National Rehabilitation Association Governmental Affairs Summit April 2-4, 2017

The 2017 National Rehabilitation Association (NRA) Governmental Affairs Summit, held in Alexandria, VA, was attended by 6 representatives from the Minnesota Rehabilitation Association (MRA): Doris Illies, NRA President; Katie Hartl, MRA President; Aaron Cross, MRA President-Elect; Pat Bienfang, NRA and MRA ARTS representative; Holly Ingling, NRA Secretary; and Tyler Sadek, MRA Governmental Affairs Chair. The summit was a great opportunity to learn and network with our peers from other state chapter of NRA.

The political climate is such that the services we deliver and the way we deliver them is ever changing. It is our duty as professionals in the field to be aware and mindful of the potential impact these will have on those who participate in our programs.

A few notes from the NRA Board meeting. Agenda items from the Executive and Full Board meetings included:

Membership data– NRA Executive Director Dr. Fred Schroeder and Membership staff Rachel Munchmore have identified that during the recent data transfer from one membership software program to another that previous staff did not enter all of the data into software and were keeping excel spreadsheets to track data. This data now has to be entered correctly into each member’s profile and is requiring additional staff time. We are hoping to get this corrected within the near future. They have also identified that Organizational Memberships have not been entered correctly, this too is being corrected. We are hoping for patience during this time.

Financial data – our accountant now has all the data from February and is working to get us reports before the end of April. NRA board has given the authorization for him to work with our Office Manager Veronica Hamilton to make sure information is entered into the correct accounts on the front end so that reports are accurate.

Membership committee- the membership committee offered a ‘Sweetheart of a deal” in February to entice former members of NRA to renew at a discounted rate, there were 11 people who renewed their membership during this promotion. The membership committee will be offering this type of program for students with a promotion “Back to School” in August. The membership committee recommended two new NRA awards for Students – one for a Graduate and one for a under graduate level, they are working with the awards committee on criteria and announcement. The committee meets via phone monthly and is working on share of membership best practices.

GA Summit – it was reported that there were 70 people registered for this year’s Summit. This year the Summit included concurrent sessions to give attendees choices. It is the responsibility of the NRA Immediate Past President to chair this committee, which will mean I will chair it in 2018. Plans for the 2018 Summit will start in May.

GA and support to chapters – NRA GA Liaison Patricia Leahy has agreed to host monthly calls with chapter GA reps to help them develop local activities. The first call will be held in May.

Strategic Planning – the board did strategic planning, following up on work done in 2014. It was led by Former NRA President and MRA member Sara Sundeen. We broke into

groups looking at Membership, Leadership, Organizational Structure and Resource Development. The board requested we work further on this and will plan to meet for full day of planning in conjunction with our face to face meeting in October. This will be led by Sara and Former NRA President Ray Feroz.

NRA Annual Conference 2017 – The registration officially opened for the conference which will be held in Corpus Christi October 27 thru 29th. Speakers have been identified and there will be a full agenda.

The 2017 Governmental Affairs Summit began with brief remarks from Current NRA President and Minnesota Representative, Doris Illies, as well as remarks from the Honorable Dr. Fredric K. Schroeder, NRA Executive Director.

The Welcoming Remarks were followed by Capitol Hill 101: The People’s House and Senate presented by Dr. Jennipher Wiebold and her students from Western Michigan University, educating newcomers on how to connect and interact with legislators at a national level.

Anil Lewis, Executive Director of the National Federation of the Blind (NFB) Jernigan Institute.

Develop relationships with the organization. You are only successful if you empower the other to enhance their lives. Cross-disability knowledge is powerful. I was a consumer to a provider and teacher. Set high expectations for our clients to empower individuals. Teaching people to find their jobs is important as opposed to finding a job for people. They did not come back to the revolving door. You cannot do this alone, developing relationships with your professional organizations to help advocate together. Give your consumers a choice and explore real career opportunities for them. Have the integrity to assist people by focusing on a small area that you will see growth. Relationships building is advocacy. Don’t talk for a person give them the power to speak for themselves.

