Managed care

Bethesda group homes has written this letter regarding the situation we face with Medicaid.  You will find it important.
Medicaid .

Most individuals with developmental disabilities receive funding through the Medicaid program. Medicaid was established in 1965 through Title XIX of the Social Security Act in order to provide health coverage for low-income children and adults, as well as medical and long-term care coverage for people with disabilities and low-income senior citizens. It currently funds 78 percent of total developmental disability services expenditures nationwide.
The federal government and the states jointly fund the Medicaid program. Each state administers the program under broad eligibility, quality and funding guidelines established by the Centers for Medicaid and Medicare Services (CMS). CMS matches state Medicaid expenditures through Federal Medical Assistance Percentages (FMAP). The FMAP varies by state and is attached to per capita personal income in each state.

Current rates vary from 50 percent to 77 percent, meaning the federal government contributes between $1.00 and $3.17 for every dollar a state spends on Medicaid programs.

Because Medicaid is the nation’s healthcare safety net, its costs grow rapidly during economic downturns. Recent studies indicate that a one percent increase in the national unemployment rate results in an increase in Medicaid costs of $3.4 billion due to an increased number of people who have become eligible for Medicaid. That same one percent unemployment rate increase results in a four percent decrease in state general fund revenues that subsidize the system. Adding to the crisis is the pending retirement of baby boomers. Federal Medicaid funding is expected to be about $216 billion in fiscal year 2009 or about seven percent of federal spending. By 2013, the costs are expected to increase to $287 billion or 8.4 percent of the federal budget.
The increase in costs and decrease in revenues have caused the federal government and some states, including many in which Bethesda operates, to look at drastic methods to balance state budgets. The current administration is proposing more than $17 billion in Medicaid cuts over the next five years, including $10.1 billion in FMAP reductions that will shift these costs onto states that are already ill equipped to absorb the added costs.

States are now in crisis mode. Gov. Pat Quinn of Illinois recently threatened social services providers with a 50 percent rate cut. In California, the state faces a $26 billion budget deficit and has already cut state Medicaid spending by $1.31 billion. Michigan addressed a $1.7 billion deficit by cutting rates to physicians who support Bethesda clients. Medicaid rate cuts are being threatened in virtually every state

in which Bethesda provides supports.  And with the looming influx of retirees, the situation promises to become even more dire. The Medicaid system is in crisis with no easy fixes on the immediate horizon. To address these important government-funding issues, Bethesda has launched the grassroots advocacy initiative, Bethesda Voices, which aims to unite like-minded supporters in an effort to protect the much needed funding for agencies like Bethesda.







Of course, everyone is all for removing people from institutionalized settings.  In the state of Florida I don’t believe there are thousands of people in institutions, unless you are talking about group homes–which are now homes with a maximum of six people living together with staffing.  Pretty sure this would not qualify as an institution.

Is the only alternative is putting mentally challenged persons into an apartment by themselves, where they are isolated and lonely, with minimal staffing, in the worst sections of town?   Then, yes, I believe–from the horror stories I’ve seen first-hand–this is irresponsible social work.

As an alternative, senior citizens have found that living independently when you are weak and vulnerable is a recipe for disaster, even if it is much more cost effective for the State. That is why we now have communities for senior citizens.

Shouldn’t we copy something that is proven to work, rather than doing social experiments on our most vulnerable population? I’m not sure that it wouldn’t be just as cost effective as living independently. People would be able to choose whether they would live there or not and full-time oversight could be provided by pooling State resources.

Many families are beginning to feel that this paridiam would be a win-win for everyone.  What do you think?

This is an e-mail I received regarding the Johnson resignation.  This person has held a statewide position in advocacy.  I didn’t get permission from this person because I felt s/he may want to remain unknown.

May 2, 2008, 1:19 pm

Today, Jane Johnson resigned her position as Director of the Agency for Persons
with Disabilities (APD). Ms. Johnson submitted her resignation this morning and
it is reported she will remain in the position through the end of the month.
The Agency has been plagued with budget deficits and problems implementing
legislation limiting disabled consumers to tiers. Many of the problems existed
prior to her taking over as director. The issues were compounded when the
Legislature once again cut funding for the vulnerable population APD serves.
This session, funds were cut by over $120 million, on top of July’s special
session cuts, leaving a nearly impossible task for any successor.

