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ADAPT on the AHCA

ADAPT Statement in Response to Passage of the American Health Care Act in the US House of Representatives May 4, 2017 The ADAPT Communi...

Thursday, May 4, 2017

ADAPT on the AHCA

ADAPT Statement in Response to Passage of the American Health Care Act in the US House of Representatives

May 4, 2017
The ADAPT Community is gravely concerned by the House of Representatives’ ill-considered passage of the American Health Care Act (AHCA). The legislation, which received significant amendments only days before the vote, has serious problems which House Republicans – in their haste to pass something and declare victory – have refused to address.
 
This legislation – if it were to pass the Senate and become law – will have a truly devastating impact on seniors and people with disabilities.  It will:
  • Destroy the insurance protections for individuals with pre-existing conditions that allow them to receive necessary healthcare services;
  • Undercut access to vital Medicaid healthcare as well as long-term services and supports (LTSS) needed by older and disabled Americans; and  
  • Eliminate the incentive to provide community-based services to disabled Americans established in the Community First Choice Option.
 
Eliminating Protections for People with Pre-existing Conditions
Although recent changes to the legislation secured the support of moderate Republicans, those changes do little, if anything, to mitigate the dangerous impact of this legislation, particularly on people with pre-existing conditions.  Insurance companies will be able to charge exorbitant premiums to disabled and elderly individuals leaving these individuals without healthcare.
 
Cutting Medicaid Funding Needed to Support Elderly and Disabled Americans
As written, the legislation will cut more than $830 billion from the Medicaid program, forcing states to choose between raising state taxes and cutting healthcare services for poor children, the disabled and seniors.  These cuts couldn’t come at a worse time.  As our population continues to age, more and more people will rely on Medicaid to cover vital long-term services and supports, further straining state resources.  States will reduce Medicaid benefits, impose waiting lists, implement unaffordable financial obligations, or otherwise restrict access to needed assistance.  Without adequate support in the community, families will be forced to place their loved ones in nursing facilities and other institutions, only increasing the strain on already-limited Medicaid resources.
 
Eliminating Federal Incentives Designed to Promote Community Integration
For elderly and disabled Americans who rely on it, Medicaid is not just a health insurance program: it literally supports their lives and their liberty.  Outside of the Disability Community, there has been virtually no public discussion about how the AHCA eliminates the enhanced Federal funding associated with the Community First Choice Option (CFCO).  CFCO was the result of nearly a quarter century of work by ADAPT and other disability rights advocates.  This Medicaid option provides additional funding to states that provide LTSS in the community to people who would otherwise be placed in a nursing facility or institution. 
 
CALL TO ACTION
We do not believe that American voters intended this Congress and President to cut vital services for economically disadvantaged, elderly and disabled Americans to provide tax breaks to the wealthiest of our nation. Indeed, President Trump campaigned on a promise that there would be no cuts to Medicaid.  Now, more than ever, it is critical that disabled and elderly individuals, their families, and their advocates understand the dangerous implications of this legislation and become politically active.  Although AHCA has passed the House, it still must pass the US Senate before it can be signed into law.  We must educate our communities about the dangerous implications of this bill and urge our Senators to vote against the bill. 
 
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ADAPT is a national grass-roots community that organizes disability rights activists to engage in nonviolent direct action, including civil disobedience, to assure the civil and human rights of people with disabilities to live in freedom.

ADAPT activists

Thursday, April 27, 2017

The Community First Choice Option


Funding Tennessee’s Community Living Services


 


ADAPT in action
The Community First Choice (CFC) Option [part of the Affordable Care Act] will revolutionize the long term services and supports (LTSS) system for Tennessee.   Federal funding is available now and the final rules are published so Tennessee should immediately move forward with the creation of the Development and Implementation Council.

 

CFC would allow Tennessee to draw down an additional federal funds that could be up to $60 million annually in Medicaid resources to sustain the shifts in the long term services and supports system.

OVERVIEW


The Community First Choice Option is a community-based Medicaid state plan service which includes hands on assistance, safety monitoring, and cueing for assistance with activities of daily living, instrumental activities of daily living and health related functions for individuals based on functional need, not diagnosis or age.

THE BASICS


The Affordable Care Act, Section 2401, added 1915(k) to the Social Security Act under Medicaid. Final rules available at 42 CFR 441 Part K or in the Federal Register at Vol. 77, No. 88 (77 FR 26828).


