Blog Viewer

State Disability News Highlights for Period ending 10/16/2015

By Diane McComb posted 10-16-2015 11:26 AM


State Disability News Highlights for Period ending 10/16/2015


Lead Story:  Georgia

Georgia still hasn’t lived up to its part of an agreement with the federal government to shift severely mentally ill residents out of state mental hospitals and into community settings, the Justice Department said in a scathing letter that demanded a corrective action plan by November. Federal authorities said in a Sept. 23 letter to Gov. Nathan Deal’s office that Georgia failed to comply with a number of key tenets of a landmark 2010 settlement with the Justice Department after an investigation into the abuse and deaths of dozens of patients. The probe was prompted by a series of stories in 2007 by AJC reporters Alan Judd and Andy Miller that brought the abuses to light. Since the settlement was reached, Georgia has established dozens of community services and housing for about 9,000 people with mental illness. And the state has created community support and crisis intervention teams to help others avoid hospitalization. But the feds said in the 18-page letter that the state hasn’t done enough to smooth the transition from state hospitals to community residences. It found the state has failed to strengthen hospital discharge planning, deploy mobile teams to conduct more in-person visits with at-risk residents and provide more services for patients removed from hospitals. ”This is troubling, not only because it reflects non-compliance with the state’s commitments, but because the non-compliance is associated with poor outcomes for individuals served by the state,” wrote Judy Preston, a Justice Department litigation chief. “Some of the state’s non-compliance has likely caused preventable deaths.” The state Department of Behavioral Health and Developmental Disabilities State said it disputed many of the assertions in the letter and that it is developing a response. “While the state’s obligations in the settlement officially ended on June 30, 2015, the department continues our daily work to provide people with the best possible care in the most appropriate setting to address each individual’s needs,” said Angelyn Dionysatos, an agency spokeswoman. To read more -



Iowa officials announced Friday that they have signed contracts with four national companies to manage the state’s massive Medicaid program. However, that is not the last step before the companies could take control of the program as planned Jan. 1. Gov. Terry Branstad’s administration announced in August that the Department of Human Services had chosen the four companies, Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley and WellCare of Iowa. Eleven companies bid on the project, and three of those that weren’t chosen have complained in court that the process was unfair and arbitrary. The contracts were supposed to be signed several weeks ago, but state administrators have said it took a bit longer than expected to work out the details. Critics say the state is moving too quickly to make the change. Branstad contends the shift to private management will save $51 million in the first six months, because the companies will do a better job of managing services to prevent duplication. To read more -



Joy Newcom of Forest City told Gov. Terry Branstad on Wednesday his proposed privatization of Medicaid services was too much, too soon and had too many unanswered questions. Newcom, the mother of a 24-year-old son with mental and physical disabilities, expressed her concerns at a town hall meeting Branstad held in Mason City. About 100 people attended, many of whom had questions about the changes in Medicaid. Under the new program, as of Jan. 1, about 600,000 Medicaid recipients in Iowa will go from a state-run program to one operated by four managed care organizations. "You didn't get enough input from families," said Newcom. "There are too many unanswered questions, too many opportunities where families may have to step in to fill the gaps in the program, and they can't afford it." Branstad said he understood her concerns, but the program, as it is operating now, had serious problems. "There is a lot of fear in change," he said. "This hasn't even started yet. Costs of the Medicaid program have gone up 73 percent in recent years. If you project this into the future, you can see it's unsustainable." Branstad said 25 other states have shifted to privatization of the program. Health care provider and care givers say administrative costs will increase in the new program and the only way to cut costs is to cut services. Sen. Amanda Ragan, D-Mason City, held a public meeting Friday on the Medicaid changes, attended by about 70 people who opposed the plan. Ragan said while it is true 25 states have privatized the program, none have done it as quickly and with as many unanswered questions as in Iowa. With Branstad in Mason City was Amy McCoy, public information officer for the Iowa Department of Human Services, to help answer questions. McCoy said if the present system continued, services would have to be cut because of the growing number of recipients and skyrocketing costs. "We are trying to make sure nothing falls through the cracks," she said. "Also, we will have an independent ombudsman helping us." McCoy said her department is holding informational meetings around the state and that one is planned for Mason City in the near future. Earlier this month, Jill Slaybaugh, fiscal manager for the Iowa Department of Human Services, said privatization will result in $51 million in savings in the first six months. Branstad was also asked about the Elderly Waiver program in Iowa. DHS recently rejected a request from the Franklin County Board of Health to resume services to patients who lost benefits in the program, which is a part of Medicaid. In-home assistance was discontinued last year because of a discrepancy in how eligibility and service levels were applied. DHS was able to work through an appeals process to get many of the elderly reinstated. To read more -



