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VOR Weekly E-Mail Update
December 14, 2007
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Table of Contents:
1. H.R. 3995 Update –
Cosponsors and Calls to Action
FUNDING FOR SERVICES FOR PEOPLE
WITH DISABILITIES
2. South Dakota: Centers for
disabled want to boost wages
3. Florida:
Patients lose rides to doctor; Funding shifted away from
transportation
4.
U.S. Congress: House set to consider year-end spending
package, Dec. 18
5. Give the gift of a VOR
membership –
Membership/contribution form is included at the end of this
Update.
Coming Up:
There will be no regularly published update again until Friday,
January 11, however H.R. 3995 advocacy updates will be published
as necessary during this time. Happy Holidays!!!
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1. H.R. 3995 Update – Cosponsors
and Calls to Action
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CURRENT
COSPONSORS
The list
of H.R. 3995 cosponsors is GROWING. Thanks for all your advocacy
efforts. Keep it up! Here is the most recent list of
cosponsors:
Rep. Michael Capuano (D-MA)
Rep. Bob Etheridge (D-NC)
Rep. Charles Gonzales (D-TX)
Rep. John B. Larson (D-CT)
Rep. Stephen Lynch (D-MA)
Rep. James McGovern (D-MA)
Rep. James Moran (D-VA)
Rep. Ron Paul (R-TX)
Rep. Christopher Shays (R-CT)
Rep. Carol Shea-Porter (D-NH)
Rep. Lynn Woolsey (D-CA)
Rep. Tim Walberg (R-MI)
VISITS, VISITS, VISITS!
VOR has
heard from several VOR members who have already requested
appointments with their U.S. Representatives for the upcoming
Dec/Jan recess. THANK YOU!!
As we have
reported, at the end of December and for the first couple of
weeks of January, Members of Congress will be working in their
District offices. Although the exact date of adjournment is not
yet known, Congress seems poised to head home next week
sometime. NOW is the time to request an appointment so
that you can share your support for H.R. 3995 and DIRECTLY ASK
HIM/HER TO COSPONSOR H.R. 3995.
Here’s the
Action Plan that will be included in the upcoming VOR
newsletter:
Your Advocacy “To
Do” List:
1. TODAY,
identify your U.S. Representative (Visit
http://www.congress.org; call Tamie/VOR at 605-399-1624; OR
contact your local library).
2. TODAY,
find contact information for the nearest District office.
3. TODAY,
call the District office and request an appointment.
4. TODAY,
contact Tamie at
Tamie327@hotmail.com or 605-399-1624 for H.R. 3995 handouts
and help with questions.
5. TODAY,
share this Call to Action with other advocates.
6. MEET WITH YOUR
REPRESENTATIVE,
and ask him/her to cosponsor H.R. 3995. After the meeting, be
sure to send a thank you note.
IT’S UP TO YOU:
Congressmen/women want to meet with CONSTITUENTS – that’s YOU!
Thank you
very, very much – and remember, VOR is here to help.
ACTION ALERT
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2. South
Dakota: Centers for disabled want to boost wages
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Summary:
The “centers” referred to in this story are “adjustment training
centers,” private nonprofit organizations providing residential
and other services to persons with developmental disabilities in
South Dakota. The state has only one state operated residential
center, in Redfield, SD. Advocates have called on the state
legislature to increase the wages of those direct care workers
who serve 2,650 disabled adults throughout South Dakota.
Currently, these direct-care workers are expected to make health
and safety decisions. They have to know counseling strategies
and how prevent or intervene in crises. They also administer
medications - all for about $20,000 a year. The hope is that by
increasing wages, tenure (which now averages less than 2 years)
will improve. One lawmaker has suggested a 3-year pilot program
to see if increased wages lower turnover, a proposal advocates
support.
Centers for disabled want to boost wages
By Bill Harlen
December 9, 2007
Former
Easter Seals kid Abbi Wells of Rapid City depends on Michelle
Findley to help her live as independently as possible.
Findley is an associate instructor for the Black Hills Workshop,
which serves 600 developmentally disabled adults. Wells, now 29,
lives in one of the workshop's group homes.
Higher wages for Findley and her colleagues, who take care of
2,650 other disabled adults throughout South Dakota, will be the
subject of a debate when the Legislature convenes in January.