·       Supports choice, independence, and integration in accordance with the Olmstead decision

·       Person-centered and consumer-directed

·       Services must be provided in a home and community-based setting and CANNOT be provided in a nursing facility, institution for mental diseases (IMD), or intermediate care facility for people with development disabilities (ICF-MR)

·       Must be provided on a statewide basis

·       Eliminates HCBS waiting lists

·       States that implement CFC will receive an additional 6% in federal matching funds, with no sunset

·       States that are pursuing CFC (to date): AR, CA, CO, LA, MD, MN, NY, RI, WA

 

ELIGIBILITY


Must be Medicaid eligible

Must require an institutional level of care (hospital, nursing facility, ICF-MR, or IMD)

REQUIRED SERVICES


States must provide the following services.

 

·       Attendant services and supports to assist in accomplishing: activities of daily living (ADL), instrumental activities of daily living (IADL), and health-related tasks

·       Attendant services and supports include: hands-on assistance, safety monitoring, and cueing

·       Assistance with the learning skills necessary to accomplish ADL, IADL, and health-related tasks

·       Allows for the purchase of back-up systems (such as beepers or other electronic devices) to ensure continuity of services and supports.

·       The State must develop and offer a voluntary training to individuals on how to select, manage and dismiss attendants.

 

 

PERMISSIBLE SERVICES and SUPPORTS


States can choose to provide the following services.

 

·       Transition costs, such as security deposits for rent or utilities, purchasing basic kitchen supplies, etc.

·       Services that increase independence or substitute for human assistance, such as assistance with learning how to use public transportation, for example.

EXCLUDED SERVICES


CFC funding cannot be used to pay for the following services because either the service cannot be paid for by Medicaid or the service is available through alternative mechanisms, such as HCBS waivers.   However, similar services may be permissible under the context of “Expenditures relating to a need identified in an individual’s person-centered service plan that increases an individual’s independence or substitutes for human assistance.”

·       Room and board

·       Special education and related services provided under IDEA and vocational rehab

·       Assistive technologies (other than those used as back-up systems)

·       Medical supplies and equipment

·       Home modifications

MODELS FOR SERVICE DELIVERY


States can select one or more model for the delivery of CFC. Ideally, states will provide consumers with a robust system in order to increase choice. Services must be provided under a person-centered plan.

 

“Agency Provider Model” includes a range of approaches, with the individual having the ability to select, train, and dismiss their attendant, including:

 

Traditional agency managed services

Agency-with-Choice model where the agency operates solely as a fiscal intermediary


“Self-Directed Model with service budget” including:

·       Vouchers

·       Direct Cash Payments

·       Fiscal Agent


CONSUMER RIGHTS


Emphasis on a person directed plan and planning process, which includes individuals chosen by the consumer

Consumers can select family members (except spouse or legal guardian) or any other individuals to provide services and supports

 

·       Consumers can train workers in specific areas of care needed by the individual and to perform the needed assistance in a manner that is consistent with the individual’s personal, cultural, and religious preferences

·       Consumers can establish additional staff qualifications based on their specific needs and preferences

SO, WHAT WILL CFC LOOK LIKE IN TENNESSEE?


Many decisions still have to be made. CFC sets the framework for a fully integrated, non-diagnosis-specific, community-based service system that provides individuals the civil right to live independently in the community and out of an institution. CFC is structured to allow states to work within their unique Medicaid system of state plan services, waivers, and managed care services.


The decisions for structure, implementation, and monitoring are the responsibility of the State’s CFC Development and Implementation Council, which must be comprised of mostly people disabilities, seniors, and their representatives – as required by CFC.  

 
It is imperative that Tennessee establish its Development and Implementation Council NOW! Every day delayed is money left on the table, and people’s rights ignored.    