Kathy West-Evans and Director of the National Employments Tea (The NET) of CSAVR

Council of State Administrator of Vocational Rehabilitation, 80 agencies with Marci Jasper being the contact in Minnesota. This is how we support people with disabilities across the states. Each agency has a contact; we are doing pilot work regarding credentials. How we present the disability up front.

Working in the areas of:

pre-employment; internships and training HR/Staffing; recruitment & promotion, employee advisory services, retention supports Accommodations; work site assessment and assistive technology Staff Training; disability awareness, ADA/employment law Financial Supports; WOTC, Barrier Removal Universal Design Diversity Program Compliance

Legal Product development Customer service Marketing & Outreach

WIOA – VR Focus on Business

Section 109: Training of Employers with respect to ADA Act of 1990.

Program to train employer’s on compliance with Title 1 ADA Inform employers of the existence of the program and availability of disability

Section 412

The state plan, when are in order of selection, if they client is in jeopardy of losing their job then they can be take in outside the order of selection.

Opportunities and Partnerships

503 has given us a federal contract with at least over 50K dollars must show affirmative action plan.

Industry Liaison Group at the Federal state and local level. People that look at how we are complying with Affirmative action.

Section 501 – Schedule A – 40% of Federal workers will retire. CSAVR – Vision 2020 – to develop a national initiative demonstrating evidence that the

VR Program is proactive, responsive to the principles of WIOA and a role model in the disability employment community.

TAP: Talent Acquisition Portal (Facebook – recently contact us for a pool of candidates.)

Staff Qualification

Where are, we going as a professional? Medical vs. holistic focus What was the Congressional intent of including a “Business” degree? What does it mean

to be a VR professional?

Day Two began with a presentation on the current state of affairs for the Rehabilitation Services Administration (RSA), presented by Dr. Thomas Finch, Director, Training and Services Programs Division of the RSA. This presentation included updates on changes surrounding the Workforce Innovation and Opportunity Act (WIOA), signed in 2014 by former President Barrack Obama.

The RSA Presentation was followed by a panel of two representatives who spoke on the topic of advocacy at the Congressional Level. The presenters were Kimberly Knackstedt, Disability Policy Advisor for the House Committee on Education and the Workforce, and Brad Thomas, Senior Education Policy Advisor for the House Committee on Education and the Workforce.

The next presentation was an overview of the Affordable Care Act, and the possible changes to healthcare services and Medicaid based on the failed “American Health Care Act” bill that had been introduced to Congress before the NRA GA Summit. This presentation was given by Marty Ford, Senior Executive Officer of The Arc, and included vital information related to the 2017 Issue Statements. For example, the presentation included a deeper look at the Federal/State partnership that allows Medicaid to be funded, and how that relationship would be changed by the potential block-granting of Medicaid.

This presentation was followed by Greg Mason, NRA President-Elect, who educated attendees on the Vocational Rehabilitation Counselor Coalition, a group that was established in late 2014 for the purpose of coming together on issues vital to the continuation and advancement of the Rehabilitation Counseling community and profession.

Day Two ended with another pair of breakout sessions: “The SGA Project: Improving VR Engagement and Outcomes for SSDI Only Clients; An Interim Snapshot” was presented by Ross Thelin from the Institute for Community Inclusion; and “The Art of Advocacy and Individuals in Supported Employment” presented by Laura Owens, the former Director of APSE and current Executive Director of TRANSCEN.

Visits to the Hill:

We were able to meet in person with Representative Nolan who was very welcoming. He sits on the committee that monitors the TRIO program. We were able to expand his knowledge by letting him know how the TRIO program helps our consumers who are in college. The TRIO program was one of the programs recommended to be cut and we were able to advocate for its continued support. We also met with staff members from the offices of Senator Klobuchar, Senator Franken, Representatives Emmer and Lewis. All were very welcoming and seemed interested in learning more about who we represent. Many of the staffers asked to be able to keep our contact info so that they could consult with us on future issues. We realized that the staff members are expected to be knowledgeable on so many issues that they really depend on their contacts just as we do in the field. Again – we need to do this job as a team!