This leaves the Agency in a very precarious position as Senate lawmakers try to
pass legislation to do away with the APD and move the responsibility and budget
over to AHCA, or the Agency for Health Care Administration. Thus far, the
legislation has failed.

There has also been an attempt by managed care proponents to allocate the APD
budget to HMO’s to administer the program. This effort continued until this last
week of session and is being promoted to legislators by a former senate staffer,
now employed by the managed care industry.

The developmentally disabled and providers of services to the disabled, who will experience the agony of the budget cuts, are encouraging Ms. Johnson to leave a powerful message to legislators and the Governor, who failed to rescue the many vulnerable people who will be put in harm’s way as a result of the extraordinarily deep cuts.

We received an e-mail yesterday late in the evening regarding changes The Centers for Medicaid and Medicare Services (CMS) is proposing in regard to State Medicaid agencies.  While I am a neophyte, CMS appears to be the federal agency that manages funding allocations which are appropriated to the states.  CMS has proposed what would be equivalent to private insurance plans. 

Perhaps most important, CMS proposes 11 exemptions to needy populations that would probably cover most of our rider clientele.  Mike LaVoie, who has worked in the system for more than 30 years, writes, “In case, you missed this buried in some of the documents from Agency for Persons with Disabilities, pay particular attention to CMS recommendations cited in the email- from Department of Transportation to eliminate the requirement for Medicaid to provide transportation to and from Medicaid Services.  Needless to say, this could be devastating to the provision to transport to access Adult Day Training and Supported Employment services. “

LaVoie continues, “CMS suggestions that this could take years may be misleading as we all know, CMS has approved equally impactful decisions faster than that lately”

Lsia Bacot suggests that interested parties should comment by clicking onto this link:  http://www/

The comments should were due Monday, March 26, 2008 which is the day before this posting.  Everyone apologized about the short turnaround.  However, this was an important decision that was made public much too late for most people to react.

Here are a couple of the emails that were sent yesterday:

From: Mike

Sent: Monday, March 24, 2008 2:23 PM

Subject:FW: CMS Proposed Rule- Important

 Hey folks,In case you missed this buried in some of the documents from APD.Pay particular attention to CMS recommendations cited in the email from Dept of Transportation,to eliminate the requirement for Medicaid to provide transportation to and from Medicaid Services.Needless to say, this could be devastating to the provision of transport to access ADT and Supported Employment services.Suggestions that this could take years may be misleading as we all know CMS has appoved equally impactful decisions faster than that lately.Mike 

From: Johnson, Karen E.

Sent: Monday, March 24, 2008 9:06 AM

Subject:FW: CMS Proposed Rule- Important


—–Original Message—–
From: Mack, Heather@Career & Technical Education

Sent: Monday, March 24, 2008 8:58 AM

To: Johnson, Karen E.

Subject:FW: CMS Proposed Rule- Important

  Although many of us get these from Paula, I think there are many on our ICB list that do not.  Please forgive if this is redundant for you. HeatherHeather Mack, Special Populations
Career and Technical Education
2700 Judge Fran Jamieson Way
Viera, Florida  32940
321-633-1000 ext. 379

From:Davis, Paula []
Sent: Monday, March 24, 2008 7:46 AM;;;;;;;;;;;;;;; Davis, Lacie;;;;;;;;;;;;;;;;;;;;;;;;;; Lewis, Eva@Exceptional Education;;; Lowe, Kathy; Mack, Heather@Career & Technical Education;;;;;;;;;;;;;;;;;;;;;;; Tolson, Sharon@Viera;;;;;;; Wickham, Cindy@Viera;; Davis, Paula; Becker, Brenda J; Becker, Jason L; Breslin, Brian R; Bryant, Stephanie L; Dettra, Samuel R; Ford, Suzanne; Golden, Ian J; Hansen, Christine; Harris, Tammy J; Herriott, Carl J; Holt, Leigh R; Howell, Cheryl; Ingalls, Joyce L; Joiner, Chenita M; Langan, Judy; Parks-Martin, Donna; Mcdonald, Michael E; Mcguffie, Glenn A;; Parks-Martin, Donna; Reich, Rosa M; Singleton, Lesley D; Spiller, Laverta; Urban, Sandra; Williams, Gay N; Wright, Pam

Subject:FW: CMS Proposed Rule- Important

 FYI – regards M-NET 

PaulaPaula C. DavisHuman Services Planner IIBrevard County Housing and Human Services2725 Judge Fran Jamieson Way, Suite B103Viera, Florida  32940 
Disclaimer: “This e-mail is for information purposes only and does not necessarily reflect the views of the Brevard County Board of County Commissioners nor Brevard County Housing and the Human Services Department.”

