DISABILITY RIGHTS NEWS REPORT
Courtesy of California Disability Community Action Network www.cdcan.us
Advocacy Without Borders

#020-2007  February 6, 2007  Early Tuesday morning
Edited/Written By: MARTY OMOTO, Director/Organizer 
To Respond to THIS report reply to: martyomoto@rcip.com   CDCAN website: www.cdcan.us

Proposed Federal Budget for 2008
* SIGNIFICANT CUTS TO MEDICARE & MEDICAID PROPOSED
* MEDICARE PROVIDERS & RECIPIENTS BOTH IMPACTED
* VALUE OF HOME WOULD LIMIT MEDICAID ELIGIBILITY
* DEMOCRATIC CONGRESS LIKELY TO RESIST MANY CUTS
* GOVERNOR EXPRESSES CRITICISM OF BUSH BUDGET

SACRAMENTO -  The proposed federal spending plan, for the budget year that begins October 1, 2007 through September 30, 2008, was released by President George W. Bush on Monday (February 5), and would make significant long term reductions to Medicare, Medicaid, housing and other programs impacting people with disabilities, mental health needs and seniors. The President's proposed $2.9 trillion spending plan for the federal budget year 2008 (the California budget year begins July 1 and ends June 30) unlike in previous years, however, faces a Congress controlled by the Democrats, who are likely to resist many of the proposed reductions.  The proposed federal spending plan received criticism from Republican Governor Arnold Schwarzenegger in a statement released Monday afternoon.

Medicare Provider Cuts & Medicaid Home Equity Proposed Changes Significant
* Though the spending reductions represent about 2 or 3% of the total Medicare and Medicaid budget, disability, mental health, senior and low income advocates are sounding the alarm to oppose the President's proposed spending cuts as significant, especially at a time that the nation and the State is focused on the issue of health care.  Proposed savings or spending reductions impacting Medicare providers and savings will have a significant impact - if enacted - on Medicare health facility providers and others who serve people with disabilities, mental health needs and seniors. 
* Likewise, a proposal in the proposed federal budget to eliminate the option by the states to increase the $500,000 home equity limit for Medicaid eligibility to $750,000, and instead limit equity to $500,000 would have a major impact on hundreds of thousands of people with disabilities, seniors and others in California if enacted [note: though no official legislative language was released, it is presumed that the house equity limits would apply to people who come up for "redetermination" or a review of their Medi-Cal eligibility.  California has not yet issued any regulations or change in State law regarding home equity limits, including upping the limit to $750,000]. 

[CDCAN Editor's Note: A CDCAN "Advocacy Without Borders" Townhall Telemeeting is scheduled Tuesday, February 6th at 1 PM to 2:30 PM featuring the head of the California Medicaid (Medi-Cal) program, Stan Rosenstein.  The townhall is free and open to the public - and is organized to provide a way for people with disabilities (including developmental), mental health needs, seniors, their families, workers, community organizations and other advocates to have direct access to public policy.  Go CDCAN website for free toll free number or dial toll free number: 1-800-608-4143   Note: there is NO passcode.]

2007 Federal Budget Still Not Yet Final
The US Senate is still finishing up work on making permanent - with changes made by the Democrats in both houses, the temporary federal budget for 2007 that was originally passed last December by the then Republican controlled Congress. Congress in December, unable to agree on a final budget for 2007, passed a temporary spending plan to keep the federal government operating at least until February 15, 2007. 

The Democratic controlled House of Representatives, joined by 57 Republicans,  voted on January 31 to approve HR 20, which included increases for housing (public housing authorities).  [see CDCAN Report 2/1 for more details]

Governor Raises Concern On President Bush's Proposed Budget Cuts
Gov. Arnold Schwarzenegger issued a statement late Monday and saying that  "Over the next several days, we will be analyzing the impact that the President's budget would have on California. However, several issues stand out immediately" adding that it was "...encouraging that the budget recognizes the need to spend more on the Healthy Families Program to provide health insurance for uninsured children. But what the budget calls "reforms" in Medicaid reimbursements are straight transfers of federal costs onto state budgets. I plan to work with our delegation to make sure these cost shifts aren't enacted."

It is not clear however what increases the Governor was referring to, given the proposed spending for the State Children's Health Insurance Program, fell far short, especially when combined with proposed cuts to Medicare and Medicaid,  of what most advocates believe would be needed to fund the programs in the states.  

The Governor - who has been at odds with President Bush over several policy issues in the past year, said that the President's proposal to eliminate the program that reimburses states for the costs of incarcerating undocumented immigrants is "unacceptable" 
"This program has bipartisan support in the Congress and with my fellow governors who have to bear the costs of a failed federal immigration policy. Working together, I'm confident that these funds will be restored to the budget, as they have in the past."

The Governor was also critical of budget reductions in the area of Homeland Security and Urban Areas Security Program, saying that these programs "...help our first responders protect our major cities...These programs are critical to helping California prevent against and respond to threats against some of the world's most recognized cities here in California, as well as our ability to respond quickly and effectively to a disaster."

There was no official comment available from the Legislative Democratic leadership. 
 
