, and the state intends to invest $260 million Medicaid dollars over the next two years. But the federal government won't match it. At the crux of this debate is the question of whether housing qualifies as health care.  Medicaid is supposed to be health insurance, and not every problem somebody has is a health care problem. This past December, the outgoing New York State Commissioner of Health argued in an article in The New England Journal of Medicine that housing is health care. Providing housing to the chronically homeless saves health care money, he argues, so Medicaid should help pay capital costs. New York State Medicaid Director Jason Helgerson went further — he argued that federal Medicaid money already pays for housing, through long stays in nursing homes and hospitals. But Bruce Vladeck, who formerly administered Medicaid and Medicare in the Clinton administration, says federal Medicaid dollars can't and shouldn't be used to pay for housing — it's not cost-effective. "Medicaid is supposed to be health insurance, and not every problem somebody has is a health care problem," says Vladeck. Instead, Vladeck argues that housing programs should be paid by housing agencies. "As a society, both in the private sector and the public sector, we are really cheap and niggling and resentful about paying for social services, and we are much more generous when it comes to paying for health services," he says. At the moment there is not enough housing money to go around for all the people who need it — people like Encarnacion, who are done living on the streets but still need support. For her, The Brook offers a place in between.


Los Angeles County supervisors postponed a proposal Tuesday to set aside $20 million for programs to divert mentally ill criminal defendants from jails, saying a plan is needed first. The proposal — suggested by Supervisor Mark Ridley-Thomas — comes as the county is under federal pressure to improve treatment of mentally ill jail inmates and as it embarks on a $2-billion overhaul that includes a new Men's Central Jail centered around treatment beds for mentally ill inmates. At the same time, a group headed by Dist. Atty. Jackie Lacey has been studying how to expand diversion programs to reduce the number of mentally ill inmates in county lockups. Their report is to be completed in the fall. Ridley-Thomas called the $20 million "a modest start." "It's just 1% of the entire $2 billion that we allocated for jail construction planning and modernization," he said. "I think it's the common practice for this county to set aside dollars when it's a priority."  His colleagues also voiced support for diversion, but the majority balked at what Supervisor Gloria Molina described as "throwing money at" the problem without knowing what it would pay for. "I think, yes, $20 million is only a down payment," Molina said. "The problem is, we don't have a plan. That's what we need." Advocates and family members of people struggling with mental illness urged the board to commit to the spending, but the supervisors decided to wait until Sept. 30 and look at how much money is needed during their supplemental budget process.  


Gov. Pat Quinn today signed into law a measure to put a non-binding referendum on the fall ballot asking voters whether millionaires should be taxed at a higher rate — a move aimed at helping drive up Democratic turnout. The measure represents a Plan B for Quinn, who had supported efforts initiated by Democratic House Speaker Michael Madigan to have a binding constitutional amendment placed on the ballot to require millionaire incomes to pay an additional 3 percentage points above the current individual income tax rate. That plan went nowhere in the General Assembly. The ballot proposal signed by Quinn at a Berwyn elementary school asks voters if they think the constitution should be amended to give schools, based on their student population, money from a 3 percent tax on millionaire incomes. The state Revenue Department said such a tax would generate about $1 billion. It would not have the force of law, however. “I think our tax system should be fair and based on ability to pay,” Quinn said. “My position is, the millionaires of Illinois should pay a little bit more in income tax to support more funding for our schools in the classroom.”


The Glenwood Resource Center will pay a $2,000 state fine after a resident swallowed three batteries. According to Iowa Department of Human Services spokeswoman Amy Laurentzen McCoy, an incident happened on June 2 at the Glenwood Resource Center, a care facility for people with intellectual disabilities. A press release states a resident at the facility swallowed three batteries, then received treatment at a nearby medical center before being discharged to the facility a few days later. McCoy said the facility took immediate action, notified the Iowa Department of Inspections and Appeals (DIA) and submitted a self-correction plan.  She said on Thursday the DIA cited the facility for a Class I violation for failing to provide required supervision according to the resident’s individual service plan. “Client safety is a top priority, and we’ll submit further corrective action addressing this incident as well as measures to prevent future occurrences,” said Gary Anders, superintendent at the Glenwood Resource Center. McCoy said people who live at the resource center have an intellectual or other developmental disability and are admitted because of significant behavioral and emotional challenges or medical issues requiring intensive treatment.