From:Bacot, Lisa M. []
Sent: Thursday, March 20, 2008 4:25 PM
To:CO-CTD Staff
Subject:CMS Proposed Rule- Important
Importance: High

 TO:  Entire TD Distribution List 

The Centers for Medicaid and Medicare Services (CMS) has issued a proposed rule relating to allowing State Medicaid agencies the opportunity to create benchmark packages that would be equivalent to private insurance plans.  We appreciate that CMS is looking outside the box, however, one of the proposed plans in this rule is to allow Medicaid agencies the opportunity to “relieve States of the responsibility to assure transportation to and from providers.”  Before a state could act on this (if it becomes final rule), the state plan would have to be adjusted, so it would be a year or two down the road.  In addition,  CMS proposes 11 exemptions to needy populations that would probably cover most of our rider clientele.   Regardless, it does have the potential of making very significant changes to Medicaid Transportation services to certain clients. If you do want to comment, please click on this link:  You can then enter your contact information in and either type in your comments or revise the attached sample letter and upload it into the system.  Comments are due Monday, March 24, 2008.  I apologize for the short turnaround.  I do not have a copy of CTAA’s response, but when I get it, I will send it to you. Thank you.  Lisa M. BacotExecutive DirectorFlorida Commission for the Transportation Disadvantaged605Suwannee Street, MS 49Tallahassee, FL 32399-0450lisa.bacot@dot.state.fl.usDirect Line (850) 410-5711Toll Free (800) 983-2435TTY (850) 410-5708Florida Relay System Dial 711 (Florida Only)FAX (850)  

I received this email and thought it was worth passing on.  Agency for Persons with Disabilities in Florida does not want managed care.  I’m not sure what would be best for our members.  Do you have any comments?  

Governor Charlie Crist’s Fiscal Year 2008-09 Budget RecommendationsGovernor Charlie Crist’s Fiscal Year 2008-09 Budget Recommendations were released on Thursday.In the proposed budget, services for individuals with developmental disabilities provided by the Agency for Persons with Disabilities (APD) and the Bureau for Exceptional Student Education Services are not slated for further reductions or eliminations at this time.You can examine the Governor’s complete budget by clicking here.The Governor’s office based its budget on the October 2007 estimating conference. Since October, however, Amy Baker, head of the Office of Economic and Demographic Research, has recommended that between $400- $600-million more dollars be cut from the budget, in order to better reflect the state’s continuing decline in revenues. In addition, various financial experts have warned that by the time the 2008 legislative session is over, the Florida Legislature will need to cut almost $1-billion more dollars in order to balance the state’s budget.With this information in mind, the Legislature will be studying suggestions to further reduce the costs and administration associated with serving people with developmental disabilities. Some members of the Senate, in particular, have publicly suggested that major changes need to be made to the Agency for Persons with Disabilities administratively and with regard to the prioritization of how people are served off the waiting list. As this Alert is being written, proposals for managed care solutions to controlling costs are being seriously considered.So, what can you do?The Florida Developmental Disabilities Council, Inc. strongly opposes managed care “solutions” for the implementation of Developmental Disability Home and Community Based Waiver Services and proposes expanding the Consumer Directed Care Program designed to allow consumers and families the ability to choose their services and providers, while having to live within their budgets.Please contact the members of the Senate Health and Human Services Appropriations Committee and the members of the House Healthcare Council and voice your opposition to managed care “solutions” that will take dollars away from needed services and put them in the pockets of large and impersonal managed care corporations.Share Your StoriesThe Council wants to hear from those among you willing to share your stories with the media about the importance of these services in your life and also how last session’s service reductions and eliminations have adversely affected your life and the lives of those you love.Please email Ms. Vanda Bowman at or call Ms. Bowman, toll-free, at 800-580-7801 with details and current contact information. Your information will not be released without your permission.

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