CDCAN SUMMARY: MAJOR FEDERAL BUDGET PROPOSALS FOR 2008

MEDICAID 2008 BUDGET PROPOSALS
* Medicaid (called Medi-Cal in California) provides health coverage to about 50 million people with disabilities, low income seniors, the blind and people who meet eligibility requirements under the old "Aid to Families with Dependent Children or AFDC" (called "CalWORKS"in California). In 2007, 5 million seniors 65 and over, 8.5 million are blind or persons with disabilities (including developmental), 11.1 million are needy adults and 23.5 million are needy children. 
*  In California, about 6.8 million people are on Medi-Cal, with about 1.6 million of that number persons with disabilities, seniors or the blind.  This includes people who receive In-Home Supportive Services, many regional center funded community-based services, persons in developmental centers, many persons in skilled nursing and other health facilities, and also includes thousands who are eligible for both Medi-Cal and Medicare services. 
* President Bush proposes legislative and budget proposals that call for $1.9 billion in savings (spending reductions) in the budget year 2008, and about $13 billion over 5 years.  In addition to that is a total of -$1.5 billion in Medicaid "administrative"  savings (or spending reductions) for 2008, with -$12.7 billion over 5 years.  Altogether, that spending reductions or savings to Medicaid proposed by President Bush amount to $3.4 billion for budget year 2008, and over $25.7 billion covering 5 years.  The total Medicaid budget for 2008 will be $204 billion, representing a 6.3% increase overall ($12 billion) in spending from 2007. 
* The President's proposed budget would slow the average annual Medicaid growth rate over the next 5 years from 7.3% a year to 7.1% a year. 
* The proposed federal budget will include legislation that will continue the efforts of the  "Deficit Reduction Act of 2005" (passed February 2006 by Congress and signed into law by the President) according to the Bush Administration to "restrain unsustainable growth rates in this vital program"

MEDICAID PROPOSALS IMPACTING THE STATE, PROVIDERS & OTHERS
* Streamline Administrative Reimbursement Match Rates to the states at 50% [Savings or spending reduction of -$945 million for 2008, and -$5.315 billion over 5 years]
* TANF - Deducts (recoups) Medicaid administrative costs in the Temporary Assistance for Needy Families (TANF) block grant to the states [Savings or spending reduction of -$280 million in 2008 and -$1.8 billion over 5 years]
* Targeted Case Management - Would put federal reimbursement for Targeted Case Management (TCM) at the standard administrative matching rate of 50% federal funds to the states.  [Savings or spending reduction of -$200 million or -$1.2 billion over 5 years]
* Pharmacy Medicaid Reimbursement - would reduce federal upper reimbursement limit for multiple source drugs to 150% of the average manufacturer price of the lowest priced drug in the group. [Savings or reduction in spending of -$160 million and -$1.2 billion over 5 years]
* Optional Managed Drug Formulary - would allow the states to use private sector management procedures to leverage bigger discounts through negotiations with drug manufacturers. [Savings or reduction in spending of -$160 million and -$870 million over 5 years]
* 1915(b) Waiver Period - would extend the renewal period for 1915(b) "freedom of choice" Medicaid waivers from 2 to 3 years. 
* Government Provider Payments - would recover Medicaid funds, through new regulations or sub-regulatory "guidance", that are diverted from government providers and retained by the state.  Would also propose to cap payments to government providers to no more than the cost of furnishing services to Medicaid recipients.  [Savings or spending reduction of -$530 million in 2008, and -$5 billion over 5 years]
* School Based Services - planning administrative actions effective 2008 budget year, to phase out Medicaid reimbursements for some services provided in schools, including transportation and administrative claiming. [Savings or spending reductions of -$615 million or -$3.6 billion over 5 years]
* Graduate Medical Education - through administrative action, would clarify in the 2008 budget year that Medicaid will no longer fund the Graduate Medical Education program. The Bush Administration says in its budget plan that "paying for [the Graduate Medical Education Program] is outside of Medicaid's primary purpose, which is to provide medical care to low income populations".
* 1915(b)  Services - budget proposal announces proposed regulation that would clarify which services provided under 1915(b)(3) of the Social Security Act will be allowed. [no savings or spending reductions in budget]
* "Pay and Chase" Pharmacy Claims - would issue through administrative process,  requirement that the states uphold the "cost avoidance" standard for pharmacy claims, and eliminates waivers that permit "pay and chase". [no savings or spending reductions in budget]
* Provider Tax Clarification - would issue through administrative process, a clarification of how Congress originally intended the "provider tax" limitations to operate.  [Note: the Tax Relief and Health Care Act of 2006 set the maximum rate at which a state can tax its health care providers at 6%, in effect on November 1, 2006.  Beginning January 1, 2008 though federal budget year 2011, the rate will be temporarily reduced to 5.5%.  [no savings or spending reductions in budget]

