Some of the most active entries on this blog is our devotion that appears  each Sunday.  I get feedback from people who enjoy the devotion who don’t share it with anyone.  Others tell me that they use the devotion occasionally to teach or share with a group.  This week, I wanted to share one about two of my favorite subjects–the resurrection and my mother.

He Is Alive

Matthew 28:6

Central Theme:  Jesus is not dead; he is alive.

Introduction–Tell the story from Matthew 28:1-15  Two  women were coming.  There was an earthquake.  An angel appeared.  The stone was rolled away.  The soldier saw the angel.  They fainted  The women came up and the angel told them.  He is Alive!  Go! Tell the disciples.”  As they went back to the disciples, Jesus appeared.   Have a member read Matthew 28:6

I.     Before my mother died I struggled with my prayers for my mother.

  • A. She was an amazing woman, the best Christian I ever met.
  • B. I love her and I will miss her everyday.
  • C. But when she died, she went to be with Jesus.

1.  That will makes her happy.

II.     Because of the resurrection of Jesus, we have great hope.

  • A. I know that Jesus lives.
  • B. I know that Jesus has taken the stringer out of death.
  • 1.  Did you know that when a bee stings, it looses its stinger and dies
  • C. Jesus took the stinger from death and we don‘t have to worry anymore.

III.     Jesus was alive and the women knew it.

1.  His resurrection changed their lives.

Conclusions:  Jesus’ resurrection changes our lives, too.

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Again, thanks to George Andrews for providing this sample letter that can be sent to Governor Crist encouraging him to veto this bill.  It is often better to change the wording of these letters to make them your own.  However, because of the time restaints, it will be better to just copy it and send it rather than worry about the wording. 

Gov. Crist’s e-mail address is:  Charlie.Crist@myflorida.com

His office phone number is:  850 488 7146

Fax number:  850 487 0801

Mailing address is:       

  •                                                Office of the Governor
  •                                                The Capitol
  •                                                 400 South Monroe Street
  •                                                 Tallahassee, FL  32399

 

Dear Governor Crist,                 

ISSUE:  House and Senate Bill Related to Medicaid Reform and Implementation of HMO Management of the HCBS Medicaid Waiver  HB 7723

Question:  Should the State be Divided Into Regions Managed by HMO’s and Preferred Provider Networks

ANSWER:  NO!   PLEASE VETO THIS BILL

I realize you have difficult budget decisions to make. But please DO NOT SIGN the Medicaid Reform Bill.

The House and Senate adopted these bills, written largely if not entirely by a lobbyist for one of the HMO’s, without due consideration for the data available from the pilot study of this being conducted in the Miami-Dade area of the state. The reviews from those areas are mixed and hardly conclusive in showing that they improve the quality of life for any of the disabled citizens they are supposed to serve. In fact, there are numerous concerns among a great many recipients of services in those areas regarding the loss of choice and the significant decrease in the quality of services received under the HMO system. These bills were rushed through both the House (introduced in only 1 committee and 1 week later  voted on house floor-does that sound familiar?) and Senate with limited transparency and little deliberation–as if the deals for approval were made well in advance of the readings.   Is this the type of example and values we want to teach our young voters?  The message sent was that the rich and powerful can quickly force a dramatic change on the elderly and disabled without any notice or input from the very people the new law will affect.  

The current system involves the Agency for Persons with Disabilities (APD) playing a significant role in quality assurance and private contract HCBS Medicaid Waiver providers who advocate for the needs of their caseloads working together to get the needs of the developmentally disabled citizens of the state met. It has been working very well and though harsh, the cost containment efforts of this current system are finally showing significant gains while still allowing the State of Florida a good measure of control over the quality of services provided. Surrendering the entire service system over to greedy, profit-hungry HMO entities is NOT the way we want the State of Florida to go. 

If you still are inclined to support this proposal, please first consider increasing the scope of the pilot study currently underway or allow more time to study the results of the current pilot project to see if it actually works.  Make sure this proposal is proved before inflicting this drastic change on more than 30,000 people with disabilities and their families and over 2.7 million other voting Floridians.  There will also be thousands of employees within companies that will likely lose their job once implemented since HMOs and PPNs would employ their own people.  Billions of state funded dollars may also leave the State of Florida if any of the new HMOs or PPNs are located outside of the state.  Will this improve our economy and jobs? 

