Working for Tomorrow April 2008

Working for Tomorrow April 2008 A publication of the Center for Workers with Disabilities, APHSA FEDERAL NEWS APHSA Hosts Congressional Briefings on DMIE Projects On April 15, the National Association of State Medicaid Directors, an affiliate of the American Public Human Services Association (APHSA), hosted two briefings on the Demonstration to Maintain Independence and Employment (DMIE). The DMIE is a federal grant program authorized by the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). DMIE projects provide employment and healthcare interventions to individuals who have conditions likely to deteriorate and qualify for federal disability insurance, but who are not yet receiving disability benefits. The projects use a rigorous research model to evaluate the effects of providing healthcare and employment supports on an individual’s quality of life, healthcare costs, and likelihood of receiving federal benefits. DMIE grants are unique programs in that they allow state Medicaid agencies to examine preventive care for individuals with disabilities, rather than more costly acute and emergency care after conditions have deteriorated. Currently, five states have a DMIE grant. At the briefings, representatives from Kansas, Iowa, Minnesota, Hawaii and Texas described the projects and initial outcomes. Although the projects have generated some positive initial outcomes, the nature of the study requires more time to generate stronger findings. The DMIE grants expire at the end of fiscal year 2009. During the briefings, state representatives stressed the need for more time to provide the interventions. According to state presenters, there is no need to allocate more funding beyond the original TWWIIAA allocations, but rather only extend the project’s sunset date. For more information, visit http://cwd.aphsa.org/Home/home_news.asp. House Passes Medicaid Regulations Moratorium On April 23, the U.S. House of Representatives passed the Protecting Medicaid Safety Net Act of 2008 (H.R. 5613) with a veto-proof margin of 342-62. The bill would place a moratorium on seven Medicaid rules through April 1, 2009. The vote came a day after President Bush released a Statement of Administration Policy that made clear his intent to veto this legislation. H.R. 5613 has now been referred to the Senate, where Finance Chairman Max Baucus (D-Mont.) has indicated that he will work to get moratoriums passed through that chamber. However, it is unclear when the vote may occur in the Senate, and whether or not it will have enough support to override the promised veto. The bill’s text is available at http://thomas.loc.gov. NASMD and APHSA Send Letter to Senate Leadership on Medicaid Rules Moratorium On April 28, NASMD and APHSA sent a letter to Senate Majority Leader Harry Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) expressing support for the Medicaid Moratorium legislation. In the letter, NASMD and APHSA challenged the Centers for Medicare and 1 Medicaid’s (CMS) assertion that the rules are in response to fraud and abuse. The letter contends that CMS currently has all the tools necessary to assure integrity is maintained within the program. NASMD and APHSA request that the Senate pass the Protecting Medicaid Safety Net Act of 2008 (H.R. 5613) so that states and CMS have time to review the impact of the regulations and make changes necessary to ensure that coverage of the most vulnerable is not threatened. A copy of the letter can be found at: http://www.nasmd.org. SSA Hosts Ticket Partners Summit The Social Security Administration (SSA) began a campaign to unveil the new Ticket to Work Program by hosting a Ticket Partners Summit in Louisville, Kentucky on March 10-13. CESSI, SSA’s Program Manager for Recruitment and Outreach, managed the Summit which brought together 450 partners, including public and private service providers, State Vocational Rehabilitation agencies, Work Incentives Planning and Assistance Programs (WIPAs), State Protection and Advocacy Programs, federal agencies, and key SSA staff, as well as advocates and beneficiaries. The focus of the Summit was the proposed changes to the Ticket to Work regulations, but the sessions covered a wide range of related topics including the WIPA Program and Work Incentives Seminar initiatives, federal and state partner models and examples of new opportunities for public and private-sector partnerships under the Ticket Program. For more information, visit the Summit web site at http://www.cessi.net/ticketpartnerssummit/ and click on materials to view power point presentations from the Summit, materials handed out, and background information and resource materials from this meeting. CMS Releases Proposed Rule for the Medicaid Home and Community-Based State Plan Option On March 31, CMS