MEDICAID PROPOSALS IMPACTING PEOPLE WITH DISABILITIES, SENIORS
* Home Equity (Value of Home Impacting Eligibility) - would remove the option by the states to increase the $500,000 home equity limit for Medicaid eligibility to $750,000, by proposing to codify the substantial home equity definition at $500,000.  [Savings or spending reduction of -$70 million in 2008, and -$430 million over 5 years]
* Asset Verification - would expand the Social Security Administration pilot using electronic financial records for verifying a Medicaid (Medi-Cal) applicant's assets to appropriate US Health and Human Services programs.  State Medicaid programs (Medi-Cal in California), would be required to establish pilots in locations where the Social Security Administration is operating such pilots.   [Savings or spending reduction of -$65 million or -$640 million over 5 years]
* Third Party Liability - Would make changes to current federal law by allowing the States to avoid Medicaid costs for prenatal and preventive pediatric claims where a third party (such as insurance) is responsible; would allow the states to collect for medical child support where health insurance is "derived" from a non custodial parent's obligation to provide coverage, and to authorize the states to recover Medicaid (Medi-Cal) costs from Medicaid (Medi-Cal) recipient liability settlements.  [Savings or spending reduction of -$10 million in 2008 and -$85 million over 5 years]
* Transitional Medical Assistance (TMA) - would extend his program to September 30, 2008.  The program allows families to remain eligible for Medicaid for up to 12 months after they lose welfare (CalWORKS in California) cash benefits due to increased earnings.  The Tax Relief and Health Care Act of 2006 passed and enacted last year extended the TMA program to June 30, 2007, and the budget proposal extends it to September 2008.  [Increase in spending $460 million in 2008 and $665 million 2008-2012]
* Qualified Individuals Program (QI) - would extend through September 30, 2008, assistance for Qualified Individuals who are Medicare recipients with incomes at least 120% (and less than 130%) of the federal poverty level and who have limited financial resources.  This extension will continue federal coverage of Medicare Part B premiums. 
* Refugee Exemption - would extend the Social Security Administration budget proposal (impacts Medicaid), from 7 to 8 years the exemption for refugees and those who have been granted asylum in the US, time to complete their citizenship application process without penalty. 
* Rehabilitation Services - would propose federal regulation that "clearly define" allowable services that may be claimed as rehabilitation services, which are optional Medicaid (Medi-Cal) services that persons with special needs or disabilities are typically offered. [Savings or spending reduction of -$230 million or -$2.3 billion over 5 years]

STATE CHILDRENS HEALTH INSURANCE PROGRAM 2008 BUDGET PROPOSAL
Created by the federal Balanced Budget Act of 1997, under Title XXI of the Social Security Act. Is a partnership between the federal and state governments that helps provide health care coverage for children under 19 years old. 
* SCHIP, called "Healthy Families" in California, can cover children whose families have incomes too high to qualify for Medi-Cal (Medicaid) but too low to afford their own health insurance. 
*  In 2006 about 6.6 million children across the nation were enrolled in the various SCHIP programs, including about 750,000 to 800,000 children in California.  In California, the income limit for families is 250% of the federal poverty level ($42,925 for a family of three)
* Authorization for the federal program expires at the end of the 2007 federal budget year (September 30, 2007) unless renewed (reauthorized)
* Reauthorization of SCHIP - The President's proposed budget calls for reauthorizing SCHIP every  5 years and provides for about $5 billion over five years for additional allotment funds, "consistent with submission of a five-year Budget to the Congress, and focuses each of the program elements on SCHIP's original objectives to provide health insurance coverage for uninsured, low income children at or below 200%. of the federal poverty level." (200% of the federal poverty level is $34,340 for a family of three).  [President proposed $1.2 billion for 2008 and $5.9 billion over 5 years]
* Advocates have raised concerns that the funding levels in the proposed budget for 2008 fall far short of what is needed by the states to fund their children's health programs and could result, they fear, in hundreds of thousands of children being forced off the program.

MEDICARE 2008 BUDGET PROPOSALS
* Medicare is a federal program that provides health insurance to 44.6 million persons who are either 65 years or older, or have disabilities or suffered from ESRD (End-Stage-Renal-Disease). 
* President Bush's proposed budget for 2008 includes a package of legislative proposals that include savings (or reductions) that total - if approved, $4.3 billion for the budget year 2008 and $65.6 billion over five years.  The proposed budget reduces beneficiary plans premiums by $5.6 billion over five years.   The total Medicare budget for 2008 will total $454 billion.
* The Medicare spending reductions increase further by including further cuts in Medicare administrative savings, estimated at  $1 billion for the budget year 2008, and $10.2 billion in savings (or a reduction in spending) over 5 years. Medicare administrative savings (or reduction in spending) will result, according to the President's proposal, from "new efforts to strengthen program integrity in Medicare payment systems, correct for inappropriate provider payments, and adjust payments to encourage efficiency and productivity."  These administrative savings include implementation of the "Tax Relief and Health Care Act of 2006" passed by Congress and signed by the President last year.
* Total savings in Medicare (administrative and those new savings or reductions proposed for 2008) total $5.3 billion for the budget year 2008, and $75.9 billion over five years.  This includes reductions for oxygen rentals payments of $110 million in 2008 (reduction of $2.4 billion over 5 years), reductions for power wheelchair rentals ($70 million in 2008, $530 million over 5 years), reduction in skilled nursing facility payments (updates) $1 billion in 2008 and $9.2 billion over 5 years, reduction in home health agencies updates or payment totaling $410 million in 2008 and $9.7 billion over 5 years.  See "Medicare Providers" for more information. 
* According to the Bush Administration the Medicare savings or reductions are part of a larger effort to "address the unsustainable growth of Federal entitlement programs"  and that the proposals will "...encourage efficient payment for services, foster competition, improve program integrity, and promote beneficiary [person receiving Medicare] involvement in health care decisions."
* The proposed federal budget would reduce Medicare average annual growth rate over 5 years from 6.5% to 5.6%.

