Meeting with Center for Budget and Policy Priorities

We know how important Medicaid policies are for you. Here in D.C. we are doing our part to continually insert ourselves into these discussions on behalf of individuals with disabilities, their families and those that provide care and services. Recently, UCP attended a talk with the Center for Budget and Policy Priorities (CBPP) regarding the threat posed to Medicaid in the current political environment.

Here is a summary of the meeting, along with key takeaways. The primary topic of discussion from CBPP that posed the biggest threat was the sectioning of Medicaid funding to states, primarily in the form of Per Capita Caps and Block Grants.  Amongst the various alterations in the budgetary sector of Medicaid, are Block Grants and Per Capita Cap, both of which section off the funding to states. While both have their varying adverse factors, the common ground lies in the fact that the implementation of such monetary action depletes the protection that the disability community receives through Medicaid.

We appreciate the varying level of background and impact of this issue for our network, but we wanted to provide this as a resource to use as you see fit.  If you have additional questions please reach out.

What is the difference between a Block Grant and a Per Capita Cap?

  • Block Grants are given to the state in one lump sum
    • States allocate where the money will go
    • States also have to make up the difference after federally allotted money is used
  • Per Capita Caps are fixed
    • Capped funds from the governments issued to states per beneficiary of Medicaid
    • There is an anticipated larger gap between funding and spending due to the increase of technological advancement

What is the problem at hand?

Block grants are one of the least accountable of measures to “reform” Medicaid.  It has an inability to adjust to varying economic conditions; it can be cut easily and it’s bias towards, or against, certain beneficiary groups puts it at a position of being severely harmful to the disability community.

Per Capita Caps have been a part of the Republican Task Force in regards to Medicaid Reform. Seen as the lesser of two evils, the attention surrounding this initiative has given it undue positive light in attempt to downplay the negative repercussions that the implementation of such will have on those with disabilities who benefit from Medicaid.

If implemented, Per Capita Caps will limit the budgetary liberty per beneficiary. Through its supposed flexible nature, the fluctuation of this cap will cause altercation amongst the beneficiary groups and the state governments. Seen as bipartisan, and a better alternative to Block Grants, Per Capita Caps inevitably moved conversation away from the stride that Medicaid innovation has made.

In terms of Republican Task Force strategy, many Democratic Governors and Senators have signed on for Per Capita Caps, seeing, again, that it may be considered to be the lesser of two evils. This supposed bipartisan act will decrease the amount of funding per state per beneficiary, therefore increasing the cost as time goes through due to a variety of external factors, i.e., disease, pharmaceutical drug innovation, accessible technology, as these costs will not be picked up by Per Capita Cap.

What does this mean for the disability community?

As mentioned, it is evident that the disability population under Medicaid will not be protected in the event that Per Capita Caps are implemented, due to the fact that there have been vast strides in the innovative technology surrounding assistance for those who have disabilities. As per the act, these costs will not be picked up by Per Capita Cap, meaning that any new innovation will be subject to budgetary restrictions and will only be available with additional cost.  

This is all concerning and individuals with disabilities may no longer be entitled to health care or to long term services and supports under a block grant.  Combined with a fixed amount of severely reduced funding, states could be forced to cut eligibility, benefits, and provider payments. People with disabilities stand to lose access to physicians, medications, therapies, medical equipment, and many other crucial products and services. Worse, states could go back to institutionalizing people with disabilities to save money since they would no longer have to meet the quality standards currently imposed by the Medicaid program for nursing homes or community based services.  

A per capita cap would make this problem [of the struggle that patients go through to get the necessary budgets to have accessible care] worse by limiting the federal role in Medicaid and shifting more of the program’s costs onto states, providers, and patients. Cuts to provider payments, elimination of benefits and reductions in access to care are virtually unavoidable under this type of proposal.

It seems that if Medicaid budget cuts do go underway, that many of the services that allow for individuals with disabilities to have liberties, will disintegrate, therefore forcing certain individuals to refer back to institutions to obtain services that were otherwise integrated within the community. In a way, this repercussion contradicts the Olmstead Act from 1999, which worked to remove economic influences from forcing individuals into institutions. By cutting Medicaid budget, and by proxy, its services, individuals that work in the community and live at home face the threat of losing a large portion of their own budget on medical care, forcing them out of their homes and back into institutions.

What can we do next?

We continue to watch and monitor the development of programs around Medicaid Block Grants and Per Capita Caps.  We need to look at both of these as threats to the current Medicaid system and not as one being a solution that is be is imperative that there should be a conversation shift in the way that the media portrays this endeavor. Instead of looking at Per Capita Cap as the lesser of two evils, it is important to take into account what this means specifically for the disability community and what this means for the future of technology and pharmaceutical advancements. State officials should be informed of the true bearing of cost that they will be burdened with, and they should be prepared to hear of the lack of protection that it will provide to beneficiaries.