released a notice of proposed rulemaking for State Plan Option Home and Community-Based Services (HCBS). The rule implements section 1915i of the Social Security Act, which was created by the Deficit Reduction Act of 2005. Under this new option, states can provide HCBS to individuals who do not qualify for institutional-level care. Previously, through 1915c waivers, individuals needed to meet institutional level of care requirements in order to receive HCBS. One of the main aspects of the proposed rule focuses on a person-centered planning process to develop each plan of care. Currently, Iowa is the only state with an approved 1915i state plan amendment. Comments on the rule are due by June 3, 2008. The text can be found online at http://www.cms.hhs.gov/MedicaidGenInfo/Downloads/CMS2249P.pdf. 2008 SSA Red Book Released The Social Security Administration released the 2008 Red Book: A Guide to Work Incentives, a summary of employment supports for individuals with disabilities under the Social Security Disability Insurance and Supplemental Security Income Programs. Changes include increases in:      The Substantial Gainful Activity (SGA) amount for individuals with disabilities, other than blindness, from $900 to $940 for 2008. The SGA amount for individuals who are blind, from $1,500 to $1,570 for 2008. The monthly earnings amount that is used to determine if a month counts for the Trial Work Period (TWP), from $640 to $670 for 2008. The Supplemental Security Income (SSI) Federal Benefit Rates (FBR), from $623 to $637 for an eligible individual and from $934 to $956 for an eligible couple. The income amounts that will have no effect on eligibility or benefits for SSI beneficiaries who are students, from a monthly amount of $1,510 to $1,550 and the yearly maximum from $6,100 to $6,240. 2 Also, the monthly Medicare Part A Hospital Insurance Base Premium is $423, and the 45 percent Reduced Premium is $233. The Part B Supplementary Medical Insurance monthly Base Premium is $96.40. The guide includes updates on demonstration projects, resources for employment supports, an overview of programs, a recipient guide on returning to work, and information about health care. The Red Book can be found in both English and Spanish at http://www.socialsecurity.gov/redbook/index.html. House and Senate Briefings Held on Impact of CMS Regulations APHSA and its affiliate NASMD joined with the Center on Budget and Policy Priorities (CBPP) to host briefings for House and Senate staff on the impact of many of the regulations recently promulgated by CMS. The Senate briefing was held on March 25 and the House briefing was held on March 31. They were held to educate Hill staff on the fiscal and programmatic effects of the regulations, and to garner support for proposed legislation that would impose moratoria on the regulations, including H.R. 5613. The Senate briefing was moderated by Barbara Edwards, interim director of NASMD, and presented a panel of health professionals, including a school nurse and representative of New York City’s public hospitals. Mike Fogarty, director of the Oklahoma Health Care Authority, spoke about the impact of the regulations on state services to several populations, including individuals with disabilities, those with mental illness, and children in the foster care system. The House briefing was moderated by Judith Solomon, a senior fellow at CBPP. Other panelists included Jeff Crowley, a senior research scholar with Georgetown University’s Health Policy Institute; representatives of the Association of American Medical Colleges and the National Association of Public Hospitals and Health Systems; a school nurse; and a public health provider from Baltimore. More information on the briefings is at http://www.cbpp.org/. CMS Announces 2009 Medicare Advantage Payment Rates and Medicare Part D Payment Updates On April 7, the Centers for Medicare and Medicaid Services announced that the agency will raise the aged and disabled capitation rates by about 3.6 percent. Additionally, CMS will use a new audit initiative to deal with the accuracy around diagnoses code information that is submitted by Medicare Advantage Plans. The CMS fact sheet is available at http://www.cms.hhs.gov/apps/media/fact_sheets.asp. Trustees for the Medicare and Social Security Programs Issue Annual Reports on the Programs’ Future The Medicare Board of Trustees and the Social Security Board of Trustees issued their annual reports on the ongoing financial status of the two programs. The Medicare report estimated that the Medicare hospital insurance trust fund will become insolvent by 2019. The trustees projected that Medicare spending will increase from 3.2 percent of gross domestic product in 2007 to 10.8 percent in 2082. The Social Security Trustees report indicated that the Social Security