Senator Jack Hill's analysis of the Quality Assessment Fees

Medicaid currently relies on around $90M from a 5.5% CMO “Quality Assessment Fee” that provides funds to the Medicaid population. These fees are used to “draw down” enhanced federal funds and do not have a negative impact on the CMOs. The Federal Agency with Medicaid responsibility has ruled that states like Georgia cannot assess a fee on one Medicaid provider without assessing the same fee on all health care providers. You can’t treat a Medicaid provider differently from other providers like insurance companies. So Georgia is faced with a choice which must be made and implemented by October 1, 2009. Either stop taxing the care management companies and create a $90M hole in the 2010 budget or start assessing insurance companies the same amount. Governor Perdue has proposed to lower the assessment fee from 5.5% to 1.6% but to apply the fee to insurance companies and to the net revenue of hospitals. In other words, all health care providers will be subject to this fee. The total produced by the fee would continue the $90M presently collected as well as plug a Medicaid shortfall created by the prior use of one-time reserve funds. This amount is $204.9M. The total of $217M would also pay for increased Medicaid demand and fund $60M towards a Trauma fund for hospitals. The Hospital piece of the funding, $259M has been met with strong objections by hospitals around the state. Rural hospitals particularly say they would be hard hit and that the fee has the potential to put some out of business. This is one of the crucial issues before this General Assembly. The Governor’s proposal does not appear to have widespread legislative support.

Senate Bill 1: Waste Reduction Act

The “Waste Reduction Act,” introduced by Senator David Shafer, would implement a system of zero-based budgeting for state government. Georgia currently prepares its budget on a “continuation” basis, which assumes that all current spending will be carried forward. His legislation would require that one-fourth of the budget be zero based each year, so that over a four year term, the entire budget is scrutinized by the General Assembly.

Go to www.aaddvocacy.org for legislative resources

2009 Money Follows the Person Conference

This conference, scheduled for March 2-4, 2009 in Baltimore, MD, will address subjects such as community inclusion for persons living with disabilities, innovative ways to increase housing capacity, Medicaid rebalancing, self direction and quality management systems. The Money Follows the Person (MFP) program is designed to help states move individuals enrolled in Medicaid from institutions back to the community, where they will keep their Medicaid coverage.

For more information, go to CMS website on Money Follows the Person

DisabilityInfo.gov provides quick and easy access to comprehensive information about disability programs, services, laws and benefits. You can begin your search by visiting any of the nine subject areas at the top of this page. To find disability resources in your state just click on the Find State and Local Resources map located in each of these subject areas.

Some of the many topics you will find information about on DisabilityInfo.gov include:

Americans with Disabilities Act (ADA)
Autism and other Developmental Disabilities
Fair Housing Rights
Social Security Disability Benefits
Vocational Rehabilitation

University Centers for Excellence in Developmental Disabilities Education, Research and Service
The Administration on Developmental Disabilities (ADD) funds University Centers for Excellence in Developmental Disabilities Education, Research and Service (UCEDDs) in every state and territory. UCEDD programs are designed to increase the independence, productivity and community integration of individuals with developmental disabilities. For a complete list of Centers visit ADD's Web site or the Association of University Centers on Disabilities.

Atlanta Journal Constitution letter to the editor

Thank you to Joni Pelta for writing this letter and sharing with us that it was printed.

READERS WRITE
By Joni Pelta, Robert W. Keeler, A. Jean Richardson

For the Journal-Constitution

Wednesday, January 28, 2009

Perdue needs to get hooked on special-needs kids

Every January brings the same rituals to Georgia. There’s a cold snap and a hard freeze. The Legislature resumes work under the Gold Dome. Special-needs parents and supporters must lobby hard to get funding for their loved ones’ programs.

I realize this year that state sales tax and other revenues are down as the economy stagnates. If the pie that all government programs feed from has shrunk, all worthy groups have to work even harder to grab their meager crumbs. That I can accept.

What rankles this parent of a special-needs child is that while Gov. Sonny Perdue and his staff nibble yearly to cut the crumbs of funding from special-needs programs, somehow there is $23 million for Perdue’s Go Fish project in Perry. Fishing is a fun, worthy hobby. However, why is building fishing facilities a bigger priority than those with special needs? Why is there never enough money to get the more than 6,700 people with special needs off the state waiting list and receive the services they need to become active, contributing members of society?

JONI PELTA

Atlanta

What do you think? Go to www.unlockthewaitinglists.com to learn more.

Abilities Celebration at the Georgia Aquarium!