MEDICARE PROPOSALS IMPACTING MEDICARE PROVIDERS
* Hospitals -  would reduce update or payment increase by -0.65% every year beginning in the 2008 budget year (that begins October 1, 2007) [Savings or reduction of -$720 million in 2008 and -$13.8 billion over 5 years.] 
* Hospices - would reduce update (payment increase) to hospices by -0.65% every year beginning 2008 [Savings or reduction of -$60 million in 2008 and $1.1 billion over 5 years]
* Outpatient Hospital - would reduce update to outpatient hospitals by -0.65% every year beginning 2008 [Savings or reduction of -$120 million in 2008 and -$3.4 billion over 5 years]
* Ambulance Services - would reduce ambulance fee schedule payment increase or update by -0.65% beginning 2008 [Savings or reduction of -$10 million in 2008 and -$360 million over 5 years]
* Skilled Nursing  - Proposes zero percent or no increases in updates (rates) for skilled nursing facilities in the 2008 budget year, and a reduction of -0.65%  to the update each year after that. [Savings or reduction of -$1 billion in 2008 and -$9.2 billion over 5 years]
* Inpatient Rehab Facilities - Proposes zero percent or no increases in updates (rates)  inpatient rehabilitation facilities in the 2008 budget year, and a reduction of -0.65%  to the update each year after that. [savings or reduction of -$230 million in 2008, and a total of -$1.9 billion over 5 years]
* Home Health Agencies - Proposes zero percent or no increases in updates (rates) for home health agencies in the 2008 budget year through 2012, and a reduction of -0.65% to the update every year after that. [Reduction or savings of -$410 million in 2008 and -$9.7 billion over 5 years]
* Ambulatory Surgical Centers - Proposes reducing the annual update (increase in rate payment) for ambulatory surgical centers by -0.65% beginning in budget year 2010. [Totals savings or reduction of -$90 million over 5 years]
* Competitive Bidding - would introduce competitive bidding for clinical laboratory services [reduction or savings of -$110 million in 2008 and -$2.4 billion over 5 years]
* Bad Debt Payments - would eliminate bad debt reimbursements for unpaid Medicare beneficiary cost sharing over 4 years for all providers.  Currently, Medicare pays 70% of unpaid co-pays and deductibles to hospitals and skilled nursing facilities.  [Savings or reduction of -180 million in 2008, and -$7.1 billion over 5 years]
* Provider Sequester Order - proposes a provider "sequester order" of - 0.4% to all Medicare provider payments when general fund contributions exceed 45%. The sequester order would increase each year by 0.4% until general revenue funding is brought back to 45%.  "Sequester" , according to the US Department of Health and Human Services, means the reduction of funds to be used for benefits or administrative costs from a federal account based on the requirements specified in the Gramm-Rudman-Hollings  Act (also known as the Balanced Budget and Emergency Deficit Control Act of 1985). [No budget savings or reductions in the budget regarding this. proposal]
* "Never Events" - would prohibit Medicare payment for "never events" (preventable events that include surgery on a wrong body part) and would require hospitals to report occurrences of these events or receive a reduced annual update (rate increase).  Savings or reduction of -$30 million in 2008 and -$190 million over 5 years]
*  "Tax Relief and Health Care Act of 2006" calls for increasing payment rates for End-Stage Renal Disease or ESRD facilities by 1.6% beginning April 1, 2007, and that is included in the President's proposed budget.  That Act also eliminated the previous -5% reduction in Medicare physician payments scheduled for 2007, and replaced it with a zero percent (no increase) update instead.  In addition, a 1.5% bonus payment is established for doctors who report quality measures in 2007.  The Act in 2007 extends the floor for the labor costs of doctors in certain rural areas, and establishes a "Physician Assistance and Quality Initiative Fund" totaling $1.35 billion in 2008 to promote doctor payment and quality improvement initiatives in 2008. 
* "Deficit Reduction Act of 2005" passed and signed by the President in February 2006, requires hospitals to report an expanded set of 21 quality measures required by the Centers on Medicare and Medicaid Services (CMS) or see their payment updates (increases) reduced by 2% and is part of the President's budget proposal for 2008.

MEDICARE PROPOSALS IMPACTING MEDICARE RECIPIENTS
* Post Acute Care - proposes to move to site neutral post hospital payments to limit what the Bush Administration calls "inappropriate incentives" for five post-acute conditions commonly treated at both skilled nursing facilities and inpatient rehabilitation facilities.  [Savings or reductions of -$470 million and -$2.9 billion over 5 years]
* Power Wheelchair Rentals - would establish a 13 month rental period for power wheelchairs that the Bush Administration says is being done to "...ensure that Medicare and its beneficiaries no longer pay excessively for the purchase of equipment that could have been rented". [Savings or reduction of -$70 million in 2008 and -$530 million over 5 years]
* Oxygen Rentals: would reduce the rental period for most oxygen equipment from 36 months to 13 months, which the Bush Administration says will "lower Medicare and beneficiary spending".  [Savings or reductions of -$110 million in 2008 and -$2.4 billion over 5 years]
* Medicare Part B Premium Indexing - would eliminate annual indexing of income thresholds for reduced Part B premium subsidies beginning January 1, 2008.  Medicare Part B helps pay for doctors services, outpatient hospital care, durable medical equipment, and some medical services that aren't covered by Medicare Part A.  [Savings or reductions of -$543 million in 2008 and $7.1 billion over 5 years]
* Medicare Part D Premium Subsidies - would eliminate annual indexing and reduce Part D premium subsidies based on the same income limits (thresholds) that apply to reduced Part B premium subsidies.  [Savings or reductions of -$357 billion in 2008 and -$3.2 billion over 5 years]
*  Kidney Dialysis or Transplant Medicare Recipients - Would extend Medicare as Secondary Payer status for Medicare recipients (beneficiaries) with ESRD or permanent kidney failure requiring dialysis or transplant,  from 30 months to 5 years for large employers. ESRD (End-Stage Renal Disease)  means permanent kidney failure requiring dialysis or a kidney transplant. [Savings or reductions of -$160 million in 2008 and -$1.1 billion over 5 years. Note: the "Tax Relief and Health Care Act of 2006" calls for increasing payment rates for End-Stage Renal Disease or ESRD facilities by 1.6% beginning April 1, 2007, and that is included in the President's proposed budget.]
* Federal Clearinghouse of Data - Would require group health plans (and other 3rd party payers) to report Medicare as Secondary Payer information and create a federal clearinghouse for data sharing with other federal health insurance programs (including the Federal Employees Health Benefits, Veterans Affairs) to identify health care situations where Medicare may not be responsible as the primary payer.  [Savings or reductions of -$50 million in 2008 and -$640 million over five years]
* Mandamus Jurisdiction Limit - Proposes to mandamus jurisdiction as a basis for obtaining judicial review, and clarify the Secretary of the Department Health and Human Services authority to resolve appeals of Medicare determinations (eligibility).  "Mandamus jurisdiction" is an order (writ) issued by a superior court ordering a public official or body or a lower court to perform a specified duty.  For instance, "Mandamus" may be used to compel the directors of a corporation to produce the books for inspection in the manner provided by law or to compel a lower court to accept a suit it has illegally refused. "Mandamus" is an extraordinary remedy and will not be issued if the usual remedies are available.  No savings or reductions in 2008, but -$80 million over a 5 year period (2008-2012).

