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State Disability News Highlights

By Diane McComb posted 01-28-2016 04:12 PM


State Disability News Highlights for Period ending 01/29/2016


Lead Story:   National - Rocky rollouts as states try Medicaid-managed long-term care - Chicago Tribune

The national move to home and community-based care away from nursing homes has been widely supported by senior citizen, consumer and disability rights communities. Surveys show older Americans prefer receiving health care services at home instead of in institutional settings. In recent years nearly a million people with disabilities or conditions severe enough to qualify for nursing home admission have been enrolled in Medicaid-managed long-term care programs, which operate like HMOs. In theory, the care for those very ill beneficiaries should improve with better coordination and lower costs. In Medicaid-managed long-term care, states pay private health plans monthly fixed rates to provide eligible beneficiaries' health care and services like transportation, home health nurses and personal aides for dressing, cooking and other activities of daily living. Plans only make money if they provide care for less than the monthly fixed fees. But most of the 26 states involved are new to providing managed long-term supports and services for this population. It's been a rocky transition for many beneficiaries and their families, who have seen cuts in services to parents and loved ones. Many have scrambled to find new doctors, hospitals and personal attendants. And while states like Texas and Wisconsin have seen costs drop, others such as Florida have seen hikes in health care spending. New York allowed its health plan contractors to assess eligibility for the long-term care program and the number of enrollees and program costs rose significantly. The Visiting Nurse Services New York paid the U.S. attorney in New York City $35 million in 2014 to settle fraud allegations for enrolling ineligible beneficiaries. And Connecticut and Oklahoma abandoned their managed long-term supports and services programs. This population uses many more health care and support services — services previously delivered mostly in nursing homes. States, which struggle with rising Medicaid costs, have learned that providing those services at home costs far less than nursing home stays. But politically savvy nursing home lobbies successfully fought those efforts for decades. In most states, however, the tide is changing. Many experts agree that managed long-term care holds promise for the sickest and frailest of patients. A two-year Massachusetts program saved the state $40,000 per year for each of the 2,000 patients treated in their homes rather than nursing homes. Those programs improved care, reduced hospital readmissions and ER visits and increased mammography screenings and flu vaccinations. Renee Markus Hodin, deputy director of the Boston-based Community Catalyst's Center for Consumer Engagement in Health Innovation, a not-for-profit that helps consumer advocacy groups working to expand access to health care, said the challenge is in replicating those small regional successes into statewide programs serving many more people. Hardin said a 1999 Supreme Court decision required the government to pay for long-term care in the least restrictive setting for people with disabilities and said the Affordable Care Act offered state Medicaid programs more flexibility. Fifteen states now spend more on home-based care than on nursing homes and that number is growing. States embrace managed care because it offers predictable costs. But the harsh reality of state budgets has compelled some Medicaid programs to cut spending. Patient advocates claim that states have changed eligibility requirements to reduce the number of new recipients and implemented service cuts that put vulnerable people at risk. In 2013 Kansas' Medicaid program, KanCare, adopted long-term managed care for 20,000 people with disabilities like Winn Bullers. In 2009 Bullers, 51, quit his reporting job at the Kansas City Star. He was born with degenerative muscular dystrophy that progressively destroys his muscle tissue and organs. By 2013 he was mostly bedridden. His doctors prescribed around-the-clock care. A KanCare health plan team re-evaluated Bullers to assess his needs, measuring how long it took him to perform daily activities. "I have a ventilator that needs continuous monitoring. I have Type 1 diabetes. I am a high maintenance guy," he admitted. "They crunched their numbers and concluded I only needed 25 percent of the time they had previously allotted me and cut my weekly care hours from 168 to 40, even though all my medical doctors told them I needed 24 hours per day or I would die." Bullers publicly protested. "I knew if I lost that fight, everyone else would lose, too," he said. But he appealed and won, never facing the proposed service cuts. "Had I not prevailed, I would have died. Unless you're a squeaky wheel, your voice isn't heard." Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, said KanCare's goal was never to cut expenses, but to slow the rate of growth in health care costs. De Rocha said hospital ER usage is down more than 27 percent for the home-based care population from the pre-KanCare rate. And that group saw significantly fewer hospitalizations, while many more now see primary care doctors, resulting in better outcomes. Other states sought similar results. Amber Smock, director of advocacy for Chicago-based Access Living, said Illinois overestimated what managed care plans could do. "There was an assumption that these plans knew how to move people out of nursing homes and into community settings," Smock said. "But they had no experience with that. Many patients were shocked to learn that physician specialists they'd depended on for years were no longer in their networks. This caused major life problems for many beneficiaries." Gordon Bonnyman Jr., a staff attorney with the Tennessee Justice Center, said managed care plans have incentives to cut provider rates because they share those savings. "I've been doing this for more than 25 years and regardless of what they claim about improving care and keeping people healthy, it's mostly about managing costs and bargaining for prices," Bonnyman said. Elizabeth Priaulx, senior disability legal specialist with the National Health Law Project, said patient advocates still report program problems, such as inaccessible doctor offices. "It's the responsibility of the managed care company to insure that its providers are accessible," she said. "But the bottom line is that states must police their contractors to make sure they are meeting the requirements." James Sheehan, the chief of the charities bureau for the New York attorney general, said the universal truth is everyone wonders how many good years they have left. Sheehan said most people will experience a time when they can no longer perform common daily activities. "The reality is this is what's going to happen to all of us at the end of our lives," Sheehan said, "and we need to be more conscious of how we care for each other now, because we're next."



