Panel Calls for Big Changes in Medicaid

The New York Times published this article on November 23rd about changes being discussed for Medicaid services for the elderly and people with disabilities. Only one person voted against it...

Gwendolyn G. Gillenwater, a commission member who is policy director of the American Association of People With Disabilities, an advocacy group, voted against the report. “People with disabilities have not had good experience with managed care,” Ms. Gillenwater said. “We need federal protections and safeguards. People with disabilities should at least have a choice of two managed care plans. And what are your choices if you opt out of managed care? The alternatives are getting more and more limited."

This debate is an important one as Georgia moves forward with additional funding for people with disabilities.

Moreover, it said states should be allowed to enroll some of the sickest Medicaid recipients, including nursing home residents and people with disabilities, in managed care plans. The panel said such plans “would provide a medical home and better coordinated care” for people entitled to both Medicaid and Medicare. Care is often fragmented now because Medicaid pays nursing homes while Medicare is the primary payer for doctors and hospitals, and in many cases “clinical data is not shared,” the panel said. People enrolled simultaneously in the two programs account for 13 percent of Medicaid recipients, but more than 40 percent of Medicaid costs. Medicaid, which is financed jointly by the federal government and the states, covers two-thirds of the nation’s 1.6 million nursing home residents.

The problem becomes when managed care means less care...

Senator Max Baucus of Montana, the Democrat in line to lead the Finance Committee, said many of the proposals would make it more difficult for “the most vulnerable Americans” to get comprehensive care. John C. Rother, policy director of AARP, the lobby for older Americans, said, “In some states, flexibility means cutting benefits.”

How do we offer more flexbility and control without risking the level of care that makes community living for people with disabilities possible?

Their siblings' keepers: When parents die, disabled adults need help

Gayle White wrote a very nice article in today's Atlanta Journal-Constitution about the aging of family cargivers who are taking care of people with developmental disabilities who are also aging. As she reports, more than 17,000 Georgians with developmental disabilities or 711,000 nationwide were living with caregivers 60 or older.

As of September, the list of Georgia residents of all ages on the waiting list for services from respite to 24-hour care was about 6,600. Almost 3,700 needed immediate help, according to the Georgia Department of Human Resources. Legislators increased funding in Georgia to create 1,500 slots for Medicaid-funded services in fiscal year 2007—-up from 30 two years ago. But some applicants need multiple "slots" or services, and 1,100 people enter the system each year.

Consider sending Gayle White a thank you email for her coverage. There is still time to help make a difference by sending the Governor a letter asking him to continue his support for Unlocking Georgia's waiting lists for disability supports.

Governor Perdue's Response to Letters on Unlock the Waiting Lists

Dear

Thank you for contacting my office and sharing your thoughts and concerns regarding services for Georgians with disabilities. I am pleased that the voices of people with disabilities, their families and other disability advocates are strong in Georgia, and I want to assure you that we hear those voices.

From listening, we know that Georgians with disabilities want alternatives to institutional care. They want to be active, participating members of their own communities, and they want a fair chance to be a part of Georgia's great workforce.

I am very proud of the support that we have been able to provide for Mental Retardation/ Developmental Disability (MR/DD) services during my administration. In Fiscal Year (FY) 2006, we provided funding for 925 new MR/DD services. The FY 2007 Appropriation Bill included funding for 1,500 new Medicaid Waiver services including funding to allow 150 children, adolescents and adults with DD to transition from institutions to community services. Also, the FY 2007 budget included funds to strengthen our MR/DD system's capacity to meet the increasingly complex needs of our consumer population. On an annual basis, the FY 2007 appropriation will total over $19 million in state dollars, the largest increase in MR/DD funding in Georgia's history.

Developing our state's budget involves making difficult decisions as we must weigh and prioritize the many competing and important needs of the people of our state. However, I want to assure you that I will not forget my respect for and commitment to Georgians with disabilities during this budget cycle.

Again, I want to thank you for sharing your unique prospective. I encourage you to also share your thoughts and concerns with your legislators. The General Assembly has the ultimate responsibility in the allocation of our state's resources. If you need contact information for your members, it is available from your county board of voter registration. As always, I appreciate hearing from you. Please do not hesitate to contact me at any time in the future.


Sincerely,
Sonny Perdue

Texas settles with advocacy group on Unlock the Waiting List

Summary: Pursuant to a settlement between the State and the Arc, State officials will ask lawmakers for money to reduce waiting lists for programs that provide at-home services. VOR will be studying the specifics of this settlement to determine what impact it may have on developmental center residents.

By Corrie MacLaggan
American-Statesman
Wednesday, October 25, 2006

As part of a lawsuit settlement, state officials will ask for more money to stop the growth of waiting lists for state services for people with mental retardation and other disabilities and reduce the number of people on the lists 5 percent to 10 percent a year.

Advocates say the settlement could lead to as many as 60,000 more people getting care at home or in group homes, rather than in institutions: those now on waiting lists plus those who are added to the lists in the next few years.

"This is a real issue of civil rights for individuals with disabilities," said Geoffrey Courtney, general counsel for the Arc of Texas, which is an advocate for people with mental retardation and developmental disabilities. "It enables them to live where they want to live."

But state Rep. Elliott Naishtat, D-Austin, a member of the House Human Services Committee and a supporter of reducing the waiting lists, said the settlement might not mean the issue is resolved. "I'm hopeful that the leadership in the Legislature will do the right thing, but I'm not convinced that it will happen," he said.

If it doesn't, Naishtat said, he expects advocates to file another lawsuit.

Ted Hughes, a spokesman for the Texas Health and Human Services Commission, said his agency has "long been concerned about the (waiting) lists as is evidenced by our ongoing efforts to reduce, and eventually eliminate, them."

The settlement involves a 2002 lawsuit by the Arc of Texas that said the state violated federal law granting options to people with mental retardation and other disabilities to remain at home or in group homes.


The lawsuit involved two programs that provide home-based nursing care, physical therapy, respite care and other services for people with disabilities. There were about 15,000 people on the waiting lists for
Those programs when the lawsuit was filed in 2002. There are now about 45,000.


"This is an issue that could potentially bring tremendous benefit to thousands of families across the state," said Mike Bright, executive director of the Arc of Texas. "Families can have hope that the state of Texas is going to be responding to a critical need as a result of this settlement."

But the people won't get the services if the Legislature, which convenes in January, doesn't approve $254.7 million in state dollars, which will be requested by the Health and Human Services Commission.

Among the plaintiffs in the lawsuit was Jamie Travis, whose daughter, Christy, 27, has severe physical and mental disabilities and requires around-the-clock supervision. Travis, who lives in West Columbia, near Houston, spent nine years on a waiting list for the state program that provides the services.

Now, she has a chance to take a break from full-time caregiving and volunteer at her other children's school. "It's been pretty awesome," said Travis, whose daughter is one of 12,000 Texans moving off of state waiting lists as part of a plan approved by legislators in 2005 that is not directly related to the lawsuit.

But 85,000 elderly Texans and those with disabilities are still on Waiting lists for programs that allow them to live at home or in group homes. The lawsuit aimed to reduce the waiting lists for two of the programs, both of which involved people with disabilities.