OTHER PROPOSED REDUCTIONS - PROPOSED BUDGET 2008
Note: more federal budget updates, especially on housing, will be released in a CDCAN Report, as details become available. 

COMMODITY SUPPLEMENTAL FOOD PROGRAM
Provides additional food packages valued less than $20 per month for over 440,000 very low income seniors.
* What President proposes for 2008: Terminate program

LIHEAP (LOW INCOME ENERGY ASSISTANCE PROGRAM)
Provides to several million low income families, seniors and people with disabilities assistance to afford to heat their homes in the winter.  In California this program implemented by community-based organizations (including Community Action Agencies),  overseen by the Department of Community Services and Development (CSD) under the California Health and Human Services Agency. 
* What President Proposes for 2008: Would cut LIHEAP program by $420 million (19%) below the level of funding that Congress is expected to approve this month (the House already approved last week the 2007 level of funding), adjusted for inflation.

COMMUNITY BASED SERVICES, HOUSING
* Public housing (no details) would be reduced by $377 million (5.9%) below the 2007 spending level (the spending level as passed by the House last week), before adjusting for inflation.   [Note: the House of Representatives approved HR 20, on January 31, 2007, which increases funding for public housing under Housing and Urban Development Department (HUD) for the federal budget year 2007.  The President's proposal is for the 2008 budget year that begins October 1, 2007]
* Supportive Housing for the Elderly and People with Disabilities proposed reduction of $269 million (28%) below 2007 level.
* Social Services Block Grant - proposed reduction of this block grant of $4.4 billion over 10 years.  The grant provides critical funding for the states for services for people with disabilities (including developmental), low income children and families, seniors. 
* Head Start - funding for this early child education program would be cut  by $100 million from the (expected) 2007 funding level.
* Preventive Health Services Block Grant is proposed for elimination in the 2008 budget. The block grant helps fund state and local agencies with addressing or prevention various health issues including obesity and lead poisoning.

#022-2007  February 8, 2007  Early Thursday Morning
Edited/Written By: MARTY OMOTO, Director/Organizer 
To Respond to THIS report reply to: martyomoto@rcip.com   CDCAN website: www.cdcan.us

Federal Deficit Reduction Act of 2005
* State Issues A Draft "All County" Welfare Directors Letter
* Draft Instructions on Medi-Cal Citizenship Requirements
* SSI/SSP & Medicare Recipients Among Those Exempt
* Impacts CalWORKS, IHSS Recipients Who Aren't Exempt
* Stakeholder Meeting Set for Feb 22 in Sacramento

SACRAMENTO -  The Department of Health Care Services (formerly Health Services) released late yesterday afternoon  a draft version of instructions  to the State's county welfare directors (called an "All County Welfare Directors Letter") on how to implement the federal Deficit Reduction Act of 2005 evidence of citizenship and identity requirements for all Medi-Cal applicants and recipients.  .The Department of Health Care Services is the state agency that oversees the Medicaid program in California - known as Medi-Cal, with the counties handling applicants and other eligibility issues. 

The draft letter applies to people with disabilities, seniors and low income people who receive Medi-Cal services, but also exempts many of those persons, including those who receive Supplemental Security Income (SSI) or Medicare.  It also specifies how counties are to handle persons receiving or applying for welfare services (CalWORKS) and other programs that include Medi-Cal as a benefit. 

The draft letter was issued by Stan Rosenstein, who heads the state's Medi-Cal program and will be finalized and issued to the counties sometime shortly after a meeting with interested persons to hear comments that can also be accessed via a toll free phone line on February 22 from 11:15 AM to 1:15 PM at the Department of Health Care Services building auditorium at 1500 Capitol Avenue in Sacramento.  .. 

The issue was talked about by Medi-Cal officials during a CDCAN Advocacy Without Borders Townhall Telemeeting on Tuesday which featured the head of the program, Stan Rosenstein.  Disability and senior advocates widely praised the Department of Health Care Services for its outreach and its promise to share draft documents prior to official final release. 

Persons Who Are Exempt From the Citizenship and Identity Requirements
Medi-Cal applicants or recipients in any of the following groups are exempt from the citizenship and identity requirements described in the draft letter, according to the Department of Health Care Services:
* Supplemental Security Income recipients (SSI)
* Medicare recipients
* Deemed eligible Infants who are born in the U.S. and who are citizens
* Minor Consent applicants and beneficiaries
* Title IV-E Foster Care and Title IV-E Adoption Assistance children
* Children receiving Title IV-B services
* Infants eligible under the Abandoned Baby Program who are also born in the U.S. and have no documentation.