Be a part of the first Abilities Celebration at Georgia Aquarium! Visit the Georgia Aquarium from Feb. 4-7, 2009, as we celebrate the diversity of human accomplishments and abilities. During this four day event, Georgia Aquarium will showcase the talent and creativity of special guest performers and speakers with various backgrounds and abilities. Join the Georgia Aquarium in increasing awareness of human abilities through these special performances, speakers and more!

Click here for more information and the schedule of events.

6,812 Georgians with Developmental Disabilities Wait for Help

This story came out last thursday on Savannah's WSAV-TV.

To see the video clip that went with this online story, click here.

I want to thank the Arc of Effingham's Nina Dasher for her help in making this story happen at the last minute. To learn more about the Arc of Georgia's efforts, click here. Also thank you to all those families on the waiting list who had very important stories to tell as well that I called throughout the afternoon. Note that they got the number of waiting wrong - they were using numbers from December - it is now 6,812 for people with DD and 138 for people with physical disabilities. For a list of cuts, go to the Unlock website.

State lawmakers continue looking for ways to cut two billion dollars in spending, as Georgia faces a historic budget shortfall.

The Governor’s proposed budget includes cutting $428 million to lower property taxes, $350 million dollars in cuts to education, plus cuts to transportation, prisons, and healthcare.

One area facing critical cuts is special needs service programs for the developmentally disabled, specifically developmental disability waivers. The waivers help families with providing special services and care—like mental health benefits, wheelchair ramps, and at-home caretakers— for their loved ones.

Jennifer Lanier, 37, lives with disabilities most of us can’t imagine. “Mental health status, and disability status… I had back surgery, and I suffer with schizophrenia… a developmental disability also,“ says Jennifer. Jennifer lives with a family friend but spends most of her time confined indoors.

“Either go to doctor’s appointments, or stay at home and put puzzles together,“ she says. Jennifer has qualified for a developmental disability waiver from the state that would help her in a number of ways. “Transportation, that’s a big thing I have a big problem with, because you have to call 3 days in advance to get the Medicaid van,“ she explains.

But advocate Nina Dasher says Jennifer is one of 6,700 hundred Georgians and their families on a waiting list for this assistance.“When you have a developmental disability, your functioning is that of a child most of the time, and that takes constant care for a lifetime,“ says Dasher, who herself cares for an 18 year-old granddaughter with developmental disabilities.

Dasher says Governor Perdue’s current budget includes no money for the program.

“It’ll be at least 18 months before anybody else with a developmental disability will get on that waiver, and as the population that has the waivers when they die, that money is not being left in the budget,“ she says.Joyce Arnsdorff says she’s happy to open her home to Jennifer but wishes the government could do more to help.

“It’s like they say, ‘Well, you know you need to be taken care of, so we’re going to take care of you, but we’re not going to do as much as you need,‘“ she says.

Advocates for Georgians with developmental disabilities have started a campaign called Unlock the Waiting Lists to try to reduce the number of people waiting for these services.

To see the video clip that went with this online story, click here.

Last week's Legislative Round Up

Last week, in a joint session of House and Senate Appropriations committees, legislators questioned agency heads about their budgets. The Departments of Human Resources and Community Health presented their FY09 and FY10 state budget proposals. For a list of budget cuts that will impact people with disabilities, go to the Unlock the Waiting Lists Action Alert page. There will be no new community supports for people with disabilities waiting in community for help for at least 18 months if the House and Senate accept this budget proposal.

The Department of Human Resources has proposed FY2009 budget cuts to the Governor that will leave our most vulnerable families and individuals even more at risk. While there supports for 150 DD services and 100 persons with physical disabilities to transition from institutions to the community, there are no disability supports for the over 6,900 people current on Georgia’s waiting list. We are afraid that with no new supports for these community waiting lists, we will be cutting Georgia's ability to support our most vulnerable.

We are asking Governor Perdue and our legislators to not cut funds for existing disability supports or contracts, rate increases, or developmental disability waiver slots in the Department of Human Resources or Community Health Budgets. Please help to protect these much needed supports for people with disabilities by encouraging Georgia’s General Assembly to look for revenue solutions to serve our most vulnerable citizens during these hard economic times.

Lawmakers also heard troubling state tax revenue forecasts. Economist Kenneth Heaghney projected that even if Georgia cuts its budget by $2 B (about 10%), tax revenues will still produce $600 M less than is needed in FY 2011 (beginning July 2010). He believes such shortfalls will continue for at least three years and says officials could have to decide whether to cut further or raise revenues. Georgia Budget and Policy Institute experts point to structural deficiencies in the taxation system they say must be addressed. See The Georgia Budget and Policy Insitute.

