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State Disability News Highlights

By Diane McComb posted 10-31-2015 12:24 PM


State Disability News Highlights for Period ending 10/30/2015


Lead Story:  Virginia

A U.S. District Court judge on Friday postponed a decision on whether to force Virginia to speed efforts to overhaul how the state treats people with severe disabilities. Judge John A. Gibney said he would rule in December on a Department of Justice request for hard deadlines in implementing changes agreed to in a 2012 court settlement. The agreement, based on the Americans with Disabilities Act and a related Supreme Court ruling, said that disabled people are entitled to treatment in community settings instead of in large institutions. The settlement established a set of goals to achieve by 2022, including moving people out of the five state-run institutions for the disabled and creating more opportunities for those adults to find jobs or other activities in community settings. With seven years left, the state has moved about half of the 1,018 disabled residents who were institutionalized. But it has been sluggish in financing efforts to build smaller group homes for those who have been left behind. Virginia has also delayed implementing a crisis-prevention program for children with disabilities and fully launching a system in which state officials can monitor the quality of care being given to people with intellectual and developmental disabilities. During the court hearing, the office of Attorney General Mark R. Herring (D) said that much of the state’s strategy for complying with the settlement lies in the expectation that the General Assembly will approve funds for Virginia to restructure its system of Medicaid vouchers available to the disabled. The vouchers, 11,500 of which are now in circulation, allow disabled patients to pay for care and receive other services inside their homes or in private health-care facilities. Advocates say the state’s reimbursement rates are too low to cover those costs and note that about 10,000 people are on a waiting list for vouchers. To read more -



A group that wants to see Colorado start the nation's first universal health care plan has turned in signatures to take the plan to voters. The group ColoradoCareYES turned in some 156,000 petition signatures to the secretary of state Friday. They want to see a question on 2016 ballots about a new health care system to replace the current one. Instead of participating in Obamacare, the state would charge employers and workers taxes to fund a universal health care system. ColoradoCareYES says employers would have to pay about 7 percent of a worker's wages into the system, with workers paying about 3 percent. They say the plan will cost $2.9 billion but will save $9 billion. Skeptics of the plan say costs would run out of control.



Idaho budget analysts say the state is on track to run up an end-of-the-year surplus of roughly $108 million. However, that number could increase even more if the state sees moderate 4.5 percent revenue growth during this fiscal year, which started at the beginning of July. The Spokesman-Review reports that the end of the year surplus is a relief to legislative budget writers, who spent three days this week getting a preview of upcoming expenses. This includes a multi-million-dollar wildfire tab and pay increases for teachers. Idaho's Joint Finance-Appropriations Committee drafts the budget during the 2016 legislative session. Once written, the rest of the legislative body rarely makes significant changes before approving it.



A spokesperson for the Kansas Department for Aging and Disability Services says the agency will need an additional $6.5 million to comply with a recent ruling that requires employers to pay in-home workers minimum wage and overtime. The department has asked Gov. Sam Brownback’s budget office to build the additional funding into its budget for the current fiscal year, according to Angela de Rocha, KDADS director of communications. However, tax revenues are more than $60 million below projections so far this fiscal year, creating a bleak budget situation in Kansas. Kari Bruffett, secretary of the Kansas Department for Aging and Disability Services, warned lawmakers last year that the pay change for home health workers could reduce or eliminate sleep-cycle support for 1,400 Kansans. Last week Chief Justice John Roberts of the U.S. Supreme Court denied an application to stay that U.S. Department of Labor ruling, which is expected to have the biggest effect on the state’s Medicaid-funded services — called sleep cycle supports — that involve paying workers to be present while frail elders or people with serious disabilities sleep. These workers help beneficiaries with toileting, taking medication, being repositioned to prevent bedsores or getting out of bed in the morning. The services are designed to help people continue living in community-based settings and avoid having to move to nursing homes, which are more expensive. For years, sleep-support workers in Kansas have been paid about $35 per evening, which per hour is less than minimum wage. After the ruling takes effect Nov. 12, most of these workers will need to be paid between $45 and $60 per evening. De Rocha said KDADS and the managed care organizations (MCOs) that administer KanCare, the state’s Medicaid program, will “continue to work with consumers to ensure adequate support is maintained.” To read more -