Materials were also dropped off at the offices of Representative Betty McCollum, Representative Keith Ellison, Representative Erik Paulsen, Representative Tim Walz, and Representative Collin Peterson. The materials dropped off at each office included an Annual Report for State of Minnesota VRS, a fact sheet on success and stats related to outcomes, and a personalized letter for each representative.

Thank you, MRA membership and board for allowing us to represent you at the National Rehabilitation Association Governmental Affairs Summit.

Not sure if you want the Issue Statements, but here they are:

Issue Statements

1. CREDENTIALS COUNT:  VALUING THE QUALIFIED REHABILITATION COUNSELOR

STATEMENT OF ISSUE

Today, in America, we are experiencing an alarming increase in insufficient training of Americans across the employment spectrum.

Whether you learn of the increasing or insufficient training on your iPhone, iPad, newspaper, car radio, or television, the sad story is the same:  Improper and insufficient training results in Americans being unemployed, under employed, hurt, or worse.

Proper training affects all of us, whether you are on a plane, a train, a cruise, or providing medical and vocational rehabilitation services to individuals with disabilities, including those with significant disabilities, or providing training to our wounded warriors, credentials count and they always will.

BACKGROUND AND DISCUSSION

Qualified Rehabilitation Counselors, in both the public and private sectors, possess the specialized skill sets that are needed by personnel who are providing vocational rehabilitation (VR) services to our heroes at home, an aging population who in many cases require additional services and supports to retain or regain employment and to all eligible individuals with disabilities.

These specialized skill sets include:  counseling and guidance; knowledge and appreciation of the medical and psychological aspects of disability; knowledge and implementation of vocational assessment strategies and application of transferable skills; working knowledge and integration of labor market data pertaining to employment of individuals with disabilities; skills and abilities to match business workforce needs with the client's skills and talents, providing services required to develop and implement the individualized career plan that enables the individuals to be successfully employed in a competitive integrated work environment.

According to the Rehabilitation Services Administration (RSA) in the U.S. Department of Education, the training programs under the Rehabilitation Act of 1973, as amended, is designed to support programs that provide training to new Vocational Rehabilitation staff or to upgrade the qualifications of existing staff.

In recent years, the major focus of the training programs has been to address the shortage of qualified State VR agency staff by supporting long-term training programs to train new counselors and administrators.

Currently, VR agencies are undergoing dramatic turnover due to the retirement of a large number of qualified VR counselors which also affects their Community Rehabilitation Programs/Partners (CRPs) and other qualified private providers.

According to recent data from the State VR agencies, there were 1,622 vacancies (9.1%) out of 17,655 total positions nationwide in these offices.

Over the next 5 years, these VR agencies projected an additional 5,201 vacancies.  This would mean that, in the past 5 years, State VR agencies may need to successfully fill 39% of existing positions just to maintain current staffing levels.

The Department of Education believes that similar shortages will also affect other providers in the same time frame, including VR's Community Rehabilitation Programs, and other qualified private providers.

One of the cornerstones on which our country was founded was to get a good, solid education, including college, learn a trade and to give back to your communities with the very best knowledge and know-how one individual can impart to another.

That testament to proper training seems to have changed over the past several decades.

Like so many other countries, America is in a hurry to provide the fastest services many of us have become accustomed to receiving over these decades.

But, fast is not always the best and there is no better example of this than the rehabilitation profession in America.

Many qualified rehabilitation counselors, in both the public and private sectors, have earned Master's Degrees in Rehabilitation Counseling in order to serve to the best of their ability and proper training our heroes at home and all eligible students, other young adults and adults with disabilities, including those with the most significant disabilities.

According to the Bureau of Labor Statistics' Occupational Handbook for 2015-2017, the need for qualified rehabilitation counselors, whose entry-level education is a Master's Degree in rehabilitation counseling, will grow 9 percent faster than the average.

This growth will take into account an aging population, some of whom will require individualized services and supports by the best and the brightest in the rehabilitation field, in addition to so many other individuals with disabilities.