The Alaska Legislature’s chief budget adviser has added his voice to calls for financial reform, saying in a report to his bosses [4] that the state’s “free ride” of oil revenue has ended and that Gov. Bill Walker’s proposed fix for a $3.8 billion budget deficit “indisputably takes a large step in the right direction.” In his annual review of Walker’s budget request, released this week, the adviser, David Teal, calls Alaska’s financial system “broken.” Relying on oil revenue to pay the state’s bills won’t work when both prices and production are low, he said. Using earnings of the Permanent Fund to help pay for government, like Walker has proposed [5], “is the most painless and sustainable way to fill deficits,” Teal said, even though the state has “pretended” for years that those earnings are “sacrosanct.” The analysis comes as lawmakers are beginning their dissection of Walker’s budget plan during their annual session in Juneau. Many have been critical of Walker’s proposal, which would reduce Alaskans’ Permanent Fund dividends and create an individual income tax, but Teal’s report offers lawmakers political cover to give more serious consideration to uncomfortable measures like taxes or smaller dividends. Comparing the status quo with Walker’s proposal, Teal wrote that lawmakers’ two options are to pass a “business-as-usual” budget that uses about 35 percent of the state’s savings, or adopt Walker’s plan and use 3 percent of savings. In interviews, several legislators said that they hadn’t read Teal’s report. But those who had offered a range of responses Rep. Steve Thompson, R-Fairbanks and co-chair of the House Finance Committee, called the analysis “on target,” given that oil prices have plunged even further than when Walker released his budget proposal last month. That budget assumed oil prices would average $50 a barrel this year. “What’s the price of oil today? $26?” Thompson asked. Walker is trying to restructure state finances by diverting most oil revenue into an enhanced Permanent Fund that would be used like an endowment to help fund government. Oil taxes and royalties made up 89 percent of Alaska’s general fund revenue in 2014, though that percentage has dropped after the recent crash in prices. The state faces a $3.8 billion budget deficit this year, with revenue expected to cover less than 30 percent of state spending, according to Teal’s report. Asked about Teal’s analysis of Walker’s plan, Sen. Pete Kelly, R-Fairbanks and co-chair of the Senate Finance Committee, said he respects Teal and seeks his advice.  “But ultimately the decisions are made by 60 other people,” he added, referring to the 60 members of the Alaska Legislature. “In general terms, is the governor stepping in the right direction? Probably. Do I agree with his plan? No, in specific terms.” Last year, lawmakers cut the $4.5 billion state operating budget by $400 million, or about 9 percent, and Walker is proposing to cut an additional $100 million [6]. Kelly has been one of the Legislature’s most forceful supporters of deeper cuts, saying in a news conference Tuesday that government needs to be “right-sized” and that he wants broad reductions. In his report, however, Teal wrote that when adjusted for inflation, the state’s operating budget is about the same as it was in 2010, and its per capita spending of $5,400 is less than any year since 2005.  To read more -



