Living Independently

Passive Enrollment discussed at CPWD

Teri Bolinger of HCPF

CPWD held a Medicaid forum to hear directly from the state of Colorado about the Medicaid and Medicare Dual Eligibility Demonstration. The state is looking for ways to cut costs around this group of beneficiaries because they see the cost to the state as disproportionately high.

The most controversial point of the dual eligibility demonstration was the proposal to “passively enroll” people into the program. A letter would be sent to dual eligible beneficiaries that they must act on or they will be enrolled in the program. A beneficiary must actively respond to the letter to “opt-out” and keep services untouched.

Ian Engle, the CPWD Executive Director, pointed out the contradiction of passive enrollment with the Independent Living philosophy. He said that the Center promotes an informed individual to actively chose and direct their care. CPWD works so people decide and select services and supports so that they may take ownership and responsibility for the decisions they make.

Passive enrollment happens regardless of a choice and often without either clear knowledge or desire. An individual is forced to respond in order to opt-out of the program. Typically knowledgeable people act in their self-interest and those that do not act miss-out on the benefit. However, the state looks to turn this around so that the uninformed will be enrolled.

The state contends that someone may choose to opt-in or opt-out to the program at anytime and to be consistent with the current Colorado legislation they believe that passive enrollment is the only way to currently proceed. Teri Bolinger from the Colorado Health Care Policy and Finance Department was clear that passive enrollment was the only method on the table. Colorado citizens would have to demand a change for the state to consider another form of enrollment.

We asked the state to make the case why an individual would want to opt-into the program, but they could only repeat the advantages to the government agencies and providers. They implied that people would benefit from a more centralized control of programs and services and it is easy to see how this would benefit the state and possibly save money; but from the perspective of an individual recipient, there is no advantage.

I believe it is reasonable to opt-out until the state can show that their demonstration will actually work for you. It is essential that even creating an efficient and effective system that those impacted are informed and understand the services provided by the state.

People at CPWD Medicaid Forum

Around Colorado, Independent Living HCPF, Medicaid

By Howard Levett

CPWD Independent Living Advisor

Howard Levett

Since I have some personal experience, I’d like to address the article Sheltered workshops offer little benefit, studies find by Michelle Diament in Disability Scoop. (http://www.disabilityscoop.com)

I find interesting, the article’s opening paragraph, “Sheltered workshops are significantly more costly, yet no more effective than supported, competitive employment at ensuring job prospects for individuals with disabilities, new research suggests.”

I would add that yes, this paragraph is probably true. But perhaps the best explained reason for the first paragraph is the last paragraph that says, “Other factors like the severity of an individual’s behavior challenges might also play a role.” If you thought that everyone with a disability was alike and therefore trainable, perhaps you need to rethink this. As with any other group in society, we don’t all function at the same level and never will.

Most consumers partaking of these types of services have an interest in feeling like they are contributing, learning new skills and making money. The hard truth is that not everyone is suited for competitive employment with the same level of success. So, the more skilled worker, after learning in this environment, moves on to the competitive job market.

Those less able and less skilled and those that present challenging behaviors not suitable for the competitive market are left behind in the sheltered workshop….to earn less money at a higher cost. This should not be surprising to anyone. It’s the nature of the beast that those that aren’t able to progress or that have challenging behaviors are going to cost more money. They do in most any situation.

Howard Levett

Those folks left behind in the sheltered workshop environment however are still able to feel that sense of accomplishment, the pride in earning money and learning new skills. Certainly something any of us would take pride in. Is this a bad thing? Of course not. The crime here is that work contracts are paid at below minimum wage when extra supervision and training are demanded. Not very smart when you know up front that non-disabled people working in a factory setting are going to be paid at least minimum wage with the need for less supervision.

My message is this; don’t kill off a program because perhaps it’s not paying for itself; don’t deprive those not able to work in the competitive job market with the opportunity to learn and feel the pride in putting in a day’s work and earning a paycheck.

Howard Levett
Center for People with Disabilities
10351 Grant St. Unit 1Thornton, Co 80229
(voice) 303-790-1390
(fax) 303-792-0317

Around Colorado, Howard, Independent Living, Levett, System Change Howard Levett