Living Independently

CLAG meeting hears ADAPT’s demands

Colorado ADAPT took over the agenda of the Community Living Advisory Group (CLAG) at today’s meeting and inserted demands for the state department of Medicaid. ADAPT scratched out one agenda item for the committee and demanded that Suzanne Brennan and Lorez Meinhold agree to develop an Olmstead Plan, solve the problem of Medicaid eligibility for people transitioning from nursing homes and work with ADAPT to develop state housing vouchers for the Money Follows the Person grant.

The problem with Medicaid eligibility is that one day in the Nursing home an individual is Medicaid eligible in Colorado. The day they move out into the community; however, the state is unable to find them Medicaid eligible and home services are not provided.

“For the past ten years advocates have been trying to solve this procedural problem,” said Dawn Russell of Colorado ADAPT. “What this means is that people will transition out of nursing homes without services set up in the community. Before the roll-out of Colorado’s Community Choice Transition program we need to change that.”

Joslyn Gay asked why moving out of an institution was not similar to “moving into home and community based services?”

Tim Cortez, the director of the Colorado Choice Transition program answered her question by validating the problem. He explained that a coding change had to be entered into the Colorado Benefits Management System by a county technician. Without that coding change, said Tim Cortez, providers will not supply services. Mr. Cortez however suggested the problem was only in the Denver Metro region and that a solution was currently in the works for the limited area of the problem.

Dawn Russell pointed out that in the current system statewide the application to change service from the institution to the community cannot be made until the day of the individual’s move. Therefore, if the county tech is off work or busy with other items, the person transitioning will go without state services.

Anita Cameron of ADAPT demanded an Olmstead Plan by June 22 of this year. She noted that the plan was four years overdue and Colorado already had put a lot of work in developing Olmstead recommendations; but had not made a plan.

Josh Winkler briefly explained the third ADAPT demand for the state to develop vouchers to go with the MFP program launching on Friday. Colorado found that two-thirds of the people transferring from institutions will need a housing voucher, but they failed to include any housing component in the plan to help people move from nursing homes. Josh explained how the state could subsidize housing and still recover significant Medicaid savings by having citizens avoid expensive institutions.

After a short break, the group came back together and Suzanne Brennan the Colorado medicaid Director stated that she and Lorez Meinhold the Deputy Executive Director of the Department of Health Care Policy and Finance agreed with the ADAPT demands.

We agree with ADAPT’s concept for state vouchers and will set up a meeting with ADAPT, the disability community and the JBC. We will work with ADAPT to have an Olmstead plan by June 22, 2013; use a pilot program to solve the problem of Medicaid eligibility for nursing home transition starting March 1 for the soft development period.

/s/ Suzanne Brennan
/s/ Lorez Meinhold

Statement signed by Brennan and Meinhold

ADAPT, Around Colorado, Independent Living, System Change

AHLA will meet with ADAPT and other groups to comply with the ADA.

(COLORADO SPRINGS, August 30, 2012) Colorado ADAPT crashed the Hotel lobbyists Broadmoor Classic fundraiser to demand that the American Hotel and Lodging Association (AH&LA) stop its campaign to ignore and delay compliance with the 1990 Americans with Disabilities Act. ADAPT activists in Colorado built on the work of activists across America this summer to finally bring the Hotel Lobby group to the table.

Colorado ADAPT set up an alternative “ADAPT Classic 2012” miniature golf tournament in front of the Broadmoor entrance on adjacent public property. Although the police were called, the Colorado Springs officer did not have any reason to stay because at the time ADAPT was not breaking the law in any way. The Broadmoor security however was intimidated by the constant chanting and street theater at the entrance to the exclusive resort.

“The action was awesome,” said Keith Percy of Boulder ADAPT. “The AHLA ultimately responded because we said we are not leaving until we get something concrete and something in writing. When you are on the right side of history you have more perseverance and confidence in yourself. When it is a Civil Rights issue you know the subject is bigger than you are.”

Colorado ADAPT negotiated with AHLA President and CEO Josheph McIneriney through the exclusive club’s security service to come to an agreement. The Hotel Lobbyist offered a meeting on September 11th with VP for government affairs, Kevin Maher, to precede a meeting with McIneriney. The AHLA letter states that they will discuss compliance will all aspects of the ADA including pool access that has been troubling many people with disabilities and other disability rights groups.