After many years without health insurance, Cathy Ingram recently got a subsidized policy through the state-run Kynect exchange. Her first stop was the dentist, who pulled some rotten teeth infecting her gums. "For a long time, my teeth were giving me so much trouble that I would get a migraine," said Ingram, 37, who does cleaning and laundry work around Lexington. "It felt like my eardrums were going to burst. But now that they've got my teeth out, I feel fine." Ingram can visit her dentist because Gov. Steve Beshear decided in his second term to fully embrace the federal Patient Protection and Affordable Care Act of 2010, which many call Obamacare. Voters going to the polls Nov. 3 to choose Beshear's successor will decide the Affordable Care Act's future in Kentucky. By executive order, Beshear, a Democrat, bypassed the politically divided General Assembly to create Kynect, an online marketplace of insurance policies, with public subsidies available to help many people buy a private plan. Beshear also expanded the state's Medicaid program to include people in households with incomes up to 138 percent of the poverty line — $33,465 for a family of four. The state spent millions publicizing Kynect and sending agents, known as "Kynectors," into communities to sign up people like Ingram. Federal funding and a 1 percent assessment on insurance plans paid for nearly all of this. The results were dramatic. In 2011, 14.4 percent of Kentuckians were uninsured. That figure plunged to 8.5 percent by 2014. No state saw a bigger drop. More than 400,000 people got coverage — mostly through Medicaid — letting them visit doctors, order prescription drugs, undergo preventive disease screening and enroll in psychiatric and addiction treatment. However, the next governor can dismantle what Beshear built. To read more -


New Jersey

On October 19, 2015 the director of the Division of Aging Services provided the Medical Assistance Advisory Council (MAAC) with an update on the MLTSS enrollment figures by service setting. The state has 42,247 individuals receiving long term care. Of those, 43.6 percent are enrolled in a managed care organization, and the remainder is under Medicaid fee-for-service (FFS). The majority of individuals under FFS was in nursing facilities at the time of MLTSS implementation and was grandfathered to remain carved out of managed care. Twenty-four percent of the individuals receiving MLTSS under managed care reside in a nursing facility. The state’s overall nursing facility population has decreased since the MLTSS implementation by more than 2,800, while the number of individuals receiving home and community based services has increased by more than 2,700. The majority of New Jersey residents on Medicaid who are receiving long term care are age 65 or over (over 76 percent) and dually eligible for Medicare and Medicaid (90 percent). Only a fraction of the 42,247 Medicaid enrollees receiving long term care are children (or .006 percent).  


New Mexico

New Mexico has suffered another setback in its effort to avoid a loss of at least $34 million in special-education money from the federal government. In a letter earlier this month, the nation’s top education official affirmed a judge’s ruling against the district in its battle with the feds over how much money it earmarks for special-education programs. At issue are at least two violations of funding mandates for programs aiding the state’s 46,000 special-education students. The U.S. government provides some funding for these programs, but it requires states to first allocate certain amounts of their own money. If it determines a state has contributed too little funding to the programs, it can withhold future federal funds. The New Mexico Public Education Department failed to meet those funding requirements in fiscal years 2010, 2011 and 2012, falling short by a total of more than $110 million over the three-year period. The money goes toward Individualized Education Plans for special-education students, as well as support services such as tutoring, counseling, medical support, assisted technology, and physical and occupational therapy. The state, citing a drop in its overall revenues, asked the U.S. Department of Education to grant some flexibility on the matter and allow it to reduce its base level of required financial support for special education for those years. But the federal agency approved the request only for fiscal year 2010. And in the spring of 2014, Office of Hearing and Appeals Judge Richard O’Hair said he was not persuaded by the state’s argument that it had the right to reduce its own expenditures for special education for subsequent years. In a letter dated Oct. 8, U.S. Education Secretary Arne Duncan affirmed O’Hair’s ruling. Duncan said he disagreed with New Mexico’s arguments on how it interprets the funding mandate, including its contention that a one-year flexibility provision allowed it to lower special-education support in following years. “Even if a state reduces its expenditures in one year using the state flexibility provision, it must still allocate at least as much money as in the previous years,” Duncan wrote in his eight-page response. To read more -