Details About Stakeholder Meeting on February 22
Interested persons can either attend the meeting in person in Sacramento or call in using a toll-free line.  Space in the auditorium is limited to 299 persons.  Persons who have any questions about the meeting can contact the Department of Health Care Services, and speak to Maria Delk at (916) 552 9520 or Bill Walsh at (916) 552-9453

February 22, 2007 - Thursday
11:15 AM to 1:15 PM
California Department of Health Care Services
Auditorium [capacity is 299 persons for this event]
1500 Capitol Avenue
Sacramento, CA  95814
* Persons will need to register at the Security Desk upon entrance into the building. 
* Photo identification is required.
* In consideration of people who may be sensitive to environmental odors created by chemicals and perfumes, the Department of Health Care Services asks that persons attending to please restrict the use of fragrances at this meeting.
* If reasonable accommodations are required for attendance, please contact: Mr. Steven Watson at (916) 552-9457, California Relay: 771/1-800-735-2929

To access meeting by toll free phone line:
Conference phone line: 1-888-398-1687
Passcode: DRA
* Persons who use a TTY Teletypewriter, and wish to participate in this meeting via California Relay Services (CRS), dial the CRS at 711 or (800) 735-2943.
* Tell the CRS Operator that you wish to participate in the conference call.  Then give the CRS Operator the USA Toll free telephone number, 1-888-398-1687 and the passcode: DRA.
*  From this point forward, the operator will provide further instructions.

Federal Law Passed Feb 2006 Requires Proof of Citizenship
* The federal Deficit Reduction Act of 2005 (DRA) passed by Congress and signed into law by President Bush last February,  made major changes and reductions to the Medicaid program that included requiring evidence of citizenship and identity for Medi-Cal applicants and beneficiaries who declare that they are citizens or nationals of the United States, except for certain categories of individuals who are exempt.
* Federal regulations were published in the Federal Register on July 12, 2006 by the federal Centers on Medicare and Medicaid Services (CMS) and provide the basis for the implementation of this federal requirement.

State Law Provides for Exceptions and Other Requirements for Dept of Health Care Services
State legislation was passed as part of the package of bills tied to the 2006-2007 State Budget, passed by the Democratic controlled legislature on June 27 and signed into law by Gov. Schwarzenegger on July 12.  The bill, AB 1807 (Chapter 74, Statutes of 2006 amended the State's Welfare and Institutions Code section 14011.2 to provide authority to implement the citizenship and identity requirements with as much flexibility as is allowed under federal law and policy.  A copy of the enacted version of the bill can be viewed at: 
http://www.leginfo.ca.gov/pub/05-06/bill/asm/ab_1801-1850/ab_1807_bill_20060712_chaptered.html
or the pdf versin (the section dealing with citizenship/identity begins on page 52 of the bill
http://www.leginfo.ca.gov/pub/05-06/bill/asm/ab_1801-1850/ab_1807_bill_20060712_chaptered.pdf
AB 1807 requires the Department of Health Care Services
* To provide for exceptions or alternatives in its implementation of the federal requirement to the extent federal financial participation (FFP) or matching funds is available and those exceptions or alternatives may include, but are not limited to, using an expanded list of acceptable documentation, relying on electronic data matches for birth certificates, and accepting sworn affidavits when there is good cause for not providing other evidence.
* To give Medi-Cal applicants and beneficiaries who are making a good faith effort as much time as federal law and policy will allow; to provide the required evidence of citizenship and identity.
* To require counties to assist Medi-Cal applicants and beneficiaries who are required to provide evidence of citizenship and identity and  further specifies that individuals who have been determined otherwise eligible, but are determined ineligible for full scope Medi-Cal for failing to meet the citizenship and /identity requirements within the reasonable opportunity period described in the draft All County Welfare Directors Letter, will receive restricted Medi-Cal (including emergency services, prenatal care and long-term care).
* That providing this documentation be a one time occurrence for applicants and beneficiaries and it requires that counties maintain records of receipt of these documents for future use and for inter-county transfers.

Impact on Immigrants
* The Deficit Reduction Act requirements do not change the documentation or eligibility determination process for individuals declaring as immigrants.
* The evidence of citizenship and identity requirements described in the draft All County Welfare Directors letter from the Department of Health Care Services do not apply to exempt U.S. citizens and nationals or to immigrants regardless of immigration status.

In-Home Supportive Services (IHSS)
The draft All County Welfare Directors Letter contains new requirements regarding eligibility for persons receiving In-Home Supportive Services (IHSS), with major exceptions [these requirements are not final yet]: 
* Personal Care Services Program and In-Home Supportive Services Plus Waiver services are Medi-Cal benefits, and persons who receive those services will be subject to the citizenship and identity requirements unless they are currently receiving Supplemental Security Income (SSI) and/or Medicare. 
* If a Personal Care Services Program or an IHSS Plus Waiver beneficiary is receiving SSI and/or Medicare, the citizenship/identity requirements do not apply.
* Persons receiving Medi-Cal based on eligibility for SSI and those who receive Medicare are exempt from the requirement to provide evidence of U.S. citizenship and identity.
* When a person loses SSI and eligibility is reviewed for Medi-Cal-only eligibility, evidence of citizenship and identity is not required for ongoing Medi-Cal only eligibility unless the termination was due to the client not being a citizen or eligible alien.
* The draft letter requires county Medi-Cal eligibility workers, before discontinuing Medi-Cal eligibility of Personal Care Services Program or IHSS Plus Waiver recipients,  must contact the appropriate IHSS county staff for documentation that may be in the IHSS case file relevant to citizenship eligibility requirements.
* If IHSS case records include documents of citizenship or identity, those documents must be provided to the Medi-Cal eligibility worker.
* If the IHSS case file contains no documentation of citizenship or identity, the IHSS county staff person will inform the Medi-Cal eligibility worker, and the Medi-Cal eligibility worker will help the IHSS recipient obtain the required documentation,.
 