I am earnestly asking you to VETO the Medicaid Reform Bill and allow the current system with any necessary cost reductions to work. There are NO winners in this bill with the sole exception of HMO’s.

Thank you.

 This is an e-mail received on Friday, February 19, 2010.

Subject: Senate Health and Human Services Appropriations Committee 15%

> budget reduction proposal
>
 “Suzanne Sewell” <ssewell@floridaarf.org
 <mailto:ssewell@floridaarf.org>> 2/18/2010 12:04 PM >>>
 Yesterday, the Senate Health and Human Services Appropriations Committee reviewed agency submissions in response to a request that agencies should submit 15% Budget Reduction proposals. APD submitted the following proposals:
_Item GR & Trust_
-Cap Tier 1 at $120,000 $ 12,600,000
-Eliminate behavior assistance services in standard and behavior focus group homes $ 4,000,000
-Reduce CDC+ accounts by 10% $ 3,319,623
-Consolidate and Reduce Meaningful Day Activity Services $113,925,118
-Eliminate Medication Reviews $ 100,636
-Consolidate Durable and Consumable Medical Equipment $ 932,093
-Reduce General Revenue Budget in Individual and Family Supports Category $ 1,000,000
-Room and Board Category $ 200,000
-Eliminate funding for Special Projects and Supported Employment (GR) $765,985
– Eliminate Budget Related to Reversions of FY 08-09 _$ 733,648_ $137,577,093
-The proposal to consolidate Meaningful Day Activity services represents a 40% reduction for the involved services. Director Jim DeBeaugrine explained implementation would result in the blending of Adult Day Training, Respite, Companion, Supported Employment, and Supported Living into one service which would be known as a Flexible Services Benefit and total hours of services received by individuals would have to be because it would be devastating to individuals served but to achieve the 15% reduction such cuts would have to occur.
-In the Senate Policy and Steering Committee on Ways and Means, Medicaid Reform expansion was reviewed. The primary expansion area that was addressed was traditional Medicaid coverage to more counties (MediPass for children and families). Some discussion occurred regarding the impact on “carve outs” in the areas of Mental Health Behavioral Health,
Dental, and Transportation services. There was no discussion on adding APD waivers or long-term care services as part of the Medicaid Reform(Managed Care) waivers.
-On the House side, we met with Representative Snyder and his committee
staff to discuss Background Screening changes. House staff encouraged us to work with them on this issue. More information will be forthcoming.
> Suzanne Sewell
> President & CEO
> Florida Association of Rehabilitation Facilities
> 2475 Apalachee Parkway, Suite 205
> Tallahassee, FL 32301
> Office: 850.877.4816 (#123)
> Cell: 850.251.7925
> Fax: 850.656.0168
Because I did not get this Waiver Coordinator’s permission to use this e-mail, I’ve not included his name.  However, he is known in this district as probably the best of the best and I have included his picture.

I wish I had an answer to all of your questions, Richard Stimson from his November 7 post. And he makes many really good points here. It’s a real set of dilemmas (not just one). And my time in this pond has made me clear about a few things, one of them with direct regards to the Waiver is that there were always titanic forces present motivated to it’s demise. We have to remember some history. Lawton Chiles was Governor at the time and it was my impression that he opted to make ‘a deal with the devil.’ I don’t remember any evidence that he felt the federal Waiver was a ‘good’ idea, rather it was a clever way to extend funding at a time when Florida was in another financial crisis (nothing like the one we have today though).

*I was one of many who pushed hard for the medical model. It has it’s flaws and drawbacks for certain. But again, let’s keep history in mind. Prior to it there was NO system for deciding who got what and how much they got of it. Who of us can forget the abject arbitrariness of the HRS days? It was those of us who courted relationships with HRS managers (we all remember their names), allowed ourselves as WSC’s to be verbally and emotionally abused (!!) for the sake of our clients because after a beat-down session with a state worker they were more agreeable to giving us the respite for Johnny or the Companion for Sue. Medical model directly attempted to address fairness–a way of evaluating need. It’s day may well be over (and that’s fine)–but you’d better have something in place to replace it or I guarantee you will like the vacuum even less. Rules and a system are especially important in a time of chaos like this.