trust funds will have an annual surplus of $196 billion in 2008. The National Academy of Social Insurance projects that surpluses will continue for the next 18 years and reserves will grow to $5,526 billion by the end of 2026. Beginning in 2017, tax revenues flowing into the trust funds will be less than total expenditures. In 2041, the reserves are projected to be depleted. At that time, tax income coming into the trust funds will cover about 78 percent of benefits due. 3 A detailed summary of both reports is available at http://www.ssa.gov/OACT/TRSUM/trsummary.html. AROUND THE STATES The Institute for Community Inclusion Publishes State Expenditures for Integrated Employment Services Data State Data, a project of the Institute for Community Inclusion at the University of MassachusettsBoston, published a data note showing that overall, states have increased per-person integrated employment expenditures with an average expenditure per person of $6,251, as reported by state Mental Retardation and Developmental Disabilities (MR/DD) agencies (FY 2004). This figure has increased steadily since the mid-1990s, most likely a result of changes in federal law including the Balanced Budget Act Amendments of 1997, and is expected to continue under recently enacted federal policies such as the New Freedom Initiative (2001). There is an overall increase in state expenditures, although there is significant variation across states and funding sources. The per-person expenditure for integrated employment, considering funds from all available sources, ranged from $90 in Kentucky to $14,541 in Connecticut. The per-person expenditure for integrated employment using Title XIX Waiver funds ranged from $5 in Washington state to $12,429 in Arkansas. The per-person expenditure for integrated employment using state, county, or local MR/DD funds ranged from $256 in Missouri to $14,364 in Connecticut. The differences in per-person expenditures are more likely due to variations within each state’s economy than the quantity or quality of integrated employment services. To access this data note, State Mental Retardation and Developmental Disabilities Agencies Expenditures for Integrated Employment Services, please visit http://statedata.info/datanotes/datanote.php?article_id=237. New Interactive Database on Caregiving The National Center on Caregiving at Family Caregiver Alliance (FCA) recently launched an interactive database, Caregiving Across the States. The database includes a separate profile for each state and the District of Columbia. Profiles contain the state's background characteristics related to caregiving and aging, as well as information on publicly-funded caregiver support programs. Information available on the site includes: average daily costs for home health care; average hourly costs for personal/home care; number of family caregivers and total caregiving hours; number of home health aides in the workforce; and the median hourly wages for nursing assistants, home health aides, and personal/home care aides. The database can be found at http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1274. State Allotments for Workforce Investment Act Programs Released On April 7, the Department of Labor, Employment and Training Administration announced state allotments for program year (PY) 2008 for WIA Title I Youth, Adults and Dislocated Worker Activities programs. In addition, the DOL also made available PY 2008 funding from WIA Section 173(e) for eligible states, final allotments for employment service activities under the WagnerPeyser Act, and the Work Opportunity Tax Credit program allotments. The allotments reflect a $250 million congressional rescission for funds appropriated in FY2007 and FY 2008. The WIA allotments for states and the final allotments for the Wagner-Peyser Act are based on formulas defined in the appropriations law and in relevant portions of the reports that accompanied the appropriations act. For the allotments and additional information, please visit http://www.doleta.gov/WIA_Wage_Peyser.cfm. 4 NEW PUBLICATIONS AND MATERIALS Mathematica Releases Report on Medicaid Buy-in Participants’ Enrollment, Employment and Earnings On April 11, Mathematica Policy Research released the latest in a series of annual reports on Medicaid Buy-in programs nationwide. The report examines characteristics of enrollees in 32 state buy-in programs during the 2006 calendar year. These 32 states, representing those with both a Buy-in and a Medicaid Infrastructure Grant (MIG), are required to report on their Buy-in as a condition of the grant. Key findings include:  Sixty-nine percent of enrollees had reported earnings in 2006;  Buy-in enrollment continues to grow, and nationwide enrollment tripled from 2001-2006;  National enrollment growth was due to growth in