The U.S. Department of Justice issued a proposed rule that would require hotels with pools and other public pools to provide lifts or sloped entries to make them accessible to people who use wheelchairs or have other mobility disabilities. The rule was set to go into effect on March 15, 2012, giving these pool owners two years to install pool lifts. Instead of investing their resources in accommodating customers with disabilities, the Hotel lobby is raising money at the Broadmoor Classic to continue their campaign of legal delay and civil-rights sabotage.

“Thank you for talking with me about setting up a meeting to discuss the ADA pool lift concerns,” said Kevin Maher, the Senior Vice President for Governmental Affairs for the AHLA in a written response to Colorado ADAPT. “I am particularly interested to hear about resources you mentioned that your organization may have to help the lodging industry comply with all ADA regulations.”

ADAPT, Around Colorado, Around the country Colorado ADAPT

By Steve Gold

The Supreme Court has held that the Affordable Care Act is constitutional. It also ruled that Congress cannot “coerce” States to expand the Medicaid eligibility via the ACA to cover people whose incomes are less than 133% of the federal poverty level (about $14,856 for a single person and about $30,657 for a family of four).

The purpose of this Information Bulletin is to suggest some arguments advocates can use, especially if your State is hinting that it may not expand Medicaid to cover low-income individuals and families.

First, obviously, we bet that some of the posturing States are presently taking is related to the presidential election. If Obama is re-elected, then the reality might sink in and your State might quietly accept the expansion. If Romney is elected, your State might be fantasizing that the ACA may be amended.

Second, it’s important that advocates use the State-specific data to make public arguments regarding why your State would be fiscally irresponsible not to expand its Medicaid program.

Third, since the ACA phases out special MA reimbursements for “disproportionate share” hospitals, many hospitals, which in the past received extra reimbursements because they treated large numbers of low-income patients, will lose these MA funds! Yes, one natural ally in your State are the hospitals and state-wide Hospital Association.

Fourth, this issue presents a natural potential for a “My Medicare Matters” alliance between the disability/elderly advocates and the low-income groups/AARPs/AAAs in your community. Call them up.

Here’s some national data which may be helpful.

* Between 2014 and 2022, the federal government will pay 93% of the total Medicaid expansion costs.

* The federal government will spend $931 billion for the Medicaid expansion and the States about $73 billion between 2014 and 2022.

* States currently spend $2.6 trillion on Medicaid without the ACA expansion. The additional $73 billion to cover the 133% expansion results on average in only a 2.8% increase on what States would have otherwise have spent.

* The 2.8% is probably actually larger than what States will spend because it does not reflect increased savings States will realize because of other provisions in the ACA which reduce some existing costs, e.g., state and local costs for hospital care for the uninsured.

* States savings from uncompensated care may fully cover States’ increases from the 133% Medicaid expansion.

Here are 12 States where the Governors have said either they will not implement the Medicaid expansion or are on the fence. We use a 2014-2019 timeframe.

* Alabama has 351,567 low-income people (133% of FPL) who will be denied coverage and will therefore lose $10,305 million federal dollars by not spending $470 million of State funds between 2014-19. If Alabama enrolled these people, the State’s share of Medicaid spending would increase by only 3.6%.

* Florida has 951,622 low-income people (133% of FPL) who will be denied coverage and will therefore lose $20,050 million federal dollars by not spending $1,233 million of State funds between 2014-19. If Florida enrolled these people, the State’s share of Medicaid spending would increase by only 1.9%.

* Louisiana has 366,318 low-income people (133% of FPL) who will be denied coverage and will therefore lose $7.273 million federal dollars by not spending $337 million of State funds between 2014-19. If Louisiana enrolled these people, the State’s share of Medicaid spending would increase by only 1.7%.

* Kansas has 143,445 low-income people (133% of FPL) who will be denied coverage and will therefore lose $3,477 million federal dollars by not spending $166 million of State funds between 2014-19. If Kansas enrolled these people, the State’s share of Medicaid spending would increase by only 1.7%.

* Kentucky has 329,000 low-income people (133% of FPL) who will be denied coverage and will therefore lose $11,878 million federal dollars by not spending $515 million of State funds between 2014-19. If Kentucky enrolled these people, the State s share of Medicaid spending would increase by only 3.5%.

* Maine has 43,468 low-income people (133% of FPL) who will be denied coverage and will therefore lose $1,857 million federal dollars by not NOT spending $ -118 million of State funds between 2014-19. If Maine enrolled these people, the State Medicaid spending would actually DECREASE by 1.5%.

* Missouri has 307,872 low-income people (133% of FPL) who will be denied coverage and will therefore lose $8,395 million federal dollars by not spending $431 million of State funds between 2014-19. If Florida enrolled these people, the State’s share of Medicaid spending would increase by only 1.7%.