Gov. Doug Ducey is asking lawmakers to surrender oversight of state spending between regular sessions, if falling tax revenues put Arizona's budget in the red. The proposal, tucked in the governor's $9.5 billion spending plan, troubles some Republicans and Democrats in the Arizona Legislature, who expressed concern it could overstep the Constitution's separation of powers. Currently, when midyear budget adjustments are required, the governor calls lawmakers into special session. The governor cannot on his or her own withhold from any agency money appropriated by the Legislature, except to the Governor's Office. "The only job the Legislature is actually supposed to do, by statute, by the Constitution, is pass a balanced budget. To give up on part of that?" said Sen. Steve Pierce, R-Prescott. "If he (Ducey) wanted to call us in in six months and say, 'Things are going south, we need to change this,' I think that would be more appropriate than giving him the authority to do it. Otherwise, why is there a Legislature?" But giving Ducey the authority to make spending adjustments would provide "flexibility in the budget process" during economic downturns, Daniel Ruiz, a Ducey spokesman, said in a written statement. "When revenues are too low, the governor should have the ability to adjust spending to stay within the state's means." Daniel Scarpinato, also a Ducey spokesman, said quick spending adjustments can allow a more responsible budgeting approach. To read more -



The state budget deficit for the current fiscal year has grown to $72 million, according to the latest estimates from the legislature's fiscal office. The nonpartisan Office of Fiscal Analysis now pegs the deficit at a higher level than the governor's budget office, which projects the shortfall at $7.1 million. One of the biggest discrepancies between the two estimates is $46.5 million in savings that have not yet been allocated by Gov. Dannel P. Malloy. Malloy has the authority to make those cuts, which would slice the deficit sharply to about $25 million, but the amounts "have not been identified or allocated to state agency accounts,'' the fiscal office said Monday. Overall, the fiscal office is projecting about $38 million in increased spending and a drop in tax collections of $26.8 million since the state legislature voted to slice the deficit in a pre-Christmas session in December. The legislature's actions were designed to wipe out the deficit, but that has not yet happened. The totals include $75 million less in the state income tax and $46 million less in federal grants. But that was balanced off by an increase of $50 million "to reflect anticipated one-time corporate revenue,'' the fiscal office said. The latest estimates now say that the state income tax will generate $9.57 billion, which is more than double the amount of the sales tax and is by far the largest revenue generator for the state. But the problem for lawmakers is the state income tax projection is $264 million below the level estimated by the legislature when the state budget was crafted last year. In addition, the estimates for the state's cigarette tax were increased by $4.7 million. Officials said they had likely underestimated the amount of money that would be raised when the cigarette tax was increased to $3.65 per pack on October 1, up from the previous total of $3.40 per pack. Senate Republican leader Len Fasano said Monday that the continuing deficits were not a good sign with less than six months remaining in the fiscal year. To read more -



A group representing disabled inmates has filed a federal lawsuit accusing Florida prison officials of discriminating against prisoners who are deaf, blind or confined to wheelchairs, in violation of the federal Americans with Disabilities Act. The lawsuit, filed Tuesday in Tallahassee by Disability Rights Florida, alleges that the Department of Corrections failed to provide interpreters and auxiliary aids, prosthetic devices and wheelchairs, and assistants and tapping canes to inmates with disabilities. The lawsuit also accuses corrections officials of discriminating against disabled inmates by refusing to allow them to participate in services and programs available to other prisoners. The ADA violations cause prisoners "to suffer from the humiliation, indignity, and difficulties that accompany such exclusion" and also violate prisoners' constitutional guarantees of equal protection and due process, lawyers for the Florida Justice Institute and the Morgan and Morgan law firm wrote in the 123-page complaint. The lawyers spent two years investigating complaints from inmates before filing the lawsuit on Tuesday, according to a press release. Disability Rights Florida is asking a judge for an emergency injunction forcing the corrections department to comply with the ADA. Corrections officials knew about the alleged violations laid out in the complaint but failed to correct them, "thereby exhibiting deliberate indifference to the rights of individuals" in their custody, the lawyers argued. To read more -