Health insurers refunded more than $17 million to Marylanders last year because of a rule in the Affordable Care Act limiting the amounts the companies can spend on overhead costs as opposed to providing care, according to federal data. About 206,000 consumers in Maryland received the refunds, an average of $140 per family, according to a report from the Department of Health and Human Services released Thursday. The refunds are owed under a rule that requires insurers to spend 80 percent or 85 percent of the dollars they collect in premiums on medical care or activities that improve health care quality. If they spend more than 20 percent or 15 percent on other costs, they must repay customers the difference. The rule, known as the medical loss ratio, sets the 80-20 standard for insurers selling directly to individuals or to small businesses, and the 85-15 standard for insurers selling to larger companies or corporations. Insurers issued $332 million in refunds across the country. In Maryland, those who buy insurance through a large employer, generally with more than 50 employees, benefited the most from the refunds. Nearly 145,000 of those consumers received an average refund of $157. Among those who buy individual insurance policies, 52,000 consumers received an average refund of $126 in the state. Small businesses saw the smallest and fewest refunds, with about 9,100 receiving an average of $7. The refunds went to more Maryland consumers last year than in 2012, but they were slightly smaller. In that year, insurers repaid $13 million to nearly 150,000 consumers in the state, an average of $143. Nationally, insurers had to pay less in refunds last year than in 2012, when they repaid $504 million.

New York

Two new federal audits of New York's massive Medicaid program have concluded that state government must refund $1.5 billion to Washington. The biggest hit came from an audit by the Centers for Medicare and Medicaid Services (CMS) that was revealed Tuesday at a House Committee on Oversight and Government Reform hearing. New York Congresswoman Carolyn Maloney, a New York City Democrat, criticized a federal agent for targeting New York. The new audit found that in the 2010-2011 fiscal year, New York took $1.26 billion more than it deserved to run the subsidized health care program at facilities operated by the state Office for People with Developmental Disabilities. New York State will appeal, said William Schwarz, a state Department of Health spokesman.  CMS is demanding repayment of the money as it moves ahead with further reviews of Medicaid funding of New York's developmental centers and care facilities for the 2011 and 2012 fiscal years. Earlier reviews by the federal government determined that the facilities received $15 billion in excessive federal Medicaid resources over a 20-year period. A separate new audit examining other programs in New York's $56 billion Medicaid program found that the state received $200 million in extra federal money in recent years. That audit, by the Inspector General of the U.S. Department of Health and Human Services, focused on several programs, in many cases faulting poor documentation and support for reimbursements provided. During the hearing, John Hagg, director of Medicaid audits for the inspector general, was confronted by Maloney. She asked whether similar findings arose in other states and asked why New York is drawing so much attention. Hagg said the panel asked his agency to study New York, and noted that excess payments have been found in other states. "New York must do a better job of monitoring providers to ensure that only allowable services are paid," he said. Maloney said Gov. Andrew Cuomo has "taken seriously the long-term sustainability of the program" and created a committee to recommend reforms. As a result, she said, $2 billion is being saved in the state's Medicaid program. The CMS review found the state's financial management of the program is lacking. The auditors said that the state has not adequately supported reported costs, didn't have the proper internal controls, did not comply with federal requirements for establishing a cost allocation plan, and had provided unreliable consolidated fiscal reports for 2010-2011. Auditors also found examples of what seemed to be excessive rates paid for services, particularly at two government-owned hospitals in New York City. A spokesman for Cuomo did not respond to inquiries about the demands for repayments. Schwarz, the Heath Department spokesman, would not take calls on the audits. He emailed a statement saying that the department will "vigorously appeal this unprecedented decision."  Schwarz said the federal government previously approved the funds, and giving them back "could have untold negative consequences on the state's health care system."  Like Maloney, he credited Cuomo with "proactively" redesigning New York's wasteful and inefficient Medicaid program, which had been sanctioned by the federal government and prior administrations.  "As a result, the federal government and New York taxpayers have saved billions while quality of care improved, per capita spending declined, and enrollment increased." he said.