RECOMMENDATION:

Given these effective, life-changing training programs have not received an increase in funding for at least 25 years, coupled with the increasing needs for so many students, other young adults and adults with disabilities, including veterans, who require the

individualized services and  supports that qualified rehabilitation counselors have been providing for almost a century under the Rehabilitation Act of 1973, as amended, we respectfully request an additional $50 million to the training programs administered by the Rehabilitation Services Administration (RSA) in the U.S. Department of Education.

2. THE IMPORTANCE OF CONCURRENT SOCIAL SECURITY DISABILITY INSURANCE AND UNEMPLOYMENT BENEFITS TO INDIVIDUALS WITH SIGNIFICANT DISABILITIES

STATEMENT OF ISSUE:

The Social Security Disability Insurance Program (SSDI) and the Unemployment Insurance Program (UI) were established for different purposes and largely service different populations.  UI insures workers against the loss of a job through no fault of their own.  

SSDI, a lifeline program for individuals with disabilities, insures workers in the event of a significant disability that prevents the worker from engaging in substantial gainful activity (SGA).

According to a Government Accountability Office (GAO) report, less than 1 percent of individuals served by SSDI also receive UI benefits.

BACKGROUND AND DISCUSSION:

Encouraging SSDI beneficiaries to return to work has long been a cornerstone of bipartisan Congressional policy.  The Social Security Administration (SSA) permits SSDI beneficiaries to participate in work in incentives programs, such as trial work periods, without losing their benefits.  Penalizing individuals with disabilities who are attempting to work but are laid off through no fault of their own (and are eligible to receive unemployment benefits) may have the unintended consequence of discouraging attempts to return to work.

Like all Americans, SSDI beneficiaries who work seek greater economic security for themselves and their families.  To quality, SSDI beneficiaries must meet some off the strictest standards in the world.

At the same time, some individuals with significant disabilities who receive SSDI may be able to work part-time.  Beneficiaries who are eligible to participate in SSDI and UI should be able to collect from both programs without penalty, if they meet the eligibility requirements and have lost their job through no fault of their own.

RECOMMENDATION:

The National Rehabilitation Association strongly supports all individuals with disabilities, including those with significant disabilities, who want to work. 

 The National Rehabilitation Association opposes any attempt to deny individuals with significant disabilities who lose their job through no fault of their own from receiving unemployment benefits, just like their non-abled peers do.

The National Rehabilitation Association is opposed to any attempts to deny individuals with significant disabilities from collecting UI if, through no fault of their own, an SSDI recipient, loses his or her job.

3. MAINTAIN MEDICAID’S CURRENT FEDERAL/STATE FUNDING PARTNERSHIP

STATEMENT OF ISSUE:

Medicaid is the public health insurance program for low income Americans: infants and

children, pregnant women, parents, adults, individuals with disabilities and very low

income elderly. Medicaid is the primary source of health insurance for individuals with

significant disabilities. Efforts to reduce federal government spending by eliminating the

current federal/state system would place the burden on the states and harm America’s

most vulnerable individuals.

DISCUSSION AND BACKGROUND:

Medicaid was first introduced in 1965. Since then it has expanded to protect 73 million

of our most vulnerable Americans. As the largest single insurer in the United States

health care system, it serves low income individuals including those with complex and

costly medical needs. Medicaid is the primary source of long-term care which is not

covered by Medicare or commercial health insurance. Medicaid also helps children and

adults with disabilities to remain in their own home and receive community-based

services rather than more expensive and restrictive institutions. For individuals with

disabilities, Medicaid is the primary source of health insurance as many do not have

employer-based or alternative private coverage. Medicaid is the primary funder to assist

people with disabilities with long term supports to maintain their independence and

employment.

Medicaid is a federal/state program in which all states have participated since 1982.

Medicaid costs per beneficiary already are far below those of private insurance, after

adjusting for differences in health status, and have grown more slowly in recent years

than costs in both private insurance and Medicare. States and the federal government

share costs based on a federal formula (FMAP). States are required to follow key federal

requirements but they also have broad discretion in operating their Medicaid programs.