Advocates for the state's 19 adjustment training centers,
including Black Hills Workshop, say the state should spend more
money to bring pay at the centers up to market levels.
Gov. Mike Rounds has proposed a 2.5 percent inflation increase
for health-care providers such as ATCs, but that falls far short
of what advocates for the centers want.
Rep. Jeff Haverly, R-Rapid City, who is a member of the House
Appropriations Committee, predicted legislators would propose
more money for ATCs. "There will be something more," Haverly
said. "We need to make sure we're taking care of people the way
we should."
The Black Hills Workshop takes care of people with developmental
disabilities ranging from mild to severe. Wells, who has
cerebral palsy, needs full-time assistance. Her parents,
schoolteachers Marti and Kent Wells of Box Elder, cared for her
until she was 25, when they lost a trusted private caregiver.
"The problem is, who can you rely on to always be there?" Marti
Wells asks.
The answer for the Wells family was Black Hills Workshop and
people like Findley. "She's very cool," Abbi Wells says. "She's
a good person to be around."
However, it's increasingly difficult to keep good people like
Findley on the job.
The wage gap
Associate instructors at the Black Hills Workshop earn $9.50 an
hour to start. Findley, with three years of experience at the
workshop and 10 years in the field, earns $10.40 an hour. For
the extra 90 cents, she's also expected to train new hires.
These direct-care workers are expected to make health and safety
decisions. They have to know counseling strategies and how
prevent or intervene in crises. They also administer medications
- all for about $20,000 a year.
"That just isn't enough for what we ask our folks to do," Black
Hills Workshop vice president Brad Saathoff says.
The South Dakota Association of Community Based Services
estimates there is a $1.06 per hour salary gap for direct-care
workers like Findley. The result, the association argues, is
that 48.5 percent of the direct care staff at the state's
adjustment training centers have been on the job less than two
years.
Solutions A and B
The association's proposed solution, presented to the
Legislature's interim appropriations committee last month, would
provide an additional $19.2 million over the next three years -
mainly to give raises to Findley and her colleagues at the
state's 19 private, nonprofit adjustment training centers.
That would also include a 3 percent-inflation raise that would
mainly go toward increased costs such as fuel, utilities,
maintenance and employee health insurance.
The state's share of the increase would be $7.5 million, which
would trigger an additional $11.6 million in federal funds.
That money would be in addition to the more than $90 million a
year in state and federal funds that South Dakota already spends
for people at the state's 19 private, nonprofit adjustment
training centers.
ATC advocate Tom Scheinost says his group, the South Dakota
Association of Community Based Services, already knows that the
$19.2 million plan is "too big a chunk," even spread over three
years.
A more modest ATC proposal would give the workers earning less
than the mid-point wage for their position an additional 2.5
percent raise. State workers are on a similar plan.
Giving the lowest-paid ATC workers would cost about $1 million,
Scheinost says - or $400,000 in state money matched by $600,000
from the federal government.
The Rounds budget, however, has no money for that plan, either
Part of the debate in January will be about where extra money
might be found for ATCs.
Living a 'whole life'
For
Abbi Wells, the debate is about quality of life.
Wells and a dozen other Black Hills Workshop clients live at a
group home on Sitka Street in Robbinsdale, in a quiet, well-kept
neighborhood of single-family homes.
On a typical afternoon, electric-wheelchair traffic is heavy in
Sitka. "Sometimes, this place is like a war zone," Findley says,
the way you'd say that about any family get-together.
Residents live in single rooms in Sitka. They have their own
televisions, phones and computers, if they can afford them, and
they decorate their rooms to their taste.
Wells' room, for example, is filled with Betty Boop memorabilia.
A typical morning for Wells begins about 6 a.m., when Findley
helps her into the electric wheelchair she can operate herself.
Findley helps her bathe, dress and make breakfast.
Wells is not housebound. She has a job stringing blinds at a
workshop on Range Road in west Rapid City, and she also gets out
for shopping, trips to a city pool or to meet with a writers'
group.
"I'm very busy," she says.
An associate instructor is always close by, but Findley
considers herself a teacher and coach, not a caretaker.
"If they can help pour cereal or help make a pancake, if they
can mix up something in a bowl - whatever it they can do, that's
fine," she said. "We want them to be as independent as
possible."
Gates says, "We really have a direct impact on whether people
have a whole life or not."