existing programs as well as due to additional states implementing the Buy-in;  Mental health was the largest reported disability for Buy-in enrollees;  71 percent of enrollees received Social Security Disability Insurance (SSDI) in the year prior to Buy-in enrollment;  Average annual earnings were $8,237 in 2006; and  The amount of unearned income, such as SSDI, that an individual received appeared to be related to earnings levels. The complete report is available online at http://www.mathematicampr.com/publications/pdfs/EEE_FinalReport_Apr2008.pdf. Kaiser Foundation Releases Reports on Consumer Directed Personal Assistance Services In March, the Kaiser Foundation released two reports on Consumer Directed Personal Assistance Services (CD-PAS). CD-PAS are methods of allowing individuals more control over their services, including options for hiring, firing and setting schedules for service providers. In 2006, forty-two states offered this option, but the utilization of the services remained limited. The Kaiser reports look at quality of training, motivational factors of the workers, and ways that states monitor quality. One report examines issues from the state policymaker perspective, and the other examines issues from the perspective of enrolled individuals. The reports are available at http://www.kff.org/medicaid/kcmu032408pkg.cfm. Government Accountability Office States that SCHIP Directive is Unlawful The Bush Administration’s limits on expansions of the State Children’s Health Insurance Program (SCHIP) are unlawful, according to the Government Accountability Office (GAO). According to a report released on April 17, the Centers for Medicare and Medicaid Services unlawfully bypassed congressional review when it issued a directive to states in August alerting them that federal authorities would seek to restrict raising the income eligibility level for the program. The letter, commonly referred to as the August 17th letter, restricts states’ ability to expand SCHIP for families with incomes over 250 percent of the federal poverty level ($53,000 for a family of four) unless they can prove that they already cover 95 percent of eligible children below twice the poverty level ($42,400). However, after the report was issued, a CMS spokesman stated, “GAO’s opinion does not change our conclusion that the Aug. 17 letter is still in effect.” GAO’s opinion is available at http://rockefeller.senate.gov/press/GAOAug17legalopinion.pdf. Journal of Vocational Rehabilitation Article Examines Public/Private Demonstration Projects A recent Journal of Vocational Rehabilitation article, titled “Public/private partnerships and employment of people with disabilities: Preliminary evidence from a pilot project,” examines two demonstration projects in Virginia. One demonstration project was conducted in an urban setting, while the second occurred in a rural area. The two demonstrations give promise for a 5 public/private collaboration that could increase the employment of people with disabilities. The article’s case studies offer some input on the key strategies and the lynchpins for success surrounding the development and maintenance of effective public/private partnerships. The article is available online at http://www.worksupport.com/documents/wehman2008.pdf. GAO Releases Report on Programs Connecting Youth to Education and Employment In Disconnected Youth: Federal Action Could Address Some of the Challenges Faced by Local Programs That Reconnect Youth to Education and Employment, GAO examined: (1) characteristics of locally operated programs that serve disconnected youth, (2) the key elements of locally operated programs to which directors attribute their success in reconnecting youth to education and employment, and (3) challenges involved in operating these programs and how federal agencies are helping to address these challenges. The 39 local youth programs identified key areas of their programs, including effective staff and leadership; a holistic approach to serving youth that addresses the youth’s multiple needs; specific program design components, such as experiential learning opportunities and self-paced curricula; and a focus on empowering youth. GAO recommended that the Department of Labor work with states and workforce investment boards to better ensure they have the information and guidance needed to develop and implement contracts that allow local programs to serve youth who are in need of more assistance than others while still achieving performance goals. The full report can be found at http://www.gao.gov/new.items/d08313.pdf. National Website Connects Employers with People with Disabilities The New Jersey Business Leadership Network, with support from the Henry H. Kessler Foundation, launched Accessible Employment, a national job board “dedicated to including