This flexibility allows states to better respond to demographic and economic shifts,

changing coverage needs, technological innovations, public health emergencies and

disasters beyond the state’s control. Due to this flexibility, cost-effective in-home and

community-based care is now more common than long-term institutional care in

providing services for people with disabilities. Under the current federal/state system if a

state spends more due to enrollment increases or if costs per enrollee rise, additional

federal payments are automatically generated.

Recently changes to Medicaid from a federal/state partnership to a fixed funding formula

have been proposed and are designed to reduce federal costs of Medicaid. A fixed

funding formula would place additional burden on states that are suffering under budget

constraints. Because states have already controlled spending aggressively, staying

beneath this lower rate of growth in federal dollars would be impossible for most states

without cutting benefits to those most in need of care. Less federal reimbursement would

burden already strapped states to use their own resources by changing eligibility

requirements resulting in some enrollees losing their needed healthcare, eliminating

services and/or cutting payment to providers. Fixed funding would hurt America’s most

vulnerable including children, families, people with disabilities and the elderly. Increased

costs to already strapped state budgets may then require the states to raise taxes, reduce

funding to other programs or cut provider rates. Cutting provider rates could reduce the

number of health care providers being able or willing to provide care and would result in

a decrease in needed services to those that need it most.

The services and supports that individuals with disabilities rely on in their daily lives are

dependent upon Medicaid. Medicaid is the primary payer for long term services and

supports. It has been proposed that moving to a fixed funding mechanism could provide

the states with greater flexibility and decision making. States have already instituted cost-

saving and innovative options. Fixed funding and the resulting burden on state budgets

would likely reduce or eliminate the states’ ability to provide community-based services.

Employment services and supports are a state option, not a federal requirement, and

states could be forced to reduce or end any type of Medicaid funding of employment

services and supports under a fixed formula. This would require individuals and families

to provide the supports needed to maintain their health and independence. Medicaid‘s

current structure also permits states to allow working people with disabilities at higher

incomes to buy into Medicaid coverage by paying a premium. Optional Medicaid

benefits that states can chose but are not required to provide include but are not limited to

prescription drugs, clinic services, dental, physical, occupational and speech therapy,

prosthetic devices, case management and hospice.

The Affordable Care Act’s Medicaid expansion significantly affects 70 million low

income Americans. For seniors and persons with disabilities, ACA provides the option to

obtain needed long term care, including home and community based care. The ACA’s

incentive for Home and Community Based Services (HCBS) offers an alternative to

nursing homes and institutions by providing patient centered services. For people with

disabilities, Medicaid is the lifeline for both health care and independence. Maintaining

the current federal/state funding formula ensures the advances people with significant

disabilities have made to live integrated lives of inclusion.

RECOMMENDATION:

The National Rehabilitation Association supports maintaining Medicaid’s federal/state

partnership that has been in place for over 50 years and allows the states to respond to

changing needs. Federal funding cuts including fixed funding formulas place the burden

on already struggling state budgets and hurt our nation’s most vulnerable citizens.

Maintaining the current Medicaid program is essential to the well-being and

independence of individuals with disabilities.

4. THE WAY FORWARD ON PRESERVING HEALTH CARE FOR ALL AMERICANS

The United States of America is widely thought to be the greatest country in the world and with that accolade comes the concomitant commitment to provide policies and legislation to all Americans that are inclusive, thoughtful, fair and affordable.

Inclusion has always been and continues to be one of the hallmarks of the disability community which lives by the adage:  “Nothing about us, without us”.

DISCUSSION AND BACKGROUND

On Friday, March 24, 2017, the bill to repeal and replace the Affordable Care Act, S. 1628, The American Health Care Act of 2017 was pulled from consideration on the U.S. House of Representatives' Floor by the President and the Leadership in the Republican party because this bill did not have the requisite votes to pass on the House Floor.

To this day, the Affordable Care Act (also known as Obamacare) remains the law of the land.

One of the many reasons why H.R. 1628, the repeal and replace bill dissolved was that this bill was put together much too hurriedly, was done behind closed doors, was not bipartisan, and quite frankly, frightened millions of Americans who had health care for the first time in their lives under the Affordable Care Act.