Something else that you touch on that I have been thinking a lot about over the years. What exactly are we doing with developmentally disabled people? (*Such a non-descript, inaccurate term—mentally handicapped describes it better I think.) In my 16 years doing this I can count on one hand the number of disabled people I have seen become more independent. Who were we kidding anyway with the sales pitch that a mentally handicapped person was going to achieve enough of the independence skills needed to be less dependent on someone else? It’s happened, and I’ve seen it (been a part of it I’d like to think), but it’s rare and the majority of my work has been spent sending in supports that were more permanent in nature. Not trying to be mean here. It just seems to be the nature of the beast. It’s a permanent condition. Whereas some learn and retain a few skills, many (most?) may learn a FEW skills that they rapidly lose and some don’t learn too many skills at all. Again, some do learn some things and retain them and that is great.

But it makes more sense to me to have a system that would allow us to have different goals for different disabled people; as every person is different so is the manifestation of disability in each mentally handicapped person. You folks may not know some of the silliness I have experienced in my day as a WSC (I like to suffer in silence!). Like the monitoring I went through 2 years ago where the Delmarva reviewer was insistent that a very disabled gentleman (everyone agrees he is p-r-o-f-o-u-n-d) was not experiencing enough choice in his life. Even though he has never expressed preference of any kind. Poor guy doesn’t express much of anything period. End solution was to run a program to ensure that he was given the chance to express preference on the temperature of the water in the bath. (footnote: to date no data on expressed preference is available–still waiting) There are people we maintain and others we are moving in a direction on and I don’t mind helping both types. But the system maybe does now.

A word about pressure (this maybe a law of the system). If you don’t apply pressure in the direction you want things to go you will be pushed to the bottom of the heap. Not as elegant as Newton’s first law of motion, but you get the point. In our current system the loudest or glitziest voice (almost regardless of the substance) gets the victory. If you don’t fight you will get left with very little. There needs to be an equal and opposite reaction as there are a lot of forces at work in a declining budget situation.

It’s hard to argue about the wait list from where I sit. My position is fairly clear (there are some muddy parts to it). I’ve always used the butter analogy. Spread it too thin and you might as well not use it at all because it doesn’t taste like anything. The fundamental question: Do we serve a few people well or everyone poorly? I say maximize the effectiveness of your funds and serve whoever you can well and not everyone poorly. Easy for me to say, I know. And it’s hard to argue when you look at the fact that so many initially added to the waiver in the beginning might not have been the most needy.

Just some thoughts.

This is a interesting analysis on what may be the future for mentally challenged persons in the State of Florida.  This is the response from a presentation of the iBudgets, the newest innovation from APD.

Thank you for the information on iBudgets.

I find myself hear the old Kenny Rogers song; you have to know when to hold them, know when to fold them, know when to walk away, know when to run…..

iBudget – Is that not what you get when you rebase whatever Tier you got stuck in?

Correct me if I am wrong but aren’t these really the issues that we are facing?

  1. Waiting list
  2. Limited money (shrinking money)
  3. Sustainability
  4. Equity

How do you determine “Equity?”

  1. Just those on the waiver?  Or for everyone?
  2. Equity for those on the waiting list?  If so, what does that mean?  Do we reduce what those on the waiver now are receiving so those on the waiting list can get something?  Do we prioritize who is not the waiver based on support needs?  The new prioritizing of waiting list put (I think) mentally challenged people who parents retire and move here higher on the list than people who were born here and been on the wait list for years.  For those on the waiver it appears that the funding (Tiers) level were more favorable for those who used the system and not favorable for those family that did not try to get the system to do everything.  You can have two mentally challenged persons who are exactly the same with just one difference.  One lives in a group home and one lives with their family.  The person in the group home is in a higher Tier.  Not because their needs are greater but because their family took advantage of the system funding the group home.
  3. What is fair?  Who decides?