Copy of the Draft Medi-Cal Letter to Counties on Citizenship Requirements
* Attached to this CDCAN Report is the final draft of the "All County Welfare Directors Letter" copy, called "Evidence of Citizenship ACWDL-Final Draft".  A copy of this draft is available on the Department of Health Care Services website at www.dhs.ca.gov/dra
and also the CDCAN website at:
 www.cdcan.us
* The final draft letter includes, according to the Department of Health Care Services, the instructions necessary to implement the citizenship and identity requirements of the Deficit Reduction Act.
* The Department of Health Care Services website contains all forms referenced in the draft letter and other related documents from the federal government regarding the citizenship requirements.  
* Braille, Large Print or Audiocassette or Computer Disk Copies: Upon request, the draft  letter will be made available in Braille, large print and audiocassette or computer disk.  To obtain a copy in one of these alternate formats, please call or write:
Mr. Steven Watson
Medi-Cal Eligibility Branch
1501 Capitol Avenue, Suite71.4001
MS 4607, P.O. Box 997417
Sacramento, CA, 95899-7417
Phone: (916) 552-9457
California Relay Services (CRS), 711 or (800) 735-2943

NEXT STEPS
* A previous draft All County Welfare Directors Letter on the citizenship and identity requirements was posted on the Department’s website and received over 500 comments from different persons and organizations.  The Department of Health Care Services (formerly Department of Health Services) reviewed those comments and incorporated as many changes as possible to make it easier for people to comply while still meeting the requirements of the new federal law. 
* The Department of Health Care Services says it conducted research regarding implementation of the citizenship and identity requirements of the Deficit Reduction Act 2005 in other states.
* Department of Health Care Services has scheduled a "stakeholder" or public meeting for interested persons on February 22 to hear comments on the draft letter (no written comments will be accepted due to timeframe). A final official version will be released to the counties shortly after that which the counties will use to implement. 
* Over the coming weeks, the Department of Health Care Services says it  will work with stakeholders on development of outreach materials to assist Medi-Cal applicants and recipients and advocates  to comply with the federal Deficit Reduction Act citizenship requirements.  [Note: CDCAN will be scheduling a special Townhall Telemeeting on this issue with the Department of Health Care Services]

#022-2007  February 8, 2007  Thursday
Edited/Written By: MARTY OMOTO, Director/Organizer 
To Respond to THIS report reply to: martyomoto@rcip.com   CDCAN website: www.cdcan.us

California Legislature
* Sen Budget Subcommittee on Health & Human Services Hearings
* Regional Center & Developmental Center Hearing Set April 9th
* IHSS, SSI/SSP Community Care Licensing Hearing April 19th
* First Senate Medi-Cal Budget Hearing March 26th

SACRAMENTO -  The Senate Budget Subcommittee #3 on Health, Human Services, Labor and Veteran Affairs, chaired by Sen. Elaine Alquist (Democrat - San Jose) has scheduled budget hearings through May, with hearings set to consider the Governor's budget dealing with In-Home Supportive Services (IHSS), Medi-Cal, regional centers, developmental centers, public health, aging, CalWORKs and other departments.  All hearing dates, times and budget issues scheduled are subject to change The impact and importance of the hearings scheduled will depend on the specifics in the hearing agendas, which are not usually available until a few days before the hearing date.  .

Hearings that are likely to attract wide spread attention are:
* March 12 focusing on mental health budget issues
* March 26 the first of several Department of Health Care Services hearings (Medi-Cal, etc)
* April 9 focusing on regional center and developmental center budget issues
* April 19 focusing on In-Home Supportive Services (IHSS) , SSI/SSP and community care licensing
*
The first scheduled hearing on health or human service budget issues is set for March 5, dealing with Department of Aging budget issues.  [Note: CDCAN will be organizing and scheduling a series of townhalls open to the public focusing on budget issues, featuring advocates covering issues ranging from CalWORKS, regional centers, developmental centers, accessible and affordable housing, accessible and affordable transportation, employment, support services, education (special and adult), mental health needs, aging services, and more. ]

Senate Subcommittee Members All New This Year
*  The 3 members Senate Budget Subcommittee #3 on Health, Human Services, Labor & Veteran Affairs are:
Democrats (2):  Elaine Alquist (Democrat - San Jose, 13th District) - chair, and Alex Padilla (Democrat - Pacoima, 20th District)
Republican (1): Dave Cogdill (Republican - Modesto, 14th District).
* None of the members of the subcommittee this year served on this panel last year.  Wes Chesbro, who chaired  the full Senate Budget Committee and the subcommittee, was forced out of the State Senate due to term limits.
* Sen. Denise Ducheny chaired the subcommittee last year, and now chairs the full Senate Budget Committee. The Republican member from last year - Sen. George Runner, is not returning to this subcommittee. 
* Alquist and Cogdill, who both previously served in the Assembly, never served before on the health and human services budget subcommittee in the Senate or the similar subcommittee in the Assembly. Sen. Padilla never served in either house until his election in November and swearing in December. 