North Carolina

Hospital and adult care home operators are all reacting to the $21.1 billion North Carolina budget presented late Wednesday and passed by the Senate late Thursday evening, which contains cuts to those facilities, even as the state’s hospitals have taken cuts for the past several budget cycles. Lawmakers have said they were determined to bring the state’s Medicaid budget under control. The program – which pays for care for more than 1.6 million low-income children, pregnant women, low-income seniors and people with disabilities – has been blamed for claiming an ever-increasing part of the state budget. The final budget proposal trims about $135 million from Medicaid, much of it in the form of reimbursement reductions to providers. Hospitals will realize a total of about a 3.9 percent rate cut for the biennium. According to figures from the NCHA, the 2013 budget took more than $70 million out of hospital reimbursement in the form of a 3 percent cut to inpatient rates, a cut to outpatient rates and an increase in the assessment dollars hospitals return to the state in exchange for being able to bill Medicaid.  This year’s tab for last year’s budget cuts total about $92 million; on top of that, hospitals will lose an additional $45 million from new cuts, which include a higher assessment rate, lower reimbursement for UNC Hospitals and East Carolina University’s hospital (now known as Vidant Health) and the creation of a statewide base rate for hospital reimbursement.  A different set of cuts will affect people with medical issues who live in group homes and adult care homes, as the budget trims eligibility for state- and county-funded special assistance dollars for low-income people who also qualify for Medicaid. Currently, special assistance help is available for people who earn too much to qualify for Medicaid but receive the entitlement because they are “medically needy.” Often these are people with mental health issues who earn only a disability check and live in group homes, or people with mental health or developmental disabilities who live in adult care homes. The current budget will limit special assistance eligibility to people who earn below 100 percent of the federal poverty level ($11,670 for an individual annually, or $972 per month). Anyone looking to receive special assistance after Nov. 1 who earns more than that amount will no longer qualify. “That could be extremely problematic,” said Jenny Gadd, the group home manager for Alberta Professional Services, which runs several group homes for people with mental health issues in the Triangle and Triad. “It’s hard to tell what the eligibility really is going to look like, but that could really affect people in group homes. “That’s even worse than losing personal care services,” Gadd said, referring to reimbursement for help provided to residents of group homes and adult care homes. The personal care service rate has been an issue for several years and led to a settlement with the US Department of Justice over disparate payment for services for people living in institutions than for those who live in their homes. “This is a risk to the state,” Hise said of the special assistance program during the budget debate Thursday afternoon. “The Senate’s original proposal is that [special assistance] is a program we need to eliminate. This is putting us at tremendous risk with the DOJ, and I for one believe we will get sued for this program.” But according to Evelyn Hawthorne, who lobbies for the North Carolina Assisted Living Association, the plan for covering special assistance was agreed to by the assisted living lobby, legislators and federal regulators. She said the likelihood of a federal lawsuit are slim.


Ohio Gov. John Kasich signed into law Monday new measures that will enable Ohio’s disabled and their families to instantly review inspection and compliance reports for thousands of entities providing services to the disabled. State Sen. Michael Skindell (D-Lakewood) and Sen. Kevin Bacon (R-Minerva Park) originally sponsored Senate Bill 270 calling for greater transparency of inspection reports. Up until now, those reports were never made readily available to the public—leaving the disabled and their families largely in the dark about the compliance history of a provider caring for a loved one. An exclusive 5 On Your Side investigation in November 2013 prompted the new legislation after revealing how some providers for the disabled routinely ignore even basic health and safety regulations. On the senate floor last month, Skindell said “Cleveland’s NewsChannel5 televised a three-part series by Investigator Ron Regan detailing sexual abuse and neglect of people with disabilities in Ohio.” Senate Bill 270 was eventually combined into HB 483, generally known as the Mid Biennium Budget Review legislation, signed into law by Governor Kasich during a ceremony Monday. The new legislation now requires the Ohio Department of Developmental Disabilities to post on its website all compliance and inspection reports for disability providers. The reports will reveal how well providers are complying with state regulations regarding a wide range of requirements from criminal background checks to health and safety training. The mother of a disabled woman, whose assault was described in our original report, said the new law has taken a tragedy for their family and brought something beneficial for other disabled families in Ohio.  