Wells' day, for example, also includes hanging out with friends
like Kelli Blosmo, 29, who lives across the hall.
Blosmo, who also has cerebral palsy, moved to Sitka four years
ago from another group home. "It's more fun here," she says. "I
have more freedom to do whatever I want."
Blosmo gets around town on her own. "If I want to go for ice
cream or go shopping, or if I want to be with my friends, I call
Dial-A-Ride."
Blosmo likes Dial-A-Ride so much she's campaigning to expand the
service's hours. Sometimes, speech is a struggle for Blosmo, but
she's talkative, cheerful and determined learn how to express
herself better.
"I'm
working on it as hard as I can," she says. Findley, 37, works
hard, too, and it's difficult to put a price tag on her
experience. In three years at Sitka, she has earned the trust
and friendship of Wells, Blosmo and other clients. Just as
important, she knows them well enough to accurately measure
their progress.
But Findley also needs a part-time job to make ends meet. "There
is a burn-out factor at work here," she said - even for someone
who loves the work. Staff turnover is always hard on clients.
"I get very emotional when they leave," Blosmo said. "It really
breaks my heart. I love them and like them very much."
Blosmo says she has learned to adapt to new staff. "After two or
three weeks, I'm sort of used to them," she says.
Tara Wilcox, community living supervisor for Sitka and three
other group homes, says her staff also has learned to cope with
turnover.
"We're making this work," she insists. But Wilcox wants to make
direct care at group homes a destination job that employees will
keep for more than a year or two.
Saathoff says low pay also is a problem for middle managers and
supervisors, who run the workshop's 17 residential facilities
and job sites scattered throughout Rapid City.
Barry Gates, for example, is a service coordinator at Sitka. He
monitors continuity of care - making sure nothing is overlooked
- and he works with associate instructors to help clients to
develop long-range goals and dreams.
Service coordinators must have a college degree, but the
starting salary is only about $25,000 a year - or about $5,000
less than a starting teacher in Rapid City.
Gates is retired from the Air Force, and like many workshop
employees, he's going to school.
When he gets his degree in special education, he'll leave his
job at Sitka for a better-paying position with a school
district. The effects of that turnover can be dramatic. On a
recent afternoon, one of Gates' clients at Sitka erupted in
anger, throwing a chair, acting out his frustration and sadness
over Gates' upcoming departure.
Pay raise prospects
A proposal similar to the new $19.2 million plan failed to win
enough support last year even to be introduced as legislation.
"I think it was sticker shock," Saathoff says.
Last month, however, legislators on the interim appropriations
committee seemed to support spending more on ATCs. State Sen.
Jerry Apa, R-Lead, chairman of the Senate Appropriations
Committee, called staff turnover at the centers a "crisis,"
saying it threatened the survival of some the facilities.
In the long run, Apa argued, closing centers could force clients
into the more expensive state-owned facility at Redfield.
State Rep. Jim Putnam, R-Armor, chairman of the House
Appropriations Committee, suggested a three-year pilot program
to see if raises reduce turnover.
"We want to keep good folks on the job," he said.
Scheinost said, "We jumped at that suggestion."
But even lawmakers who support spending more on ATC care are
uncertain where they'd get the money. Putnam also points out
that employees at other nonprofit facilities - nursing homes,
for example, and drug treatment centers - also will want raises.
Haverly, however, said ATCs should be "on the top of the list,"
in part because they've been making their case for at least four
years.
Gov. Mike Rounds, in his state budget address Tuesday, said he
wished he could give schools, state employees and health-care
providers a 3 percent-inflation increase, but the governor also
repeatedly said the state didn't have enough money.
Even a 3 percent-inflation increase would fall well short of the
three-year, $19.2 million proposal, and it would not provide
bigger raises to the lowest paid workers.
In January, ATC advocates will see whether lawmakers can pass
their own bill and, if they do, whether the governor will sign
it.
Scheinost said he was "not completely pessimistic," but Rounds
said Friday he was unlikely to approve more money for ATCs
beyond a 2.5 percent raise. "That's not on my radar," he said.
Whatever the governor and the Legislature decide, Abbi Wells and
her family will learn to live with it.
If the turnover rate remains high, Wells might miss out on some
of her activities. Her educational progress might slow. But she
has no other options.