New Mexico

Top-ranking Human Services Department officials told legislators Tuesday they will need nearly $1 billion next year for the state’s share of rapidly rising Medicaid costs – described by one key lawmaker as a “runaway train.” Members of a key legislative panel reacted with alarm to the request for an additional $85.2 million, or 8.5 percent, to keep up with skyrocketing enrollment and a looming decrease in the federal matching rate for states like New Mexico that opted to expand their Medicaid programs. Several legislators also point out that plummeting oil prices have made it unclear how much money they will have to spend in the coming year. “This is not a pretty picture, but it’s something we’re going to have to deal with,” said Rep. Larry Larrañaga, R-Albuquerque, during Tuesday’s meeting of the Legislative Finance Committee. Human Services Secretary Brent Earnest said Medicaid enrollment has increased much more rapidly than the agency expected. By June 2017, the department now projects there will be more than 919,000 New Mexicans enrolled in Medicaid – a figure that would be more than one-third of the state’s total population. That’s up from about 560,000 New Mexicans on Medicaid rolls at the start of 2013. Medicaid is a joint federal-state health care program that has historically provided health care coverage primarily for low-income children, pregnant women, disabled adults and the elderly. Under the federal Affordable Care Act, or Obamacare, states were able to decide whether to expand Medicaid benefits to adults earning 138 percent of the federal poverty level, or roughly $15,856 a year for a single adult. Gov. Susana Martinez decided in 2013 to accept Medicaid expansion, saying the move would help New Mexico families and would not jeopardize the state’s long-term budget outlook. The federal government initially funded 100 percent of the expansion costs for participating states, but that will be decreased to 95 percent starting in 2017, and to 90 percent by 2020. The federal government also pays for about 70 percent of general, non-expansion Medicaid costs in New Mexico. Ernest told legislators the agency has adopted several cost-cutting measures in an attempt to slow down Medicaid spending growth. While some lawmakers said Tuesday the Medicaid expansion has created new health care jobs, others expressed concern about its budgetary impact not just for next year, but for the future. “I think having more than 1 out of 3 New Mexicans having their health care being covered by Medicaid is going to be a budget-buster,” said Rep. Jason Harper, R-Rio Rancho. “I see this as not sustainable – we need to be very careful.” In addition, Rep. Larrañaga described Medicaid spending as a “runaway train.” After several largely flat spending years, Medicaid spending for the current budget year that started in July is $891.7 million – or about 14 percent of the state’s $6.2 billion budget. Under the proposal for the coming fiscal year, that would increase to $976.9 billion.



­­­­­Facing falling revenues amid an oil industry downturn, Gov. Mary Fallin ordered state agencies  Monday to prepare to cut nonessential expenses by 10 percent. In her executive order, she also placed a moratorium on taxpayer-funded, out-of-state travel.  "I'm asking every agency to start planning for potential spending cuts and to develop a strategy that protects essential services," she said. "It's important we get ahead of this issue as we enter a difficult budget year. Families and businesses tighten their belts during lean times; our state agencies can do the same." If state tax receipts continue to fall, a revenue failure could be declared, requiring immediate spending cuts. State officials are trying to restrict some expenditures now to ward off such a failure. Fallin's order demands that every Oklahoma agency, board and commission prepare by Dec. 1 a plan for cutting services. Agencies would then need to implement these plans, said Preston Doerflinger, Oklahoma secretary of finance and revenue. The plans are to explain how money saved through reductions will be reallocated to other needs within the agency. Also, effective Dec. 1, advance written notification must be given for proposed state payment of any agency, state and public employee or officer memberships in any private or public organization; nonessential out-of-state travel for agency employees and officers that is wholly paid for by an entity other than the state; nonemergency purchases that exceed $10,000. The public would not likely notice the reduction in nonessential services, but significant money could be saved, Doerflinger said. To read more -



With no state budget in place months into Pennsylvania’s fiscal year, school districts and nonprofit organizations aren’t the only ones taking out loans. Much of the state General Assembly, too, has turned to the banks to make payroll. The state Senate on Friday borrowed $9 million from PNC Bank so it could pay the salaries and benefits of both Republican and Democratic senators and staff, said Jennifer Kocher, spokeswoman for Senate Majority Leader Jake Corman, R-Centre. Months after the July 1 start of the state’s fiscal year, the Senate reserves have been depleted, Ms. Kocher said. “We would not have made payroll,” she said. House Republicans, meanwhile, signed an agreement Oct. 19 for a $30 million line of credit and drew down $5 million that day, said Steve Miskin, spokesman for House Republicans. The money will pay for the salaries of House Republican members and staff, operations at district offices, and non-partisan House management functions, he said. “We’re doing our job,” Mr. Miskin said. “We are trying to put together a bipartisan budget that ultimately would have the governor’s signature.” Gov. Tom Wolf, a Democrat, and the Republicans who hold the House and Senate majorities have been locked in a budget standoff over Mr. Wolf’s proposals to raise taxes and Republican calls to change the pension systems for state and public school workers and to disband the state business in alcohol sales. To read more  -



Even though Rick Perry has received his fair share of criticism for his actions as Governor of Texas, there are some believe that his successor, Greg Abbott, has revealed himself to have even “crazier” ideas. Examples include appointing someone who was homeschooled by Christian parents to oversee the state’s public education system and organizing the state’s guard troops to ensure that president Obama doesn’t “invade” Texas during recent military exercises. A recent investigation has uncovered an even more troubling action on Abbott’s part: shaping medical policy based on advice from Scientologists. Governor Abbott has recently vetoed a bipartisan bill which would give more resources to medical professionals that help residents dealing with mental health problems. The bill in question was widely popular, supported by many large medical associations in the state and both political parties.  Instead, Abbott killed the bill after receiving information from a Scientology group which believes that mental illnesses are a myth and that treating them causes more harm than good for the patients. Scientology, based on the writings of its founder L. Ron Hubbard, is strongly opposed to psychiatry in all its form and even compares mental health professionals to “terrorists” in some of its publications. One of the reasons why the Citizens Commission on Human Rights, the group run by Scientologists, opposed the bill is because it contained a provision that would have prevented patients from refusing mental health care if they were determined by physicians to be a danger to themselves or to others.