Georgia has failed to ensure that developmentally disabled people discharged from state hospitals receive adequate services to remain safe and avoid harm, federal attorneys say in a recent court filing. The attorneys said that of the approximately 503 people with developmental disabilities discharged from state-run hospitals since 2010, 79 have died. “The available records indicated many unaddressed medical needs,” said U.S. Department of Justice attorneys in their arguments for improvements in community services for people with developmental disabilities and mental illness. “While the majority of these persons had complex medical needs that are associated with higher mortality, many of the death reports document poor assessments, care, and oversight across the state,” said federal attorneys Jan. 19 in their filing in federal court. Some of the deaths were not investigated by the state, said a consultant for the Department of Justice who analyzed state r344dwecords. The federal filing, which asks for court intervention, contain new details about problem areas that remain with a 2010 settlement agreement between Georgia and the Justice Department over care for people with mental illness and development disabilities. Georgia and DOJ remain at an impasse over provisions of the pact, despite U.S. District Court Judge Charles Pannell’s recent push for quicker action to resolve their differences. Earlier this month, after meeting with the two sides, Pannell told them to prepare for a formal hearing in late March. A spokeswoman for the state Department of Behavioral Health and Developmental Disabilities said Monday that the agency will appear at a court hearing on the matter March 28. “We remain steadfast in our commitment to fulfill the settlement obligations and to support recovery and independence for the people we serve,’’ said the spokeswoman, Angelyn Dionysatus, in an email to GHN. Previously, Jaime Theriot, an attorney representing Georgia, has argued that the state has fundamental disagreements with the Justice Department over what is required under the settlement. Theriot has said the state does not dispute the numerical targets on hospital discharges. But she said Georgia does object to what she called a federal “attempt to enforce terms that don’t exist in the settlement agreement.” To read more -



Hawaii lawmakers are introducing a bill that could make the state the first in the nation to offer long-term care benefits to seniors. Democratic Sen. Rosalyn Baker said during a legislative hearing Thursday that the bill would provide eligible seniors with a benefit of $70 per day for a year. The seniors could use the benefit to pay family caregivers, hire in-home aides and help offset the cost of safety equipment, like walkers and ramps. The bill would ask for a 0.5 percent increase in Hawaii’s general excise tax to cover the costs. The tax is about 4 percent and it’s added to most business transactions in the state. University of Hawaii political professor Lawrence Nitz says about 25 percent of the tax revenue comes from visitors.



Gov. C.L. "Butch" Otter's proposal to provide basic medical coverage to people who fall in the so-called "Medicaid gap" has been split into two separate bills, meaning the plan will have to pass through two separate committees to succeed. The Republican governor's program, if approved, would create a new program to provide basic medical care to nearly 78,000 Idahoans who make too much to qualify for Medicaid but also don't qualify for health insurance subsidies. The funding mechanism of the proposal — arguably the most critical part of the legislation — will have to clear the House panel in charge of vetting tax changes, said Republican Rep. Gary Collins of Nampa, who chairs the Revenue and Taxation Committee. "I haven't seen a bill yet from the governor's office," Collins said. "But that's what I've been told." Meanwhile, members on the House Health and Welfare Committee will be asked to sign off on the structure of the program. Otter's proposal — dubbed "Ottercare" by Idaho's Democratic lawmakers — comes with an estimated $30 million price tag. The funding is proposed to come straight from the state's coveted cigarette and tobacco taxes. The state tobacco tax is a 35 percent levy on wholesale prices on non-cigarette tobacco products, and the cigarette tax is 57 cents per pack. Together, they are estimated to bring in more than $44 million in the upcoming fiscal year that starts July 1. To read more -