"The Black Hills Workshop is the only game in town," Marti Wells
says.
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3.
Florida: Patients lose rides to doctor; Funding shifted away
from transportation
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Summary:
Florida budget cuts are being felt by Medicaid consumers who
rely on subsidized transportation to get them to and from
doctor’s appointments. In Florida, the state Agency for Health
Care Administration gives Medicaid money to the Commission for
the Transportation Disadvantaged, which in turn, contracts with
county and private nonprofit busing companies to transport
Medicaid-eligible patients to doctor appointments, as well as
clients of the Department of Children and Families and
Department of Elder Affairs. The following news story details
one private nonprofit bus company’s struggle to keep pace with
demand and budget cuts. The result has been cuts in services,
leaving some needy Floridians stranded. And, cuts to
transportation are only part of the story. In Florida, the
Agency for Persons with Disabilities is facing cuts of $144
million from its budget, which has already resulted in caps and
cuts to services. A group of 6 consumers with developmental
disabilities have sued in federal court to challenge the
cost-cutting state law (see, London v. Agwunobi).
By Jennifer Booth
Reed
December 10, 2007
News-Press
In the past
month, Johanna McCants has missed two appointments with her foot
specialist, a physical therapy session and a trip to the lung
doctor. It's all because she couldn't get transportation.
Good Wheels Inc., the nonprofit bus service she uses, recently
scaled back its service for Medicaid recipients like the
65-year-old McCants because its director said state funding
hasn't kept up with passenger demand, gas prices and insurance.
Now, the bus company is cutting services even deeper, which
means patients like McCants may not get rides at all.
On Jan. 1,
Good Wheels will see a $39,000-a-month budget reduction, a
result of a state Medicaid policy shift and funding change.
Good Wheels President Gary Bryant said the entity will stop
providing rides to people who need occasional medical trips or
who must travel out of the county for specialized care. That's
about 10-25 people per day, although the number requesting the
service but not getting it because of budget constraints is
higher.
Good Wheels
will continue to bus patients managing chronic conditions, such
as those needing dialysis, chemotherapy and ongoing
rehabilitation therapies. The company provides rides for 100-115
such patients every day.
The changes
only affect Medicaid recipients, and not those who ride Good
Wheels by other means.
Bryant is not the only one cutting services.
Officials from Miami-Dade, Escambia and Sarasota counties told
the state Commission for the Transportation Disadvantaged — the
agency that distributes the Medicaid transportation money — they
are getting out of the Medicaid transportation business, said
commission spokesman John Irvine. During an emergency meeting on
Friday, the commission awarded contracts to new providers.
"Throughout
the state, there's not enough funding locally, and the county
governments are making up the difference," Irvine said. "A lot
of them are saying, 'We're not doing this anymore.'"
That's scary to patients like McCants, who already has had a
tough time finding a ride.
"It's
really becoming a problem," McCants said.
What happened is this: Florida has been moving its Medicaid
beneficiaries from the traditional state-run program into
private health management organizations, or HMOs, to manage
costs and increase consumer choices.
The patients' share of transportation dollars followed them out
of the state-run system that pays Bryant and other private or
county bus services.
New
Medicaid figures
New figures
from the Agency for Health Care Administration show 13,355 Lee
residents have shifted from state-run Medicaid to a Medicaid
HMO. There are a total of 50,270 Medicaid clients in Lee, though
not all of them qualify for transportation help.
In all, 28
counties saw patients move into the HMOs and will lose $8.6
million in transportation money. That follows a $1.3 million
adjustment made earlier this year.
On the surface, Bryant said, the cut sounds reasonable: If he
has fewer clients, he should get fewer dollars. But it doesn't
work like that, he said.
He said HMO
patients are less sick and less dependent upon his service than
the clients who are left in state-run Medicaid. In effect, the
minimal users subsidized the frequent users — just as in an
insurance company the healthy clients' premiums offset the cost
of caring for the sick, according to Bryant.
"They've cherry picked," said Glee Duff, the president of the
Good Wheels board of directors.
Irvine said he's heard that complaint from other transportation
directors, too, but he has no data to support it.
"But that's
the CTD's biggest fear: Don't take the easy ones and leave me
with the hard ones," Irvine said, referring to the Commission
for the Transportation Disadvantaged.