* North Dakota has 28,864 low-income people (133% of FPL) who will be denied coverage and will therefore lose $595 million federal dollars by not spending $32 million of State funds between 2014-19. If North Dakota enrolled these people, the State’s share of Medicaid spending would increase by only 1.4%.

* Ohio has 667,376 low-income people (133% of FPL) who will be denied coverage and will therefore lose $17,130 million federal dollars by not spending $830 million of State funds between 2014-19. If Ohio enrolled these people, the State’s share of Medicaid spending would increase by only 1.6%.

* South Carolina has 344,109 low-income people (133% of FPL) who will be denied coverage and will therefore lose $10,919 million federal dollars by not spending $470 million of State funds between 2014-19. If South Carolina enrolled these people, the State’s share of Medicaid spending would increase by only 3.6%.

* Texas has 1,798,314 low-income people (133% of FPL) who will be denied coverage and will therefore lose $52,537 million federal dollars by not spending $2,619 million of State funds between 2014-19. If Texas enrolled these people, the State’s share of Medicaid spending would increase by only 3.0%.

* Wisconsin has 205,987 low-income people (133% of FPL) who will be denied coverage and therefore lose $4,252 million federal dollars by not spending $205 million of State funds between 2014-19. If Wisconsin enrolled these people, State’s share of Medicaid spending would increase by only 0.9%.

The data for the 12 States are from the Kaiser Commission’s “Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL” at Table 1. The national data are from the Center on Budget and Policy Priorities, “Federal Government Will Pick Up Nearly All Costs of Health Reform s Medicaid Expansion.”

If your State is not one of the 12 listed in this Information Bulletin, Google the above Kaiser report. If you still have difficulty and want to know, email me at address below.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada1@gmail.com<stevegoldada@cs.com>or call 215-627-7100. Ext 227.

ADAPT, Around Colorado, Around the country ACA, Affordable Care Act, Steve Gold

By Steve Gold

The Center for Medicare and Medicaid Services has issued its Proposed Rules, which define what it means to live in “a home and community-based setting.” See 77 Federal Register at 26382.  We think it is important for your voices to be heard and your comments must be submitted and received before 7/2/12.

While some disability advocates have responded to CMS previously regarding the same issue, many providers and other service entrepreneurs (for profit and not-for-profit) have a different view regarding what “home and community-based setting” means.  CMS, instead of just doing the right thing, seems to have gotten frightened by the outpouring from the providers and has requested additional comments.

In a thumbnail, we always thought that people with disabilities want to live in settings just like people without disabilities with the same rights and responsibilities.  What a revolutionary idea!  Hmmm.  Here are some points you might want to include if you write to CMS

1. Nondisabled people do not have their housing conditioned on whether or not they accept services.Therefore, housing rights for people with disabilities should be entirely separated from services that a person may or may not want, need or desire without any conditions related to services.
2. Nondisabled people are afforded the protections (and assume the   responsibilities) from eviction under your State’s landlord tenant law.Therefore, disabled people should have the same rights, protections and responsibilities under your State’s landlord tenant law.
3. Nondisabled people, wherever they reside, have an absolute right, wherever they reside to the following minimum rights.Therefore, if a person with a disability resides in a “provider-owned or controlled residential setting,” the following minimum rights should be required no “wiggle room,” no “if, and, or buts,” no presumptions of any kind that undercut or infringe on these minimums:
   1. A lease under the State’s landlord tenant law protecting against illegal evictions.
   2. Privacy in sleeping and living units.  This means a lockable entrance.
   3. Sharing units ONLY if person with disability freely and knowingly wants to share and with person of one’s choice.
   4. Right to decorate sleeping and living units.
   5. Control own schedules and access to food at any time.
   6. Visitors of their choosing at any time.
   7. Physically accessible.

Nondisabled persons would not consider it a “home” if they did not have ALL of these protections.

Tell CMS no restrictions of basic housing rights for persons with disabilities.  Tell CMS not to fund services in settings which do not comply.

Are we missing something?  Aren’t these basic, minimal human rights? What does it matter if the person is disabled or nondisabled?

Advocates — send your comments to:

Centers for Medicare & Medicaid Services
Dept. of Health and Human Services
Attention: CMS-2249-P2
P.O.Box 8016
Baltimore, MD 21244-8016

These must be received before July 2, 2012.

– Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at: http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. As of August 2010, Information Bulletins will also be posted on my blog located at: http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

ADAPT, Around Colorado, Around the country, System Change CMS, HCBS, housing