Republican Gov. Bruce Rauner is delivering his second State of the State address Wednesday during one of the most tumultuous times for Illinois in recent history. The seven-month budget standoff with Democrats who control the Legislature has caused cuts to social services and higher-education programs and plunged the state further into debt. Neither side is budging. Democrats say a tax increase is necessary to close a multibillion budget hole. Rauner maintains he won't support a tax increase without reforms he wants, including imposing term limits, limiting the power of unions and making it easier for businesses to operate in Illinois. Homeless shelters, mental help counseling and in-home care for seniors are among the 30 programs Lutheran Social Services is closing because of $6 million in overdue bills from the state, the 149-year-old agency announced Friday. The agency also is laying off 750 employees - about 43 percent of its staff. The programs closing served 4,700 people. Around the state, hundreds of human services agencies have made cuts and the future looks dire, according to a survey released Tuesday by the United Way of Illinois. It found that 85 percent of 444 agencies it queried this month have reduced the number of clients they serve since July, when the state's annual budget should've taken effect. The agencies provide an array of services, including emergency housing, aid for disabled children, home-delivered meals for seniors and employment training. To read more -



Gov. Terry Branstad’s plan to privatize Medicaid will save the state millions of dollars less than the figure on which lawmakers based this year’s budget, documents obtained by The Des Moines Register show. The revised estimate shows a savings of $36.6 million in the first six months. That's nearly $15 million less than was previously projected. The latest report — and the only one to date that provides a cost-savings estimate — was completed on Oct. 30. That is 23 days after Iowa Department of Human Services Fiscal Manager Jean Slaybaugh testified in court that a $51.3 million six-month savings projection was based upon a midpoint of estimates provided by multiple experts, some of whom predicted that privatization would save the state no money. Agency officials, however, were unable to document how they arrived at that number or identify any of the multiple experts they said they consulted in the process. The new document was prepared by Milliman, a Seattle-based actuarial firm the state regularly uses to calculate projected costs and savings. It was provided to the Register after Branstad mentioned it during his meeting with the newspaper's editorial board earlier this month, saying  the savings would top $102 million a year. Branstad said failure to achieve the Medicaid savings could mean cuts into education funding. “You want to cut education by $100 million? You could criticize it all you want, but you tell me what you would do differently and come up with the other $100 million,” Branstad told the editorial board. The report does show a nearly $104 million six-months saving but the majority of that — 65 percent — is federal money and does not affect the state budget. DHS spokeswoman Amy McCoy said the department sought the report as part of preparations to launch the privatized programs. She said the report doesn’t include all of the savings the department anticipates, including contract adjustments. Asked to document those additional savings, she said that information was not available. To read more -



Kansas will bring its privatized Medicaid program before federal officials for reauthorization this year, but with new requirements to better serve rural populations, the state’s top health official said. Susan Mosier, secretary of the Kansas Department of Health and Environment, spoke to the House Children and Seniors Committee on Tuesday about Medicaid and the Children’s Health Insurance Program. In Kansas, three private managed care organizations administer Medicaid and CHIP through a waiver program known as KanCare. Photo by KHI News Service Susan Mosier, secretary of the Kansas Department of Health and Environment, told a House committee that the state will seek federal reauthorization for KanCare later this year and include new requirements to better serve rural populations. View larger photo KanCare is open to adults with certain disabilities or chronic conditions, the “frail elderly” and low-income children and pregnant women. Adults without those conditions are eligible only if they have a child and earn less than 38 percent of the federal poverty line, or about $6,050 annually for a family of two. KDHE will develop a request for proposals to administer KanCare and submit it to the federal Centers for Medicare and Medicaid Services this fall, Mosier said. If CMS approves, KDHE will send the request for proposal for bids by the end of 2016, she said. The winning bidders would take over in January 2018.  To read more -