Medicaid
reform
Whether the
HMOs can provide transportation more cheaply also is unclear.
Irvine said he's seen no data analyzing HMO transportation
spending. It appears the insurers get a lump sum per patient to
cover all their needs, he said.
Agency for Health Care Administration spokeswoman Shelisha
Durden said the state has not changed the overall amount it's
spending on transportation services. It has simply shifted
dollars.
The busing
situation is one piece of a Medicaid reform effort the state
hopes will manage the cost of caring for the poor and offer more
consumer choice. A report from the Legislature shows Medicaid
swallows 22 percent of the state's $71 billion budget — the
biggest line item behind public education — and is projected to
rise by $563 million in fiscal year 2008-09.
The privatization strategy, however, has been criticized for lax
oversight — the FBI raided one Medicaid HMO in Tampa last month
— and the companies' poor reimbursement rates to doctors.
Good Wheels' monthly amount is now $65,000 a month, down from
$104,000.
The new
amount isn't enough to cover all the people who need regular
care, such as the dialysis patients, Bryant and Duff said. The
board of directors has voted to spend $15,000 to $25,000 a month
of Good Wheels' revenue to ensure they get rides. The bus
company earns money from charter services and other endeavors.
Duff doesn't know for how long the board can offer those funds.
"There's
only so much money. This is a not-for-profit," he said.
Bryant said he worries he'll eventually lose his contract to
provide Medicaid transportation if he can't meet the demand.
"What the state has done and has said is, 'Here's what you're
getting and you've got to do it all and we can't,' " Bryant
said.
The real
issue, though, is what happens to patients, he said.
"Something has to be done about this injustice," said Cynthia
Yerian, 53, of Cape Coral.
She said
she is terminally ill with hepatitis C. She also takes morphine
for back problems and cannot drive because of side effects. She
said her sister will try to help, but with a full-time job it
will be difficult.
State insurance shunned
Anita
Kuklish's transportation problems stem from another Medicaid
issue — a shortage of area doctors who take the state health
insurance. Kuklish, 65, said she relied on Good Wheels to take
her to Tarpon Springs to see a foot specialist, to Tampa for a
dermatologist and to Seminole for a dentist. Good Wheels backed
out of her latest out-of-town trip to Sarasota, she said.
"I don't know now what the story is .... I don't know what I'll
be limited to," said Kuklish, of Cape Coral.
Deloris Schnarr, 54, of Fort Myers said she's just sick of
government cuts. She said Good Wheels has essentially cut her
off from service. In the past few months, she's been unable to
get rides to her appointments.
She needs
to see a doctor every two months for a medical condition she did
not want to make public.
"It's devastating," she said of the cuts.
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4. U.S.
Congress: House set to consider year-end spending package, Dec.
18
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CQ TODAY MIDDAY
UPDATE
Dec. 13, 2007
The House
appears on track to consider a year-end omnibus spending bill
Dec. 18, one week after Democratic leaders had planned to bring
up a costlier version that was ditched after a White House veto
threat.
House Speaker
Nancy Pelosi , D-Calif.,
said Thursday she hoped to have the omnibus text online over the
weekend. Subcommittees are in the process of making cuts to
programs to achieve an approximately 1.5 percent cut to their
allocations. They must complete their work by this weekend.
Although
earlier this week House Appropriations Committee Chairman
David R. Obey , D-Wis.,
had threatened to eliminate all earmarks in the spending package
to reach President Bush’s total of $933 billion in discretionary
spending, that proposal attracted little enthusiasm from fellow
lawmakers.
Earmarks are
expected to be reduced, but only slightly.
Democrats had
originally wanted to provide $23 billion more than Bush
requested for the bills, and then reduced their demands to $11
billion extra. But they were forced to back down further in the
face of White House opposition and a lack of Republican support
for a veto override.
Meanwhile,
Congress was moving to clear a one-week extension of the current
continuing resolution funding the government, which expires Dec.
14. The House was preparing to vote Thursday on the stopgap
measure, which would last through Dec. 21.
The omnibus
package is expected to roughly adhere to Bush’s request, but
exceptions may be made for veterans’ funding and an
Environmental Protection Agency clean water program. Democrats
are expected to provide an additional $3.7 billion for veterans,
funding the White House has signaled is acceptable, though the
president wants it to be offset.
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Tamie Hopp
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