Tuesday, April 18, 2017

Mid-South ADAPT confronts Corker

Local ADAPT Chapter asks for support for Disability Rights
Sen Bob Corker
Today Mid-South ADAPT confronted Tennessee Sen. Bob Corker asking him to cosponsor the Disability Integration Act (S. 910). Standing on a chair in the Crave Coffee Shop in Arlington Tennessee, a Mid-South ADAPT member caught the Senator at a rare public meeting and requested the Senator support people with disabilities civil right to live in the community.
“Elderly Americans and people with disabilities demand choice in long-term care,” said the activist standing above the crowd on a chair. “Tennessee more than most states needs the Disability Integration Act to avoid expensive institutions and nursing homes.”
Corker spoke briefly at the coffee shop outside of Memphis and answered some questions from the crowd that packed the small venue. The Senator stopped promptly at 9:AM. Mid-South ADAPT handed Disability Integration Act information to Senator Corker and he said that he would look at the information.
The Disability Integration Act (DIA) is civil rights legislation, introduced by Senator Schumer to address the fundamental issue that people who need Long Term Services and Supports (LTSS) are forced into institutions and losing their basic civil rights. The legislation (S. 910) builds on the 25 years of work that ADAPT has done to end the institutional bias and provide seniors and people with disabilities home and community-based services (HCBS) as an alternative to institutionalization. It is the next step in our national advocacy after securing the Community First Choice (CFC) option.
The legislation, when enacted, establishes new federal law - similar in structure to the ADA - that requires states and insurance providers that pay for LTSS to change their policies, provide community-based services first, and offer HCBS to people currently in institutions. DIA operates alongside CFC, but these two laws work very differently. CFC is an option which states can choose. Even though CFC provides money for states to support independent living, many states have not chosen CFC. DIA requires states and insurance providers that pay for LTSS to make real and meaningful changes that support the right of people with disabilities to live in freedom like every other American.
The proposed legislation establishes new federal law - structured like the ADA - that says “No public entity or LTSS insurance provider shall deny an individual with an LTSS disability who is eligible for institutional placement, or otherwise discriminate against that individual in the provision of, community-based long-term services and supports that enable the individual to live in the community and lead an independent life.”
Congressman Kustoff meets JoannDIA makes it illegal for a state and insurance providers that pay for LTSS to fail to provide HCBS by using waiting lists, screening people out, capping services, paying workers too little for services, or the other excuses that have been used to keep people with disabilities from living in freedom. DIA requires each state to offer community-based services and supports to any individual who is eligible to go into an institution. It also requires states to take active steps to make sure that there is enough affordable, accessible, integrated housing.
The legislation requires states and LTSS insurance providers to complete a self-evaluation to evaluate current services, policies, and practices that do not or may not meet the requirements of the Act and to make the necessary changes in services, policies, and practices required to comply with the law.   Additionally, public entities are required to develop a transition plan using an extensive public participation process. Public entities that fail to comply with the law may face legal action for the Attorney General or may be sued directly. People who have been discriminated against may receive damages under the law.
Crowd at the Corker townhall
 

Tuesday, March 21, 2017

Press Release: ADAPT asks Sen Alexander to preserve our right to live in the community.


For Immediate Release  

For more information:
Allison Donald (901) 283-1412 (cell)
Tim Wheat (303) 887-9406 (cell)


People with disabilities ask Sen. Alexander to preserve disability rights aspects of the health care law.


(Memphis, March 22)  Mid-South ADAPT is calling on Senator Lamar Alexander to preserve critical components of the Affordable Care Act which secures the rights of people with disabilities to live in the community and provide vital healthcare services.  ADAPT demands equality for people with disabilities and is visiting Sen. Alexander’s Memphis office to share personal narratives of the critical importance of inclusion of people with disabilities.

“The American Health Care Act (AHCA) threatens to take back all of the victories disability advocates have fought for the past thirty years or more,” said Allison Donald Organizer for Mid- South ADAPT.  “We are here today to let Senator Alexander know we want him to keep the preexisting conditions provision prohibiting discrimination by insurance companies, say yes to CFCO, say yes to money follows the person, and say yes to accessibility standards for diagnostic medical equipment. We want him to say no to Medicaid block grants, because our lives depend on it.  Healthcare is a Human Right!”

Congressional Republicans are moving forward with legislation that eliminates the Community First Choice Option (CFCO) for Tennessee by 2020 as part of a strategy to cut Medicaid funding for disabled individuals.  CFCO, which was introduced as part of the Affordable Care Act (ACA), is the only current Medicaid program aimed at ensuring disabled people’s rights to live in the community.  By providing enhanced federal funds to states that have adopted the program, CFCO gives Medicaid beneficiaries greater access to home and community services enabling them to live in their communities rather than expensive nursing facilities or institutional settings that rob them of their civil right and fundamental liberties.  Tennessee could save millions with CFCO, we are asking Alexander to keep this option available for our state even if he chooses to repeal the ACA.