The Medicaid portion of the failed repeal and replace bill, which called first for the block granting of Medicaid, and later would have instituted per capita caps on the program, (1) would have changed the way pre-existing conditions were interpreted in the ACA to one that would have instituted "high risk" insurance pools, which had been tried before and failed, (2) would have had a devastating impact on Medicaid expansion in the States, and (3) would have had a disastrous impact on Americans who depend on the ACA for their health insurance.

The great Supreme Court Justice, Louis Brandeis, said "Sunlight is the best disinfectant." He was right.

The disability community strongly believes in transparency, in productive partnerships when making policy or drafting legislation, and that all Americans must be part of that process.

RECOMMENDATION

The National Rehabilitation Association respectfully requests that if the Affordable Care Act is to be revisited in the future that any changes to the ACA be open, bipartisan, incremental, thoughtful, and inclusive of the many stakeholders involved in the process.

We, in the National Rehabilitation Association, stand ready to assist in any way we can should the Affordable Care Act be revisited and we want to offer our expertise on these important issues as a resource, going forward.

5. INCREASED RESOURCES FOR MENTAL HEALTH SERVICES

There is an urgent need for substantial, additional resources to respond to the dramatic increase in the incidence of mental health services in our country.

Approximately, 1 in 25 adults in the United States, 10 million people, experience mental health illness in a given year. 

Approximately 1 in 25 adults in the U.S., 10 million people, experience a serious mental illness in a given year that substantially interferes with or limits one or more major life activities. 

Over one-third (39%) of students with mental health conditions, age 14-21 and older who are served by special education, drop out of school -- the highest dropout rate of any disability group.

BACKGROUND AND DISCUSSION

For far too long additional funding for mental health services in our country has languished in Congress.

With the increased incidence of mental health issues in this country, coupled with the fact that more than 90% of children who die by suicide, have mental health conditions and the alarming fact that each day an estimated 19-22 veterans die by suicide.

There should never be a time in our great country when an individual with a serios mental condition be turned away from a hospital or any other appropriate place to seek help because of a lack of adequate hospital beds and/or staffing.

RECOMMENDATION:

Mental health services in this country need to be appropriately funded to respond to the increased incidence of mental health issues in our society, including, but not limited to, our wounded warriors returning home with oftentimes undiagnosed disabilities like Post-Traumatic Stress Disorder (PTSD) or other brain-related injuries

The National Rehabilitation Association respectfully recommends significant funding increases in mental health services to our heroes at home who have sacrificed so much in the defense of our country, and for other Americans with mental health issues.

6. MEDICARE ACCESS TO REHABILITATION SERVICES ACT OF 2017

STATEMENT OF ISSUE

The National Rehabilitation Association strongly supports the bills H.R. 807 and S. 2531, the Medicare Access to Rehabilitation Services Act of 2017, the outpatient therapy services cap repeal legislation.

DISCUSSION AND BACKGROUND

The bills, H.R. 807 and  S. 2531, the Medicare Access to Rehabilitation Services Act of 2017, enjoy bipartisan support.

Individuals with brain injury, spinal cord injury, stroke, amputation and other serious and chronic conditions often need intensive and ongoing rehabilitation care to improve their health, maintain their functional abilities, and prevent deterioration of function.

Outpatient rehabilitation therapy is a critical component of an overall plan of care for many Medicare beneficiaries and help such individuals live independently in their homes and communities, rather than being institutionalized.  For individuals with chronic conditions, outpatient therapy services are vital to avoiding unnecessary and expensive acute care visits and preventing secondary conditions.

The National Rehabilitation Association believes that therapy caps are completely arbitrary and harm beneficiaries most in need of rehabilitation.

RECOMMENDATION:

The National Rehabilitation Association believes that outpatient therapy services should be administered in the best interests of individuals needing rehabilitation, rather than based on arbitrary limitations on coverage.

We, therefore, strongly support the bipartisan Medicare Access to Rehabilitation Services Act of 2017.