The state says cost overruns and an uncertain federal funding situation have helped cause a $400,000 shortfall in the agency providing services to 1,100 Mainers who are blind and visually impaired. It has led the Maine Department of Labor to freeze 4½ positions, including three administrative positions, in its Division for the Blind and Visually Impaired, which has a $4.7 million annual budget and provides job training, life skills and educational programs. Advocates are concerned with the plan. The shortfall — for the federal fiscal year ending in September 2016 — is because of circumstances discovered in June, including cost overruns in service delivery, the effects of federal budget cuts and rising personnel costs, according to Julie Rabinowitz, a Maine Department of Labor spokeswoman. Also, she said an upcoming change in federal law that will make agencies reserve 15 percent of federal vocational rehabilitation funds on pre-employment services for those ages 14 through 24 could make these services harder to fund in the future. Maine has had only 14 people in that program in the past year, and previously, that money was available to fund services for older Mainers, Rabinowitz said. Now, she said, the state is examining potential funding to fill that gap, but it froze the administrative positions out of caution and services shouldn’t be affected. “The positions have not gone away, and if the fiscal situation isn’t as dire as we’re preparing for, we can bring those back,” Rabinowitz said. But it has led to heartburn among advocates: The governor-appointed State Rehabilitation Council for the Blind and Visually Impaired, which advises the division, sent an Oct. 2 letter to Gov. Paul LePage, saying “extraordinary efforts are underway to dismantle” the division and potentially consolidate functions with the Division of Vocational Rehabilitation, which provides job services to people with other types of disabilities. To read more -



Advocates of assisted suicide are significantly expanding their efforts to build support in Maryland for broader end-of-life options, hopeful that a recent victory in California will provide new momentum for legislation that failed to get out of committee in Annapolis this year. Across the state, organizers are meeting with faith-based communities; inviting small groups to watch the documentary “How to Die in Oregon,” about that state’s assisted-suicide law; and serving coffee and doughnuts at “house parties” that offer information about end-of-life options for people who are terminally ill. The recent signing of California’s assisted-suicide bill by Gov. Jerry Brown (D) “has made us even more motivated to make sure Marylanders have the same options,” said Donna Smith, a field consultant in Maryland for the Denver-based organization Compassion & Choices.



J.R. Robinson rubbed his hands together. A hollow sadness sits behind his eyes, punctuating a broken expression. "I'm struggling every day," said the 51-year-old Holland resident; a Tennessee accent filling soft, steady words. "Bipolar depression doesn't go away like a virus. There's only so much medications can do." His appearance at the Holland Drop-In-Center on Sept. 29, was no easy feat. Without scheduled classes two days a week at Community Mental Health of Ottawa County, motivating himself to leave his apartment is a battle. "It kept me from isolating; it kept me from drinking," Robinson said. "We felt like we were somebody." It's been six months since CMH dropped Robinson from services. He's not alone. About 50 CMH clients in Ottawa County no longer receive treatment after the agency went through a round of budget reductions this spring. Swift budget cuts made this year by the county meant reductions in services for clients with mental health and developmental disabilities, and staff layoffs. Local officials have pointed to changes in their Medicaid funding, but regionally, there's more in play. To read more -



Oklahoma's general revenue fund is continuing its slide. September collections of $544.1 million were $4.8 million, or 0.9 percent, below estimates, and $16.9 million, or 3 percent, below prior year collections. Total collections for the first quarter of the 2016 fiscal year were $1.4 billion, which is $4.4 million, or 0.3 percent, below the official estimate and $12.3 million, or 0.9 percent, below prior year collections.  "First-quarter revenues landed on decent footing, but the road ahead will be rockier," Finance Secretary Preston L. Doerflinger said Tuesday. A 5 percent cushion is built into the state budget, so if revenue falls by more than 5 percent for long enough, a so-called "revenue failure" is declared, triggering immediate spending reductions. The state is in no immediate danger of this, but it remains a possibility if state revenues continue shrinking as the result of low oil prices and layoffs in the energy sector. “Given the ongoing oil price challenge and resulting workforce reductions, every bit of that five percent cushion may be needed,” Doerflinger said. “Some agencies, including mine, are already discussing what spending adjustments may be necessary if a midyear budget reduction were to occur. That's not always a pleasant discussion, but it's certainly a prudent one considering the circumstances.”