These hardscrabble Appalachian hills so rife with need and illness have been a national testing ground for Obamacare over the past two years, but they may soon test something more fundamental – the age-old struggle to balance personal responsibility with the obligation to care for the poor. The Affordable Care Act gave thousands of residents in Eastern Kentucky, one of the nation’s most vulnerable communities, unprecedented new access to health care – mostly through expansion of taxpayer-funded Medicaid, helping make Kentucky a national model. But it also raised fears about yet another burden on a fragile state budget and skepticism among conservatives who saw it as out of step with their political ideology. Newly elected Republican Gov. Matt Bevin alluded to both concerns when he announced plans to remake Kentucky’s Medicaid expansion to look more like nearby Indiana’s program, a more limited version that calls for patients to share more costs so they have a bigger stake in their care. Bevin is moving forward with plans to dismantle the state’s popular “kynect” health insurance exchange where residents sign up for both Medicaid and private coverage. If the governor succeeds and Medicaid changes begin next year, Kentucky would join six other states with specially-designed Medicaid expansion programs approved by the federal government. It also would be one of the first states to replace the traditional Medicaid expansion envisioned by the ACA with one that includes co-pays and premiums.



Gov. Paul LePage has announced a plan to house forensic mental health patients at the Windham Correctional Center. It’s part of a major proposal that would delay the planned renovation of Windham, and lawmakers tried to get more details at a hearing Friday at the State House. During MPBN’s call-in radio program Maine Calling, LePage was asked what could be done to improve the state’s response to the ongoing opioid drug crisis. The governor surprised many by indicating that he wants to delay action on a bill that would have renovated the Windham Correctional Center so that he can develop another plan that would bring forensic patients there. “I am going to be ready shortly to give a comprehensive conceptual framework of what we want to do and then we’ll get the rest of the plans together,” LePage says. The plan is aimed at helping the state win back federal recertification for the Riverview Psychiatric Center, and $20 million in forfeited Medicaid payments that were lost due to noncompliance issues that arose over patient care. LePage’s plan is also expected to address serious infrastructure issues at the aging prison, which has been planning a $173 million renovation. It appears the administration will instead substitute a bill with provisions for both Windham and Riverview. To read more -  



Governor Charlie Baker on Wednesday unveiled a $39.6 billion budget proposal that would add 281 workers to the state’s child protection agency, add recovery beds for opioid addicts, and make good on a campaign pledge to change the state’s welfare system. The Republican governor also pledged to slow the rise of state health care spending on the poor as part of an effort to bridge what administration officials have pegged as a $635-million budget gap.  “Getting state spending under control,” Baker said at a news conference flanked by top officials, “is essential to the state’s economic health going forward.” The governor’s proposal drew a range of reactions from advocates, activists, and lawmakers in the Democratic-controlled Legislature, which will have the final say over state spending. Attorney General Maura Healey, perhaps the highest-profile Democrat in Massachusetts, thanked Baker on Twitter for proposing new money for law enforcement to combat drug trafficking and curb the supply of illegal opioids. The state Democratic Party, though, panned the budget as a “status quo” document, lacking vision. Perhaps the strongest criticism came from advocates for the poor, who savaged Baker’s attempt to cut welfare payments for the disabled. “To do something that is going to hit families that are headed by a severely disabled parent, and pauperize them even further, would put children at dramatically increased risk of homelessness, hunger, and illness,” said Deborah Harris, senior staff attorney with the Massachusetts Law Reform Institute. But Jeff McCue, commissioner of the Department of Transitional Assistance, said the state would take the estimated $29 million in savings and pour it into job training, transportation to and from work, and child care. “It’s a pretty strong menu of true stabilization efforts for the working poor,” he said, adding that the services would promote self-sufficiency. Harris said the job supports are worthy programs, but the disabled people losing cash assistance would have little use for them because they cannot work. But many advocates praised Baker’s push to spend more on the beleaguered Department of Children and Families, which has come under fire for the injury or death of several children under its supervision in recent years. To read more -