Keeping everyone who is affected by the funding changes in Medicaid updated is imperative, seeing as it is one of the issues that will affect life on a day to day basis for individuals with disabilities. We wish to drive programs and legislations that will allow for a higher standard of health care. We not only wish to expand upon the knowledge that our affiliates hold on Medicaid and other health care issues, but also wish to understand how each individual is impacted by these issues and work towards significant policy change.

UCP Celebrates the 17th Anniversary of The Olmstead Decision

 

The outcome of the Olmstead v. L.C. case began in Georgia where two women, Lois Curtis and Elaine Wilson, saw constant segregation due to their intellectual disabilities. Their frequent trips to state mental hospitals brought attention to the fact that community support and personal choice for individuals with disabilities was lackluster, almost nonexistent. After being represented by an attorney at the Atlanta Legal Aid Society, Lois, and later Elaine, saw her position for removal of institutional bias being taken up to the U.S. Supreme Court for consideration.

It was found under the Americans with Disabilities Act of 1990 (ADA), that discrimination against an individual with disabilities was illegal, and that the behavior portrayed towards both Curtis and Wilson held both legal and moral conflict.

 

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Under the Olmstead decision, The Court stated that individuals with disabilities have rights that are inclusive of:

  • Prohibition in the segregation of individuals with disabilities in community living
  • The ability to receive services in integrated environments
    • Services received may be appropriate to individual needs
  • The ability to receive community based services rather than institutionally based ones, in the event that:
    • Community placement is the appropriate course of action
    • The individual in question does not oppose to the treatment being offered
    • The individual’s placement can be accommodated in a reasonable manner

 

As a section under the ADA, the Olmstead decision follows the anti-discriminatory nature that the ADA set many years ago. The ADA, which celebrates its 26th signing anniversary, prohibits discrimination against individuals with disabilities in a number of areas that include transportation, employment, government activities, and more. According to the Olmstead decision, unjustified segregation would violate Title II of the ADA, which stated that individuals with disabilities may not be discriminated against when it came to State and local government provided public services. This gave individuals with disabilities the right to choose where they were to live, instead of having economic factors coerce them into making decisions they may not otherwise wish to make. The Olmstead decision tied together the anti-discriminatory nature of the ADA by not legally binding individuals with disabilities to be institutionalized, meaning that there legally cannot be a system that will inevitably end up with a majority of the disability community in institutions.

For individuals with disabilities, these acts held the power to allow them to work in traditional office environments, live in community settings that foster independent lifestyles, receive equal opportunities when it came to a variety of traditionally implemented services, and most importantly, have the right to decide where to live, without economic or legal influences.

Here at UCP, we appreciate the previously implemented and ongoing efforts for integration, habilitation, and opportunity for expansion for those who live with disabilities. Many of our affiliates provide services that both directly and indirectly relate to the Olmstead decision. For example, most of our affiliates offer community living based services. Outlined below are a sampling of specific services that follow ideals set by the Olmstead decision.

 

 

  • Within the UCP of Central Pennsylvania lies In-Home and Community Support Programs, which offer a variety of training and support to individuals with disabilities in the realm of opportunities that allow them to participate further in the community around them. These community integration and in-home habilitation programs allow for an individual to feel as though they can be cared for and supported throughout processes in any environment that they choose. It need not have to be an institution that can provide habilitation, but rather, it can occur within the home, simultaneously alongside community support options.

 

  • Through UCP of Central Arizona, the Summer Program, as an extension of the Day Treatment and Training for Kids and Teens Program, works on even further enhancement and training of social, community, cognitive, and communication skills for kids and teens. This program focuses on the individual needs of each child, and exposes each individual to real life scenarios in preparation for community integration. This program, along with many other of it’s kind, provides services of transportation to and from the individual’s home/school, making it clear that such services, again, are not contingent upon whether or not an individual is residing at home or within an institution. Usually, habilitation skills are not necessarily provided for children outside of an institution setting, however, as can be seen from such programs, not only is the child free to reside wherever he/she may desire, but he/she may also be provided with many character building and habilitation services that otherwise would confine them to institutions.

 

In addition to skill specific programs, services such as Child Development, Respite Care, and Early Intervention are made available in a location of the individual’s choice, making it clear that community integration, and most of all, personal choice, is the priority when it comes to the creation and reformation of programs focused towards individuals with disabilities.

While disability rights and removal of bias and segregation from the disability community has seen great progress, there is much still much to be done.  On the 17th anniversary of the signing of the Olmstead decision, we at UCP wish to not only celebrate, but also take part in movements that further advocate for the rights that all individuals are entitled to.

We want to hear how the Olmstead decision has impacted your life! Share your stories using the hashtag #OlmsteadAction on social media.

Find out more information on the Administration for Community Living’s celebration of the Olmstead Anniversary here.