Gov. Tom Corbett’s proposed Healthy PA Medicaid reform plan – currently under final review by the federal government – no longer will seek to repeal a program that provides assistance for 33,000 low- and middle-income Pennsylvanians with disabilities. “After looking at the [Medical Assistance for Workers with Disabilities] program, we realized that it falls in line with the governor’s goals,” said Kait Gillis, press secretary of the Pennsylvania Department of Public Welfare. “It encourages employment while ensuring that the individual’s needs are met.” Earlier versions of the Healthy PA plan, unveiled in September and submitted for federal review in February, would have eradicated the program. Medical Assistance for Workers with Disabilities provides medical benefits to 33,000 Pennsylvanians who have no more than $10,000 in resources and a household income below 251 percent of the federal poverty level — or an individual annual salary of $29,175. Under the previous version of Mr. Corbett’s proposal, workers with disabilities earning up to 133 percent of the federal poverty line would have been eligible to purchase private insurance through the federal marketplace with “premium assistance” from the state. Medical Assistance for Workers with Disabilities recipients currently earning between 134 and 250 percent of the federal poverty level would have lost state-subsidized coverage altogether. Through state webinars and public hearings, opponents of the repeal argued that workers with disabilities should not be expected to navigate the marketplace.  


In jobs that some see as opportunities, others as exploitation, about 13,000 disabled Pennsylvanians are earning an average of $2.40 an hour in a legal use of subminimum wages. The majority work almost solely with other disabled people, in a world tucked away from the mainstream labor market. Since 1986, there has been no limit to how little they can be paid. And even the federal government, which issues the certificates that allow employers to pay subminimum wages, doesn't track the hourly earnings of the workers. An average worker at the Venango Training and Development Center in northwest Pennsylvania, for example, earns $1.72 an hour for shrink-wrapping mugs or assembling toys. In Montgomery County, workers are baking dog treats for an average of $3.16 an hour at the Center for Creative Works in Wynnewood. Boxing screws and preparing mail to be sent to prospective college students yields an average of $1.62 an hour at the Milestone Centers in Monroeville, Allegheny County. The federal program as a whole is under attack at state and national levels. Opponents say people with disabilities are being treated as cheap labor and segregated into dead-end jobs at sheltered workshops. "There is ignorance and fear," said Joyce Bender, founder of Bender Consulting Services in Pittsburgh, which recruits and hires people with disabilities. "It's not a physical barrier. … It's the feeling that the person will be inferior or that they'll take too much time." Supporters of the work programs say the activity provides socialization, training and purpose for people with disabilities. "I understand why people say ... it's a disgrace, but it's just not that way," said Richard Edley of the Rehabilitation and Community Providers Association, a coalition of state health and human service groups, including several that run sheltered workshops. "The pay is someone else's issue, certainly not the workers or their families. … People haven't really looked at the whole picture because they don't live it." PublicSource analyzed 1,600 pages of documents from the U.S. Department of Labor that track the program between June 2011 and December 2013. They provide the first statewide look at the use of a provision that was passed during the Depression and allows employers to pay people with disabilities less than the federal minimum wage, which is $7.25 per hour. The state Department of Labor and Industry refused to release the documents that the federal government gave PublicSource. There is very limited oversight of employers who use the program. Of about 3,300 in the nation, 250 were investigated by the Labor Department in fiscal year 2013. The issue of wages for people with disabilities has created a rift among their advocates. Read more:,0,2582120.story