Governor Jay Nixon today to announce that his Fiscal Year 2017 budget proposal earmarks additional funding for Missourians with developmental disabilities, including $5 million to expand the University of Missouri Thompson Center for Autism.  The money will allow the center to accommodate an additional 2,000 visits per year by expanding dedicated research and training space, and train 100 more providers over the next five years to alleviate the shortage of autism services in Missouri.  “Here in Missouri, we believe that all children – including those with autism – deserve the opportunity to live up to their God-given potential,” Nixon said. “From passing landmark autism insurance legislation to expanding access to in-home services through the Partnership for Hope, we have made Missouri a nationally-recognized leader in caring for our most vulnerable citizens.” The Governor’s budget will also include $1 million to help launch an autism clinic at Truman State University and $500,000 to expand services at the Mercy Kids Autism Center in St. Louis and St. Charles counties. “We’ll be able to expand our clinical services to accommodate more than 2,000 additional clinic visits each year, getting more children the diagnostic and treatment services they need,” said Thompson Center Executive Director Dr. Stephen Kanne. The center provides more than 8,000 instances of online and in-person professional and parent trainings annually.  The center also expects to offer greater capacity for newer programs that promote autism best practices in the community and supporting families To read more -


New York

Gov. Andrew Cuomo's proposed health care budget makes no provisions for a $15 minimum wage even though it will lead to higher Medicaid costs, according to health industry officials and lawmakers who attended a daylong hearing Monday on the governor's proposed health care budget. "How will this be addressed in the context of the budget?'' western New York GOP Sen. Cathy Young asked state Health Commissioner Howard Zucker and Medicaid Director Jason Helgerson. "All of us expected that at some point in this budget document we would see funding,'' added Staten Island Sen. Diane Savino, an Independent Democratic Caucus member. "There is no allocation for them to be able to pay that minimum wage.'' Cuomo has made the push for a $15-an-hour minimum wage a centerpiece of his agenda for this year. While many hail the move, others such as the operators of not-for-profit human service agencies and businesses like nursing homes and home care agencies say it will impose higher costs.  Many of those institutions get substantial funding from Medicaid, the federal/state health insurance program for the poor. At more than $50 billion, Medicaid is among the largest of state budget items, along with education. But with no clear budget item it remains unclear how the Medicaid-related raises will be funded. Health care providers laid out the potential costs of a raise. The state's Home Care Association, in a report prepared for the hearing, estimated that the minimum wage increase will cost their industry $1.7 billion. To read more -


North Dakota

North Dakota suffered its worst revenue shortfall of the current biennium so far in December, with tax revenues arriving more than $63 million below forecast and further darkening the state’s budget picture as an advisory group prepares to meet Friday to discuss a new forecast. Last month’s shortfall brought the total gap for the first six months of the biennium to $215 million below the forecast that state lawmakers had when they adjourned in late April. Office of Management and Budget Director Pam Sharp said that makes it “very, very likely” that state agencies will see across-the-board budget cuts and that the state’s $572 million Budget Stabilization Fund will be tapped to cover any remaining shortfall. Sharp said it also affirms her decision last month to request a new revenue forecast from Moody’s Analytics. The state’s Advisory Council on Revenue Forecasting will meet with Moody’s officials at 9:30 a.m. Friday at the Capitol to discuss factors for the new forecast, including taxable sales and purchases and the price of crude oil, which has dropped by more than half since lawmakers adjourned. If the new forecast predicts that state revenues will be $400 million to $500 million below projections, it will trigger automatic budget cuts  for most state agencies of up to 2.5 percent, or about $105 million, Sharp has said. State law allows the governor to use the Budget Stabilization Fund to cover any shortfall beyond the 2.5 percent. To read more -