In the states that have implemented it, CFCO has become a vital tool in moving disabled people out of nursing facilities and other institutions and into their own homes.  Members of the Disability community have expressed concerns that the GOP is using CFCO and block grants to play partisan politics without consideration for the many people with disabilities whose live are hanging in the balance and the potential benefits to states that could use the federal funds to move people out of expensive facilities.

“[People with Disabilities] should be able to do things on their own instead of having to depend on anyone to do things for them,” said Davina Williams of Mid-South ADAPT. “They should be able to do what they want to do for themselves.”

The concern in capping or block granting Medicaid congressional Republicans are setting limits on how many disabled people can transition from institutions into the community, and eliminating CFCO restores the Medicaid bias toward institutionalization that the disability community has long fought for.

 

WHEN: 11:30 A.M. Wednesday, March 22, 2017

WHERE: Sen. Lamar Alexander’s Memphis Office
125 North Main Street, Memphis Tennessee

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Wednesday, February 22, 2017


Outraged Disability Rights Leaders Send a Message to their Governors and the National Governors Association about ACA Repeal/Replace/Repair

 

 

For Immediate Release:Allison DonaldMid-South ADAPT901-726-6404Allison@mcil.org
www.midsouthADAPT.org

 


(February 22, 2017 Memphis) – Disability rights leaders in Tennessee are sending a “loud and clear” message to Governor Haslam to take with him to the National Governors Association when it meets in DC later this week, February 24 – 27: 

 
61 million Americans with disabilities are at risk of losing health care coverage, benefits and their right to live in the community.


Disability leaders are asking their Governors to put people first, over partisan politics. Several Republican Governors, including Governors Kasich (OH) and Snyder (MI), have been very outspoken against the Medicaid cuts.  In similar statements across America, disability leaders are united in their demands:

 
We oppose the GOP repeal and replace proposal because:

 
- Medicaid block grants and per capita caps are nothing more than an attempt by the federal government to cut support to states for Medicaid.

 
- Over the next 10 years Federal support is projected to be cut by $1 trillion; states and/or counties will have to come up with the replacement revenue or make major cuts.

 
- Cuts will be made to prescription drugs, physical, occupational and speech therapies, Personal Care, HCBS waivers and state plan amendments, Community First Choice  and Health Homes, etc. These so called “optional” services often mean the difference between “life and death” for many people with disabilities.

 
- Under block grants, states would receive a fixed amount of money each year for the program regardless of actual needs or costs. Per capita caps provides a fixed amount of funding per Medicaid beneficiary with states liable for all medical and LTSS costs beyond the caps.

 
- Neither Block Grants nor per capita caps can or will control health care and LTSS costs.

 
- Enhanced Medicaid expansion matching funds in 31 states and DC would be reduced, another loss of revenue to states, further squeezing state budgets, and resulting in a resurgence of uncompensated care to emergency rooms and hospitals, reduction in treatment for people addicted to opioids, and millions of people losing access to health care they only recently received.

 
- Reduction in federal revenue to the states will result in enrollment caps, increase in waiting lists, and human pain and suffering. 10 million people are covered by Medicaid expansion, and about 20% of those are people with disabilities.

 
- Decrease in federal revenue will result in a major loss of jobs in health care and long-term services and supports (LTSS) in every state.

 
- Eight states with Community First Choice (CFC) will lose their 6% enhanced Medicaid match: CA, CO, MD, MT, NY, OR, TX, and WV.

 
- Of the 73 million Americans covered by Medicaid, 15 million (21%) are children and adults with disabilities and senior citizens.  People with disabilities  account for 48% of total Medicaid dollars due to higher acute care costs and costs of LTSS.  Kids and moms receiving TANF (Temporary Assistance to Needy Families) benefits are generally healthy, and so are quite inexpensive to Medicaid. Therefore, capping Medicaid will result in potential draconian cuts in services to people with disabilities and senior citizens.

 
- People with disabilities who are employed may have to quit their jobs due to loss of funds for Personal Care Attendants (PCAs) or access to state optional Medicaid buy-in plans, now existing in 65 states (only AL, FL, HI, TN and D.C. do not have buy-in plans).  

 
- End of enhanced federal matching funds for Money Follows the Person (MFP) that liberated over 63,000 people from institutions, and loss of Community First Choice (CFC) will make it far more difficult for people to leave or avoid institutions, which in the aggregate are 2-3 times more expensive for a poorer quality of life than the costs and benefits of community services and supports.