Texas health officials have asked an appeals court for permission to proceed with cutting payments to a therapy program for children with disabilities — the latest development in an ongoing lawsuit over the budget state lawmakers crafted this year. The Texas Health and Human Services Commission is seeking to override an order by state District Judge Tim Sulak in September that temporarily stopped health officials from implementing the cuts, saying the move would jeopardize children’s access to necessary care. But lawyers for the state now say Sulak overstepped his bounds and had “no statutory- or rule-based right” to keep the state from cutting payments. State lawmakers earlier this year ordered the health commission to cut $100 million in state funding by slashing payments to speech, physical and occupational therapists through Medicaid, the federal-state insurance program for the poor and disabled. Therapy providers cried foul, saying the cuts would cause businesses to shut down and limit children's access to care, and won an early but temporary victory in district court. Now, state health officials are hoping the 3rd Court of Appeals will nix that decision. The health commission's motion, submitted Tuesday, argues that any complaint about how Texas sets its Medicaid payments to providers is the federal government’s concern, not a state judge’s. The health commission said Sulak’s order “usurps a power expressly reserved to the executive branch of the federal government” — and amounts to a veto of a state budget provision, a power reserved for the Texas governor.


West Virginia

Continued cuts could cost senior services across West Virginia.  Pocahontas County isn’t the only place to feel the pinch — many smaller counties across the state continue to struggle with similar challenges. The minimum wage increases mandated at the state level — first to $8 an hour, and up to at $8.75 this coming January — are essentially “unfunded mandates” for senior centers that have seen no increase in funding. “We had to close our adult daycare program, which we had for 15 years, because we couldn’t afford it with the wage increase,” said Sandra Viselli, the executive director of the Hampshire County Committee on Aging. “They increased the minimum wage, but no one increased the reimbursement that we got, and we’re a private nonprofit corporation, so how can you pay them? You have to come up with money somehow, so we cut the days of service for our senior centers, we cut out the adult daycare and we cut out extras for our employees. When it goes up 75 cents again this year — our board is now in the process of looking to see what’s going to go next, because unless someone gives us more money, something has to go.” Viselli said she understands the rationale for raising the minimum wage for most workers, but feels that the state forgot to look at how the wage increases might affect nonprofits. “You can’t spend money if you don’t make more, so it’s really been a problem,” she said. “It’s hurting seniors; that’s who it’s going to hurt. We might have to close senior centers — I’m not sure, or cut back days is probably what we’ll do ... they probably just didn’t think about nonprofits. They were looking out for the worker, so I think it was just an oversight that they didn’t consider what could happen to a nonprofit agency, and I’m positive that they’re really going to start looking for ways to help us.” Laura Beckelhimer, executive director of the Brooke County Senior Center, said the financial strain on all sides has equaled fewer services for fewer seniors in Brooke County. “We can’t take on as many clients because we can’t afford to hire the people needed,” Beckelhimer said. “We have a waiting list for meals because we can’t afford the gas and the upkeep on the older vehicles that we’re using to deliver it, and we can’t get new vehicles because there’s no extra money. We might have to cut down days we deliver — we have one route where we only deliver three days a week, and we might have to do that on some other routes.”



A new state revenue report has confirmed many fears in the state of Wyoming`s budget. The revenue forecast report released Monday concluded that Wyoming is expecting to receive 617 million dollars less than what state officials expected. The report calculated projected losses through June 2018. This fiscal year alone Wyoming is looking to accumulate nearly 160 million dollars in shortages. The Consensus Revenue Estimating Group accredited the losses to the struggling oil, coal, and natural gas industry. Federal regulations surrounding the natural gas industry and the inconsistent oil and coal markets have resulted in over 300 million dollars in financial losses for the state. "When you look at the volatility of it all historically the actual decrease we`re seeing here, we`ve seen decreases like this before. However, the report expects the levels to sort of stick around for a while given that the supply demand imbalance we`re seeing in both oil and natural gas, “said State of Wyoming Economic Analysis Administrator, Alex Kean. The most significant hit to the Wyoming economy came in the forms of natural gas and oil. Oil saw about a 200 million dollar decrease while natural gas saw a 110 million dollar reduction.