Months without financial aid from Harrisburg - and no sign the spigot will flow again soon - is starting to wear on officials and agencies across the region. Through this month, Delaware, Chester, Montgomery, and Bucks Counties have shelled out more than $70 million from reserves to keep critical social service providers afloat. But officials from each aren't sure how long they can last and are watching their coffers week by week. "The budget is becoming stressed," said Jonathan Rubin, director of human services for Bucks County, which has spent between $6 million and $7 million monthly to fund social service programs usually paid for by the state. With the state House in recess and no sign the impasse will end, the stress will likely continue. In interviews Wednesday, Gov. Wolf reiterated that he needs to "stand tall" and negotiate a budget with the Republican-led legislature that contains new revenue. Otherwise, he said, "we're going to be facing huge cuts in schools, huge cuts in county-level human services, and huge property tax increases" come 2016. To read more -



State tax revenue over the next two years will fall short of expectations by $2.6 billion, largely because of sluggish oil prices, Texas Comptroller Glenn Hegar said Tuesday. Tax revenue is expected to total $110.4 billion — still more than the spending called for by the Legislature, which was capped at $106.2 billion. The revised estimate released Tuesday forecasts a $4.1 billion drop in tax revenue from oil and natural gas production and regulation over the next two fiscal years, compared with the two years that ended in August. But revenue from other sectors of the Texas economy will temper the downturn in oil prices, Hegar said. The projection is based on an estimated per-barrel oil price of $49.48 during this fiscal year, which began Sept. 1. Hegar projects the price per barrel to increase to $56.52in 2017. Crude oil is now trading at $46.58. “Oil prices are extremely hard to predict,” Hegar told the American-Statesman. “A lot of people try, but it’s not only a national but also an international market, and small amounts of news can significantly change the price daily.” The estimate released Tuesday takes into account policies adopted during the last legislative session and changing economic conditions that could affect the amount of revenue the state collects. A previous estimate was issued in January before the Legislature convened. To read more -



Federal regulators said conditions at Washington’s largest psychiatric hospital were so dangerous for patients that they threatened to cut millions of dollars in funding three times this year.  The state agency that oversees Western State Hospital said Thursday that they are addressing the problems, but they need more money and staff to make the facility safe.  The federal Centers for Medicare and Medicaid Services sent 90-day termination notices to the hospital in January, March and September after inspectors found it failed to ensure the safety of patients. The violations ranged from failing to supervise violent patients to broken fire alarms and smoke detectors, according to documents obtained by the Associated Press.  The loss of federal funds would be significant: The 800-bed hospital receives $4.7 million from Medicaid and $11.2 million from Medicare each year.  Federal regulators’ series of threats in such a short period of time reflects serious problems with the state Department of Social and Health Services’ mental health division, said David Carlson, a lawyer with Disability Rights Washington.  “It’s operating at its limits right now,” Carlson said. “When there’s not appropriate staffing, bad things happen.”  Carla Reyes, acting assistant secretary for the department’s Behavioral Health and Service Integration Administration, which oversees the state’s mental health services, said patient safety is a priority, but the agency needs more than the $9.4 million added to the latest budget.  The department is asking for supplemental funding to hire staff needed to maintain accreditation status and operate safely, Reyes said.  The warnings are among a list of troubles facing the state’s mental health system. In April, a federal judge issued a permanent injunction against the agency for failing to provide timely competency services to mentally ill people charged with crimes. And the brother of a patient who died after choking on an orange in the hospital’s day room while staff walked by has sued several workers.  The federal violations in March resulted from a surprise fire inspection that found broken fire alarms; problems with walls and doors that should stop smoke and fire from spreading; and the absence of a fire-watch system for some buildings. To read more -



Gov. Matt Mead announced Wednesday that state budget cuts will be needed to make up for lower-than-expected energy revenues. Mead said during a press conference that state officials expect a $100 million to $200 million shortfall for the current fiscal year. The governor said he doesn't want to look at layoffs or tax increases to bridge the budget gap. But he said he has ordered a new hiring freeze and told agencies to cancel computer upgrades and look for other ways to find savings.  Mead said he doesn't want to tap the $1.8 billion rainy-day fund before the 2016 budget session begins in February. But he said there could be other reserve accounts that could be used to avoid some of the budget cuts.