The federal stimulus package could bring Georgia $5.6 Billion. President Obama’s American Recovery and Reinvestment Plan could bring some near-term relief, and experts say it could create 143,000 jobs here. Now being marked up in the U.S. Senate Finance Committee, the plan includes such measures as tax cuts, spending on infrastructure projects, unemployment insurance, fiscal relief for Medicaid, and help with COBRA coverage for people losing jobs. The President wants a bill by mid-February, although it is drawing opposition in some quarters, including from some of Georgia’s delegation.

The General Assembly reconvenes today, January 26th. The House opens at 10:00 a.m. and the Senate begins at 1:00 p.m.

Legislator's Responses

Throughout this year's session, I will post legislator's responses to your emails and letters. Keep checking back here to see what they are saying about our issue.Here is a fantastic letter from one of Georgia's Partner in Policymaking graduates (Note that Jackie put "I live in your district" in her email's subject line):

Dear Rep. Walker,

Subject: Re: I live within District 107
RE: Unlock the Waiting List
I live within your district and have also had the privilege of hearing you speak at a Town Hall meeting that was held at Gwinnett County School's Instructional Support Building. Our 13 year old daughter, is currently on the waiting list for a MRWP (Mental Retardation Waiver Program) and has been waiting for a little over 2 years. She has autism and is totally nonverbal. She has severe learning disabilities and requires lots of care and support. Since she turned 13, her behaviors have become more challenging. Our family is in need of support on how to guide her and help her.

Since she has the mental capacity of someone much younger, we are not able to leave her alone. It requires that I be at home to see her off to school and meet her bus in the afternoon. Needless to say, I am not able to work fulltime and that further inhibits us from being able to afford needed services. She requires help with her personal care and all other activities, even going to bed. My husband works many hours to support us and I am She's primary caretaker. We do not get to spend any time together as a couple and our son is also asked to make sacrifices no child should have to make. I dread to think of
what single parents are doing to survive and take proper care of their child with disabilities.

Please do not cut support to families like ours, who are in desperate need of help. Ask them to do all they can to find funds to offer support for those who are on the waiting lists for waivers.

If you have any questions or wish to contact me, I can be reached at [phone number]

Thank you,
Jackie McNair

Len Walker wrote back:

From: Len Walker
To: "Jackie McNair"
Subject: Re: I live within District 107
Date: Thu, 22 Jan 2009 19:13:02 +0000

Jackie,
Thank you for this reminder. This, as you know, is an issue of enormous
importance. I will certainly do all I can.
Sincerely,
Len Walker
Sent via BlackBerry by AT&T

The Governor's Budget Address

Governor Perdue delivered his State of the State Address yesterday. Included in this address was his budget proposals for amended budget for Fiscal Year 2009 and his full budget for Fiscal Year 2010.

His speech can be found at on his website. Some highlights include:

The Governor thanked the legislature for working with his administration to help replenish the Rainy Day Fund, which now stands at $1.2 billion. In these budgets, Governor Perdue recommended using the maximum amount available for appropriation from the reserves, appropriating $187 million for the education midyear adjustment, $50 million in 2009 and $408 million in 2010. In 2009, a number of one-time strategies unavailable in 2010 will be implemented to balance the budget. Therefore, Governor Perdue recommended the largest portion of available reserve funds be committed to the 2010 budget.

Governor Perdue also outlined a proposal to restructure the Department of Human Resources. Currently, $3.8 billion is spent within DHR every year. The plan calls for the creation of a new Department of Behavioral Health which will include all mental health and addictive disease programs. The bill also establishes a Department of Health, a combination of the public health and oversight programs in DHR and the current functions of DHR. Remaining social services, such as Developmental Disabilities, Aging, DFCS and Child Support, will come together under a reconstituted Department of Human Services.

Governor Perdue will also introduce legislation to ask those who receive Medicaid payments to help fund the system. This proposal takes advantage of the fact that every dollar used toward Medicaid purposes draws down almost two additional dollars from the federal government. The budget will reflect, and an accompanying bill will propose, a 1.6 percent fee on hospitals and health insurance plans to, not only fill the hole in Medicaid, but also to do what the healthcare community has asked of Governor Perdue’s administration. This proposal will significantly raise Medicaid rates, particularly for hospitals; and in conjunction with the SuperSpeeder legislation, provide $60 million for trauma to sustain and expand the state’s trauma hospitals, EMS and trauma physician infrastructure.

Video of the Governor's Speech can be found here.

To see an update on the budget, go to http://www.unlockthewaitinglists.com/