Congressional Panel

Kim Knackstedt

IDEA we are not expecting that would be coming up anytime soon, we are holding off if possible due to impact.

Looking how we can assist people in higher education to be disability access. WIOA we are watching the implication of this what is working and what is not

working Receiving tweets is the best way to keep up to date on the on bills. You can also

go to Congress and search ADA, etc… The app called WHIP WATCH to keep up what is going on at the hill.

Ann serves on the Senate Health Committee

Senator Murry from WA Defending of the Affordable Care Act to modify and not place. Trump has released the skinny budget (his preferences). Lots of cuts that directly

affect people with disabilities.

15% set aside for Transition 16 years of age. Demographics of the blind agency is separate in some states than the general agencies. If the blind cannot utilize the all the 15% then it will need to be given back, this along with major of the blind served people are older adults.

ACA/Medicaid – Marty Ford, Senior Executive Officer

American Health Care Act – we won the battle, but the war is not over. Medicaid covers low-income people about 70 million Medicare covers people over 65 and some people with disabilities about 55

million. Group insurance covers 155 million people Prior to ACA no protection in private market on preexisting conditions, annual

and lifetime caps and many services were not covered. ACA mattered a lot of nondiscrimination and health insurance reforms,

affordability, and comprehensiveness, expansion of long-term support and services and Medicaid expansion.

ADA, insures may not discrimination against people with pre-existing conditions, no annual/lifetime caps, include rehabilitative services, devices, mental and behavioral health services, prevention and wellness services, premium subsidies to make insurance affordable, children to age 26.

ADA Expanded eligibility to o Community first optiono State Pan home and community-based serviceso Extension of money follows the person rebalancing demonstrationo Creation of balancing incentives program.

Medicaid expansion brought in 11 million people in 32 states, created new edibility category for childless adults.

Medicaid Services optional for the state in the photo below, left side of the screen is required services and the right hand side is the state optional services a state can provide.

Medicaid has two important entitlement

a. Individual - Anyone who meets eligibility criteria and “need” has a right to enroll in Medicaid coverage.

b. Federal-State Partnership - State must meet mandatory requirements including mandatory eligibility and services.

Facts:

o States have guaranteed federal financial support for part of the cost of their Medicaid program.

o The average Federal match is 63% it fluctuates with the enrollment and adds, services, new treatments, and drugs, increased provider reimbursement.

o People with disabilities and Sr. Citizens account for about 21% of Medicaid beneficiaries and 48% of Medicaid spending.

o Medicaid is projected to serve 77.5 million individuals in 2024 at a total cost of $920.5 billion with a federal share of 61%.

Threat to Medicaid: Cutting in funding, removing the entitlement to individuals and the states, block grants/flexible state allotment/per capita caps, structural changes that will lower the cost to the federal government over time.

Medicaid per capita cap. Limit federal spending by changing the federal and state financing relationship. NOT just a cut in spending. Apply to the entire program. Difference caps for different populations, shortfalls in funding unavoidable, conflict between beneficiary groups, consumer protection, regulations

Medicaid block grant: Limit federal spending by changing the federal and state financing relationship. NOT just a cut in spending, less accountability, in able to adjust to economic conditions, easier to cut federal share in future, does not affect costs of health care services, ignores aging population and impact on health system; ignores new health crisis.

Impact on Medicaid: if ACA’s Medicaid expansion is repealed –block grants will be an easier sell. Disables the program in the expansion states

Possible results: states loss entitlement, no federal rules or protections.

American health care act: get rid of individual mandates and employer mandates, allow insurers to charge older adults five times what they charge younger adults. Repeals tax on health insurance prescription drugs, medical devices, release Medicaid expansion.

Messaging for Congress

o Medicaid is a critical support for people with disabilitieso ACA has improved the quality of life for millions of people who previously did

not have health coverage. o Congress must maintain the critical non-discrimination of health insurance

improvements that enable people with disabilities and chronic health conditions to benefits from health insurance.

o Congress should ensure that health insurance benefits are comprehensive and affordable.

survey thearc.org/finds More information on The Arc website