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2004 Washington Initiative with Legislative Updates |
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VOR’s 2004 Washington Initiative Protect Medicaid and Preserve Choice. During the week of June 14, more than 75 VOR participants made sure that every Member of Congress heard that simple message. Each year VOR carries our unique “voice for choice” to the nation’s capital. This year we focused on preserving Medicaid funding and rights, including the right of individuals and families to choose from a full array of Medicaid services. VOR participants shared with Members of Congress and their staff our opposition to the Medicaid Community Attendant Services and Supports Act (MiCASSA), our support for extending the temporary increase in federal Medicaid funding (FMAP), our opposition to Money Follows the Person proposals, and our opposition to block granting the Medicaid program. Central to each of these positions is access to adequately-funded, high quality services based on the unique needs of each individual.
Mark and Pat Crawford, Marilyn Straw, Sybil Finken and Warren Snow enjoy Washington, D.C. Initiative Speaker Bobby Hillert Bobby Hillert, Legislative Aide to Rep. Pete Sessions (R-TX), was the keynote speaker for VOR’s Washington Initiative Briefing. His presentation was much appreciated. He shared his Capitol Hill and health care expertise with participants. His presentation helped prepare VOR’s choice advocates for the week ahead. Medicaid Reform VOR is watching any efforts to revisit proposals to block grant the Medicaid program very carefully. In the first-half of 2003, a broad-based coalition organized by Families USA (including VOR), as well as protests by the National Governor’s Association, effectively stalled any movement of the Administration’s proposal to block grant the Medicaid program. VOR and other advocates, however, are watching carefully continued federal efforts, as well as efforts by the states to “backdoor” the block grant approach by using the Medicaid waiver. Efforts in New Hampshire and Connecticut were defeated this year, and pending proposals in Florida and California are being watched very carefully. In the Fall of 2003, the House Energy and Commerce Committee held a hearing on Medicaid reform strategies, and in April 2004, the Senate Finance Committee held a hearing, “Strategies to improve to Medicaid Home and Community-Based Services.” VOR submitted written comments for both hearings and we remain involved in the Medicaid coalition. The Medicaid Community Attendant Services and Supports Act (MiCASSA) remains stalled in both the House (H.R. 2032) and the Senate (S. 971), presumably due to the high cost estimate. MiCASSA proposes a mandatory Medicaid entitlement to community-based personal attendant services. VOR objects to MiCASSA because its eligibility provisions target individuals eligible for Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR), and because of its exorbitant projected cost ($10-20 billion in new federal Medicaid funding each year). VOR fears that this price tag will jeopardize funding for all other optional Medicaid programs, including ICFs/MR and home and community-based waiver supports. Senators John Rockefeller (D-WV) and Gordon Smith (R-OR) introduced S. 2671, a bill to extend the temporary FMAP increase. The Federal Medicaid Assistance Percentage (FMAP) is the federal Medicaid amount received by states. S. 2671 proposes $4.8 billion over 15 months in fiscal relief for Medicaid, as well as reimbursing states for the $1.2 billion in net costs from the Medicare drug bill. S. 2671 would extend the temporary FMAP relief that states received last year, which expired June 30. Family Opportunity Act and Money Follows the Person In its original form in the House (H.R. 1811) and in the Senate-passed bill, the Family Opportunity Act (FOA) sought to allow moderate-income families to purchase Medicaid coverage for children with severe disabilities. VOR wholeheartedly supported this version of FOA. Recently, however, the Money Follows the Person (MFP) proposal was added (costing $1.75 billion over five years) along with a cut to Medicaid-supported targeted case management to offset the total cost of the new FOA, including the MFP program. The Medicaid offset has sparked tremendous opposition from the disability community, as well as great controversy among Members of the House, including sponsors of the bill. This opposition effectively stalled consideration of H.R. 1811, despite efforts to place it on the House suspension calendar for a full House vote. VOR agrees with the opposition of previous House sponsors as well as many advocates and consumers. The Medicaid offset would require we rob Peter to pay Paul, which satisfies no one; neither Peter nor Paul will be well served. Furthermore, the addition of the MFP proposal poses a threat to the concept of bringing much needed medical assistance to moderate income (i.e. working poor) families who struggle on a daily basis to keep their children with severe disabilities at home. VOR also takes exception to the assertion that the system needs rebalancing in favor of community-based services, as is the main intent of MFP. The expansion of one Medicaid program cannot be justified at the potential expense of the extremely needy and vulnerable individuals living in Intermediate Care Facilities for the Mentally Retarded (ICFs/MR). The $1.75 billion price tag also makes it more difficult to find the necessary offset to pay for the FOA. VOR has disseminated its position on H.R. 1811 to every Member of Congress. We are hopeful that a reasonable Congress will reinstate the original version of the Family Opportunity Act so that desperately needed assistance can be provided to working families with special needs children. Federal 2005 Budget Since Congressional conferees have been unable to reconcile two disparate FY 2005 budget resolutions passed several months ago by the House and Senate, congressional leaders are moving ahead with spending bills under last year’s budget. The primary sticking point has been whether new tax cuts should be subject to a “pay go” process – requiring any tax cut to be paid for with new taxes or spending cuts. While both resolutions apply pay-go rules to new spending, only the Senate would apply it to tax cuts (Source: Perspectives, NASDDS, July 2004). IDEA Reauthorization Both the Senate and the House of Representatives have passed their versions of a bill reauthorizing the Individuals with Disabilities Education Act (IDEA) (S. 1248/H.R. 1350). Before House and Senate conferees can be appointed to work out the differences in the respective bills, Senator Kennedy wants a pre-conference agreement with the Republican leadership that certain provisions of the Senate bill will not be weakened by the conference committee. Reportedly, these areas include teacher qualifications, procedural safeguards (due process provisions), data collection and enforcement of the law.
Most disability advocacy organizations support Senator Kennedy because of their opposition to the House bill. Without a reauthorization this year, current law will remain in effect (Source: Govt. Affairs Newsline, National Down Syndrome Conference, July 29, 2004). VOR releases paper on “The Myth of an Institutional Bias in Medicaid for Persons with Mental Retardation” Often it is alleged that 70% of all Medicaid long-term care dollars pay for institutional care. In reality, the Medicaid program for long-term care spends more dollars and supports more people with MR/DD in the community than for those in Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR). What then, is the basis for the 70% myth? The so-called institutional bias in the numbers occurs because Medicaid defines “institutional care” to include all Medicaid-eligible populations, the vast majority of whom are the non-MR/DD, elderly who reside in nursing facilities. The facts are far different when one separates the MR/DD and elderly populations. The “institutional bias” of Medicaid myth as applied to services for persons with MR/DD can have dangerous consequences for our most fragile citizens. For example, proposals such as Money Follows the Person (MFP) and the Medicaid Attendant Services and Supports Act (MiCASSA) are motivated by a desire to “rebalance” the system by increasing community supports at the expense of “institutional” (including ICF/MR) options. In this process, ICF/MR care may become uneconomical and extinct, risking the health, safety and very lives of people with severe and profound mental retardation if these facilities close. While there is a great need to expand community-based options, it should not be done at the expense of another Medicaid population. Focus on expansion must address the areas of greatest need for people with MR/DD – the provision of quality community options, including ready access to health care services, and helping those on waiting lists for services. VOR has disseminated its “Myth” paper to all of Congress and is considering broader dissemination, including to VOR members.
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VOR * 836 S. Arlington Heights Rd., #351 * Elk Grove Village, Illinois * 60007 877-399-4VOR ph. * 847-253-0675 fax * tamie327@hotmail.com |