disabled employees in today’s workforce.” Potential employees can post resumes, create profiles, and set up e-mail alerts for employment opportunities meeting specific criteria. Information and links about federal law, health, and hiring are available for potential employers. For more information visit http://accessibleemployment.org/index.asp. The New America Foundation Releases Report on Asset Building The New America Foundation released a report on assets focused on lower income families and those with fewer resources. The report includes sections on policy developments from the last year, an examination of the President’s budget proposals for 2009, and a forecast of issues Congress may consider in the next year or two. Highlights from policy developments in 2007 include the Senate introduction of the New Saver’s Act, a set of 14 low-cost proposals to increase savings, especially by lower-income Americans; proposals to reform the asset limit in the Food Stamp Program; and the passage of the College Cost Reduction and Access Act, which changed the way some Section 529 accounts are treated in financial aid calculations. The President’s proposed budget included consolidation of tax-preferred savings accounts, which would create a system of Retirement Savings Accounts, Lifetime Savings Accounts, and Employer Retirement Savings Accounts, as well as a second consecutive proposal to extend “Saver’s Credit” eligibility to deposits made in Section 529 College Savings Plans. The preview of what Congress may consider in the next year or two includes the potential onset of a recession that may trigger additional calls for a policy response, which could include a focus on savings incentives and financial education, and further examination of issues that created the housing crisis that may lead to legislative and regulatory changes in the mortgage market and more broadly to the provision of financial services. The Assets Report 2008: A Review, Assessment, and Forecast of Federal Assets Policy can be found at http://www.newamerica.net/publications/policy/assets_report_2008. 6 Recommendations for Improving College Outcomes for Students with Disabilities An article from the Office of Community College Research and Leadership of the University of Illinois at Urbana-Champaign summarizes reports about outcomes for students with disabilities in college and recommends methods to improve these outcomes. Linking employment and poverty to education levels, the authors note that 28 percent of people with disabilities have some college, compared to 30.5 percent of people without disabilities, and 12.8 percent have a bachelor’s degree or more, compared to 30.1 percent of people without disabilities. The article includes a summary of relevant federal law and discusses disability disclosure and accommodations. Recommendations for improving outcomes include adopting universal instructional design and academic adjustments. The article, Improving Access, Transition, and Success: Meeting the Challenges Facing College Students with Disabilities, is available at http://occrl.ed.uiuc.edu/Newsletter/2007/fall/fall2007_2.asp. Taskforce on Aging of the American Workforce Releases Report In February, the Taskforce on the Aging of the American Workforce released a report on issues surrounding older employees, and strategies to extend the professional careers of American workers. The Taskforce on the Aging of the American Workforce is composed of senior representatives from nine federal agencies, including the Departments of: Commerce, Education, Health and Human Services, Labor, Transportation, and Treasury; the Equal Employment Opportunity Commission; Small Business Administration; and Social Security Administration. The report outlines a number of issues that present barriers to the employment of older workers, including social attitudes, legal barriers, policies and work environments. The report then outlines strategies to mitigate these barriers and improve the employment prospects for older Americans. Strategies include:     Legal and regulatory solutions; Flexible work options, including self-employment and workplace accommodations; Outreach and education; and Technical assistance. Many of these strategies closely resemble best practices for workers with disabilities. Many professionals believe that integration of strategies for older workers and workers with disabilities will strengthen employment outcomes for both groups. The report is available online at http://www.doleta.gov/reports/FINAL_Taskforce_Report_2-1108.pdf. AVAILABLE GRANTS DOE Inviting Applications for FY 2008 Projects with Industry Program The Department of Education, Office of Special Education and Rehabilitative Services, is currently inviting applications for new awards for fiscal year (FY) 2008 for the Projects