Lawmakers are concerned that a spiraling drop in oil prices could result in a second revenue failure for the current fiscal year. A number of scenarios to deal with it are under discussion, including additional cuts in general revenue to state appropriated agencies, House Appropriations and Budget Committee Chairman Earl Sears, R-Bartlesville, confirmed Wednesday.  “If oil continues to drop, I feel there will be another revenue failure for 2016,” Sears said in response to questions about the budget. The regular session begins Feb. 1, when lawmakers will craft a fiscal year 2017 budget. That budget is expected to be at least $900.8 million less than the current fiscal year budget. A revenue failure for fiscal year 2016 was declared in December. As a result, Finance Secretary Preston Doerflinger made a 3 percent across the board cut in general revenue to state appropriated agencies. Doerflinger can make across the board cuts to state agencies, but only lawmakers can make targeted cuts, Sears said.



A federal judge has dismissed much of a long-standing lawsuit over Tennessee’s treatment of people with intellectual and developmental disabilities. Advocates sued the state in 1995 over conditions at several Tennessee institutions, including the Clover Bottom Developmental Center in Nashville and the Greene Valley Developmental Center in Greeneville. Last year, parties to the lawsuit agreed to an exit plan requiring the Department of Intellectual and Developmental Disabilities and the Bureau of TennCare to complete several obligations. They included developing training for law enforcement, physicians and caregivers around the special needs of people with developmental and intellectual disabilities. The DIDD also has revised support plans to include the person’s “vision of a preferred life” and ways to implement that vision. And the department is implementing a new model for dealing with serious psychiatric or behavioral health needs. It also has established a respite program for times when caregivers may be overwhelmed by their responsibilities. The state closed the 90-year-old Clover Bottom Developmental Center late last year. At its peak in the 1960s, it housed 1,500 people. In November, the Department of Intellectual and Developmental Disabilities moved the last six residents into small group homes. To read more -



Despite years of discussing the issue without resolution, Utah lawmakers will again take on Medicaid expansion and various plans to implement it for the thousands of Utahns who remain uncovered by health insurance. And, while some lawmakers are taking approaches that have been tried before, others are trying new things — an indication of a potential desire to bring health care benefits closer to Utahns who can't afford them. "We're moving slowly in the direction of getting it. It's frustrating how long it takes, but I believe we're moving in that direction," said Rep. Ray Ward, R-Bountiful, who is backing a bill (HB18) with an underlying concept similar to that of UtahAccess+, which failed to gain favor of the house majority and never made it before the whole body for consideration last summer. There are nearly 70,000 Utahns in the coverage gap — earning too much to qualify for existing Medicaid coverage, but not enough to qualify for subsidized health insurance through the Affordable Care Act's federal marketplace. The majority of them has no option for health care and usually end up looking for help in the emergency room, with insured Utahns making up for those costs. Ward wants health coverage options for every Utahn in the coverage gap, up to 138 percent of the federal poverty level, seeking waivers to get there and then pay for it with a hospital assessment and a new tax on e-cigarettes. To read more -



Virginia Gov. Terry McAuliffe’s administration is seeking an extra $110 million over the next three years to provide more services to residents with severe disabilities to comply with a federal court settlement. The money would intensify the state’s efforts to move people off a waiting list for services that currently has about 10,100 names. It would fund 855 Medicaid waivers for residents who do not have them and pay for an overhaul of how the state awards those waivers to better prioritize services for people in immediate need of aid. The state Department of Behavioral Health & Developmental Services (DBHDS) also plans to expand the services it offers to families of the disabled who are in crisis; shut four state-run institutions; and finance the construction of more homes or apartments for the disabled in communities where those facilities are in short supply.  “This will be a really significant step forward,” said Jack Barber, interim commissioner of the state agency for people with disabilities. “It will be very significant in moving us into compliance with the settlement agreement, but more importantly, providing the kinds of services in integrated settings that we want to provide.” Virginia has struggled to comply with the terms of a 2012 federal court settlement that, based on the Americans With Disabilities Act, requires the state to offer more opportunities for people with disabilities to live and work in community environments rather than in institutional settings.