South Dakota

The state Department of Social Services decided it could increase Medicaid reimbursement rates to nursing homes by 4 percent this summer, on top of the 3 percent raise the Legislature approved last winter. Several legislators made it clear Monday that they weren’t pleased that the state department didn’t tell them before notifying nursing homes about the extra 4 percent. The 4 percent will cost an estimated $2.5 million of state general funds and about $5.3 million from all sources of government revenue, according to state Social Services Secretary Lynne Valenti. Valenti discussed the matter Monday with members of the Legislature’s Joint Committee on Appropriations that oversees state budget matters. Valenti didn’t tell legislators during the 2014 session that an extra increase was planned. She said reimbursement rates are routinely reviewed every spring after the session is complete and before the department submits its budget request to the governor for review in August. Nursing homes have been running about 150 Medicaid patients below expected levels in recent years. Because the money was already appropriated by the Legislature, giving the additional 4 percent won’t cost any more than was budgeted, Valenti said. The nursing facilities need to stay open, Sen. Deb Peters, R-Hartford, said. “It’s a specific target,” he said. Sen. Phyllis Heinemann, R-Sioux Falls, asked for the reason for the trend of fewer people than expected. Valenti replied there are more community services, more community-based providers and people are receiving community services longer rather than moving into nursing homes. “The utilization is down in both Medicaid and private pay,” Valenti said. There are approximately 8,000 nursing beds, and the average Medicaid occupancy rate is 57 percent. Rep. Susan Wismer, D-Britton, told Valenti she was “puzzled” why the Legislature wasn’t briefed about the possibility of the extra 4 percent during the 2014 session that ended in March. “The decision was made well after session,” Valenti responded. “This was an example of an area where we used the appropriated funds.”


The state is expected to bring in less money in tax revenues in the next year than previously anticipated, prompting Gov. Peter Shumlin to call Thursday for a 2 percent cut in state government spending. Revenues had been expected to increase 4.8 percent this year, but now appear to be headed toward a 3 percent increase, economists for Shumlin and the Legislature said Thursday. That means the state would receive $31 million less than the Legislature and governor had expected when they crafted the 2015 state budget earlier this year. "We're taking in slightly less revenue than we thought we would," Shumlin said. "This is a manageable challenge." Shumlin said he asked state agency and department heads Wednesday night to come back to him with by the end of next week with plans for how they would cut 4 percent from their budgets. Those ideas will be used to cut 2 percent from the budget, he said. Some items, including raising taxes or cutting funding for pensions, will be off the table for cuts, he said. The Legislature's Joint Fiscal Committee has to approve any cuts and will hold a public hearing before voting. Shumlin said he expects meet the slower growth in income without layoffs. In a memo Thursday, Administration Secretary Jeb Spauling told department heads that filling any vacant positions would be forbidden without his permission.  


The Wisconsin Supreme Court on Thursday upheld a law that significantly limits collective bargaining rights for most public workers, dealing a decisive blow to labor unions in the state and handing Gov. Scott Walker a crucial victory in an election year. The law, known as Act 10, became the signature legislation of Mr. Walker, a Republican who drew national notice when he proposed it after taking office in 2011. The measure brought thousands of union supporters to the State Capitol in protest and galvanized efforts to limit unions in Republican-controlled states. In a 5-to-2 decision, justices rejected arguments that the restrictions on collective bargaining violated freedom of association and equal protection rights, among others.  “No matter the limitations or ‘burdens’ a legislative enactment places on the collective bargaining process, collective bargaining remains a creation of legislative grace and not constitutional obligation,” Justice Michael J. Gableman wrote in a majority opinion.  “The First Amendment cannot be used as a vehicle to expand the parameters of a benefit that it does not itself protect,” he also wrote. The justices also ruled on two other closely watched issues, upholding a law requiring voters to show photo identification and another creating a domestic partnership registry for same-sex couples. The immediate effect of those rulings was somewhat limited because of other, still-waited decisions expected on related issues in the federal courts. In a written statement, Mr. Walker said of the collective bargaining case: “Act 10 has saved Wisconsin taxpayers more than $3 billion. Today’s ruling is a victory for those hard-working taxpayers.” The law had been entangled in litigation since its passage. To read more -