with Industry (PWI) program. The PWI program creates and expands job and career opportunities for individuals with disabilities in the competitive labor market by engaging the talent and leadership of private industry as partners in the rehabilitation process. Projects identify competitive job and career opportunities and the skills needed to perform those jobs, create practical settings for job readiness and training programs, and provide training, job placements, and career advancement services. Eligible applicants include employers, nonprofit agencies or organizations, designated state units, labor unions, community rehabilitation program providers, trade associations, Indian tribes, tribal 7 organizations, and other agencies or organizations, including faith-based and community organizations, with the capacity to create and expand job and career opportunities for individuals with disabilities. Grant awards will be made only to organizations that provide job and career opportunities for individuals with disabilities within the state in which the organization is located or a contiguous state. Additionally, cost sharing of at least 20 percent of the total cost of the project is required of grantees under the PWI program. The deadline for transmittal of applications is May 27, 2008. For more information, see http://edocket.access.gpo.gov/2008/E8-6453.htm. CMS Announces Real Choice Long-term Care Reform Grants On April 18, CMS announced that it has approximately $13 million dollars available to support states’ efforts in the area of long-term care reform. This grant opportunity provides funding for states to develop “Person-centered Hospital Discharge Planning Models” in partnership with hospitals, patients and their caregivers, community-based providers and single entry points to long-term supports. The voluntary notice of intent to apply is May 9, 2008 and the grant application due date is July 17, 2008. For information regarding the solicitation and application process, please visit http://www.cms.hhs.gov/RealChoice/Downloads/RCSC_ADRC2008_SolicitationFinal.pdf. CONFERENCE AND EVENT CALENDAR National Direct Service Workforce (DSW) Symposium on Strengthening the HCBS Direct Service Workforce National Direct Service Workforce (DSW) Resource Center May 8-9, 2008 Hyatt Regency Baltimore Baltimore, MD For more information, visit http://www.dswresourcecenter.org/ National ADA Symposium Hosted by the Network of DBTAC-ADA Centers May 12-14, 2008 America's Center St. Louis, MO For more information, visit http://www.adasymposium.org/ AAIDD 132 Annual Meeting The New Professional: Leadership in Science, Practice, Policy and Advocacy May 28-30, 2008 L’Enfant Plaza Hotel Washington, DC For more information, visit http://www.aaidd.org/ International Conference on Diverse Abilities & Innovative Supports 2008 Life, Liberty, & the Pursuit of Community Co-sponsored by CRA, SECOH, Autism Today, and Ability Magazine, with additional support from the Bubel Aiken Foundation June 9-11, 2008 Sheraton Waikiki Hotel & Resort Honolulu, Hawaii For more information, visit http://www.lifelibertyandthepursuitof.com/ 2008 UCP Conference nd 8 Believable Hope Conference Sponsored by United Cerebral Palsy June 18 – 21, 2008 Washington, DC For more information, visit http://www.ucp.org/ucp_general.cfm/1/12438. RESNA 2008 Annual Conference June 26-30, 2008 Washington, DC For more information, visit http://www.resna.org/Conference/Conference.php The 19th Annual National APSE Conference The Winners Cup ...Everybody Works! Everybody Wins! APSE The Network on Employment July 9-11, 2008 Louisville, Kentucky For more information, visit http://www.apse.org/conference/rfp.cfm Center for Workers with Disabilities Annual Conference Hosted by the Center for Workers with Disabilities, APHSA August 18-19, 2008 The Westin St. Francis San Francisco, California For more information, visit http://www.aphsa.org/Conference/calendar.asp. 24 National Home and Community Based Services Conference Convened by the National Association of State Units on Aging and the Massachusetts Executive Office of Elder Affairs September 28 – October 1, 2008 Boston, Massachusetts For more information, visit http://www.nasua.org/ Expanding Inclusion: The Business Strategy USBLN Annual Conference & Career Fair October 5-8, 2008 The Marriott Portland Portland, Oregon For more information, visit http://www.usbln.org/. The Arc's 57th Annual Convention "Telling our Story - Weaving our Future" November 6-8, 2008 Albuquerque Convention Center Albuquerque, New Mexico For more information, visit http://www.thearc.org. 33rd Annual TASH Conference Social Justice in the 21st Century December 3-6, 2008 Nashville Convention Center and Renaissance Hotel Nashville, Tennessee For more information, visit http://www.tash.org/2008tash/ th 9