- If ACA is repealed we will revert to Lifetime Caps in commercial insurance which harm people with significant medical and community LTSS needs.

 
- There can be NO repeal without replacement, and any replacement plan must assure access to quality coordinated health care in Medicaid including Health Homes and cost-effective LTSS FOR personal care, CFC, and HCBS state plans and waivers rather than nursing homes and INSTITUTIONS FOR PEOPLE WITH DEVELOPMENTAL/intellectual disabilities (ICFs/DD).


- On the commercial insurance side, we cannot accept High Risk Pools – they are proven to not work, are very expensive and have high deductibles and co-pays. Health Savings Accounts have NO savings in them for low and moderate income people with disabilities.

 
- Disability leaders cannot support reinstatement of annual and lifetime caps by insurance companies, and denial of coverage or massive surcharges for preexisting conditions.

The disability community is united in its determination to protect access to affordable, quality health care and long term supports and services that promote community living and employment and we insist that your policy changes do no harm.

          - It’s about saving lives and improving health

          - It’s about independence and community participation

- It’s about civil rights, freedom and liberty  

 
We can help improve Medicaid without harming people. Nothing about us without us,

Mid-South ADAPT

Friday, January 20, 2017

Disability Aspects of the ACA

Congress is on the fast track to repeal the Affordable Care Act (ACA). There are many, many advocates fighting to preserve the insurance provisions of the ACA – known as ObamaCare, but virtually no one is talking about the disability-specific aspects of the law. Here are four important provisions in the ACA that are critical for the Disability Community.
1. The ACA prohibited discrimination against people with pre-existing conditions by insurance companies.
2. The ACA extended Money Follows the Person, a Republican New Freedom initiative that is liberating thousands of disabled people from institutions, but that program is ending because of Congressional inaction.
3. The ACA established the Community First Choice Option a Medicaid option that incentivizes states to FREE OUR PEOPLE from nursing facilities and institutions.
4. The ACA authorized accessibility standards for Diagnostic Medical Equipment so people with disabilities could get access to preventative healthcare screenings and appropriate diagnostic testing.
Congress is acting swiftly to repeal the ACA, but most members of Congress have no idea that these provisions were even included in the ACA! We cannot rely on other groups to defend our interests and issues. The Disability Community – itself – needs to act now!
TAKE ACTION
1. Do this electronic action alert to tell Congress to preserve these disability-specific provisions of the Affordable Care Act. Click here
2. PROMOTE and SHARE this link to get as many other people as possible to TAKE ACTION on this issue! Click here
3. Sign on your ORGANIZATION to this letter urging Congress to save these disability-specific provisions in the ACA. Click here
4. Send your OWN letter to Congressional Leadership and the people that represent you in Congress. Use the text from the sign on letter to make this easy and send us a copy at MMoore@CDRNYS.org
TWEET!
Whether you like him or not, President-elect Trump demonstrated the power of Twitter. US policy is now being made in 140 characters or less. We should leverage our special media voice and our social media networks to get the word out. Although Congressional leadership doesn’t follow Twitter closely and respond, the President-elect does. If we can’t get through to Congress, we should ask @realDonaldTrump to help us make the case.
#ACA included Money Follows the Person- Republican initiative giving #NewFreedom to #disabled. @realDonaldTrump #ReadB4Repeal #CripTheVote
#ACA included Community First Choice- giving #Liberty to #disabled. @realDonaldTrump #ReadB4Repeal #CripTheVote
#Liberty of #Disabled shouldn’t be culture war collateral damage. @realDonaldTrump help get Congress to #ReadB4Repeal #CripTheVote
#ACA gave #Disabled women access to mammography. @realDonaldTrump help get Congress to #ReadB4Repeal #CripTheVote
#ACA stops discrimination against #disabled by insurance. @realDonaldTrump help get Congress to #ReadB4Repeal #CripTheVote
.@realDonaldTrump #ACA’s Community First Choice Option let Disabled people Stay in our homes! #ReadB4Repeal #CripThgbeVote
.@realDonaldTrump #ACA included the #GOP created Money Follows the Person Initiative giving Disabled ppl Freedom. #ReadB4Repeal #CripTheVote
ADDITIONAL ADVOCACY TOOLS
We know it is easier when you have a toolkit to work with. We have crafted a press release you can use and are finalizing some talking points to reference when the press calls you. We will add additional tools as this campaign continues. Here is the toolkit link