Assembly Democrats Scheduled to Return to Capitol Friday
* The Assembly returns tomorrow (Friday, February 9) after a four day policy summit for the 48 Democrats and has not yet released any schedule of budget hearings. 
* Other Senate Budget Subcommittees covering education, housing and transportation issues that could be of importance to people with disabilities, mental health needs, people with tramautic brain injuries, seniors, their families, and others have not yet been scheduled. 

LIST OF SENATE BUDGET HEARINGS SCHEDULED TO DATE IMPACTING PEOPLE WITH DISABILITIES & SENIORS, MENTAL HEALTH NEEDS:
* Schedules of any legislative hearing is always subject to change, including time change and room change. 
* All hearings are open to the public - and hearings at least through the first week of May allows public testimony.  Hearings after that usually only allow testimony on new budget items proposed in the Governor's budget revisions
* Some of the hearings are televised and can be viewed on Cal Channel or on the internet Cal Channel site. 
* Details of each of the hearings (agendas) are not yet available. 

MARCH 5, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
1:30 PM 
State Capitol - Room 4203 
Department of Public Health (Budget Item 4265)
* Selected issues including establishment of the new department
PRIORITY: Important (the Department of Health Services is splitting into two departments by June 30, 2007 - Public Health and Health Care Services.)

MARCH 08. 2007
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
(Thu)  Meets upon adjournment of Senate Floor session
State Capitol - Room 4203 
Department of Aging (Budget Item 4170)
Also: Department of Alcohol and Drug Programs (Budget Item 4200) and Office of Statewide Health Planning and Development (Budget Item 4140)
PRIORITY: Important

MARCH 12, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
10:00 AM
State Capitol - Room 4203 
Department of Mental Health (Budget Item 4440)
* State Hospitals
* Community Based Issues
PRIORITY: HIGH PRIORITY

MARCH 15, 2007 (THU)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
Meets upon adjournment of Senate Floor session 
State Capitol - Room 4203 
Department of Social Services (Budget Item 5180)
* Child Welfare Services, Foster Care, KinGAP
also: Health and Human Services Agency - Office of System Integration (Budget Item 0530) and Department of CHild Support Services (Budget Item 5175)
PRIORITY: Important

MARCH 26, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
10:00 AM
State Capitol - Room 3191
Department of Health Care Services [formerly Health Services] (Budget Item 4260)
* Medi-Cal - selected issues
* Managed Risk Medical Insurance Board including Healthy Families (Budget Item 4280)
* Selected issues including establishment of the new department
PRIORITY: HIGH PRIORITY

MARCH 29, 2007 (THU)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
Meets upon adjournment of Senate Floor session
State Capitol - Room 4203 
Department of Social Services (Budget Item 5180)
* CalWORKS
* Child Care
PRIORITY: HIGH PRIORITY

APRIL 9, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
10:00 AM - State Capitol - Room 4203 
Department of Developmental Services (Budget Item 4300)
* Community-based programs - selected issues
* Developmental Centers - selected issues
PRIORITY: HIGH PRIORITY

APRIL12, 2007 (THU)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
Meets upon adjournment of Senate Floor session
State Capitol - Room 4203 
* Department of Rehabilitation (Budget Item 5160)
* Veteran Affairs (Budget Item 8950)
* Employment Development Department (Budget Item 7100)
also: Secretary for Labor & Workforce Development Agency (Budget Item 0559), California Workforce Investment Board (Budget Item 7120) and Department of Industrial Relations (Budget Item 7350)
PRIORITY: Important

APRIL16, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
10:00 AM
State Capitol - Room 3191
* Department of Public Health - selected issues (Budget Item 4265)
* Emergency Medical Services Authority (Budget Item 4120)
* Department of Health Care Services - selected issues, all programs (Budget Item 4260)
PRIORITY: Important (could change)

APRIL19, 2007 (THU)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
Meets upon adjournment of Senate Floor session
State Capitol - Room 4203
Department of Social Services (Budget Item 5180)
* In-Home Supportive Services (IHSS)
* Adult Protective Services
* SSI/SSP (Supplemental Security Income/State Supplemental Payment)
* Community Care Licensing
Health and Human Services Agency (Budget Item 0530)
* Office of System Integration
PRIORITY: HIGH PRIORITY

APRIL30, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
10:00 AM
State Capitol - Room 3191
Department of Mental Health (Budget Item 4440)
* Selected issues
Department of Health Care Services (Budget Item 4260)
* Medi-Cal Program and other selected issues
Department of Public Health (Budget Item 4265)
* Selected issues
PRIORITY: HIGH PRIORITY

MAY 3, 2007 (THU)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
Meets upon adjournment of Senate Floor session
State Capitol - Room 4203 
* Department of Community Services and Development (Budget Item 4700)
* Open issues - all departments as needed
PRIORITY: Important

MAY 7, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
10:00 AM
State Capitol - Room 3191
Open issues
Priority: not known

MAY 21, 2007 (MON)
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
10:00 AM
State Capitol - Room 3191
Governor's May Budget Revision [Departments will be scheduled prior to hearing]
Priority: not known

MAY 22, 2007 (TUE
SENATE BUDGET SUBCOMMITTEE #3 ON HEALTH, HUMAN SERVICES,
LABOR AND VETERAN AFFAIRS 
Time to be announced
State Capitol - Room to be announced
Governor's May Budget Revision [Departments will be scheduled prior to hearing]
Priority: not known