Sustainability – What we are now doing is not sustainable.  We have to either get more money or cut services.  We get more money by either raising taxes or cutting spending somewhere else in the Sate Budget.  Does anyone think that is going to happen?  If so (back to the Kenny Rogers Song), we need to hold them.  We are living this year on stimulus money from the Feds that is not going to happen again. 

Sales taxes are down.  The State budget is shrinking.  Is a medical model sustainable?  At the second meeting of the Alternative Residential Option Work Group (which was held in Orlando) there were two things talked about that I think fit here:

  1. Derrick Dufresne talked about how Group Homes were demographically unsustainable.
  2. Life Share was presented as an option which was then labeled as foster care repackaged.  Before the waiver most people living in group homes were not receiving this funding we now call Res Hab.  I remember the fight about one group home in our area getting Res Hab.  The questions was asked again and again, why did only ARC group homes receive Res Hab in this county?

Limited Money – I am thinking we are at the beginning of the state saying, “we are not going to pay for that anymore.”  They have already done this with NRSS (just to name one program).  It is really what they are doing with the Tiers.  Who would have of ever thought whatever system was developed would not fund 5 days of meaningful day activity?  So if five days are not needed, why pay for five days for anyone?  Why pay for anyone to have any day program when there are people who need group homes?  What is fair (equity)?

Waiting List – For those on the waiver we do not think about this too much.  But at this time I think for every two people on the waive there is one person on the waiting list.  Those on the waiting list are more motivated because they are not receiving anything.  I hear these family saying it is not fair for those on the waiver to get everything and for us to get nothing. 

I also think there is a possibility that policy makers feel lied to.  They were told that the wavier would keep people in the community and be cheaper than putting them in institutions (ICF/MR).  With most of the people who first went on the wavier, families would have never considered putting their family member in an institutional setting. 

Policy makers were told that in the long run it would be cheaper because mentally challenged people would develop new skills, become more independent (hence cheaper) and develop community (natural) supports.  I am thinking this has not happened. 

Now the system has become unsustainable even in good financial times.  Remember when the crisis in APD budget first hit, we were not in a recession, to say nothing of the financial crisis our state and nation are in today.  I know many of my friends who are advocates feel we need to hold our ground and fight.  I think this is a fight we cannot win.

Richard Stimson

The Special Gathering

P.O. Box 685

Cocoa, Fl 32923

    321-632-0130

6 321-636-5821

+ rstimson@specialgatherings.com

        http://www.specialgatherings.com


Sent: Friday, November 06, 2009 9:41 PM
To: rstimson@specialgatherings.com;

Subject: APD – FCCF – iBudgetFlorida Power Point presentations

You all probably know about this…. I haven’t had a chance to read it yet.

Sent: Wednesday, November 04, 2009 9:49 PM
Subject: FCCF-iBudgetFlorida Power Point presentations

Hi All,

Attached please find the Power Point Presentations used to initiate the first meeting of the Stakeholders Work Group. 

Please set time aside to really go over these in detail.  Do not let the length put you off, it is good basic information we need to know.  Your understanding and input is valuable to this process and the positive outcomes that we hope to accomplish.  These PP slides introduce you to terms and language that will be important to know as this moves forward. 

Please feel free to contact Phil Pearson, Patty Houghland or myself, with questions and input.

We will have more to report at the FCCF meeting this month as well.

Hilary Brazzell, APD,  is spearheading this in depth study, and put a lot of effort into these as you will see.  She is doing an excellent job of assisting the group to understand and work to move this along to be ready for presentation to the Legislature in February.  She can be reached at hilary_brazzell@apd.state.fl.us  and really does want questions and constructive feedback from us.

I will follow up with some other readings that may assist you on iBudgets in a few days, and will also bring some additional information to the FCCF meeting as well, but thought the Power Points would be enough for right now. 

Thanks for all that you do,

Betty Kay Clements


FCCF Chairperson
352-753-1163
cbettykay@aol.com
Mission Statement:
The mission of the Family Care Council Florida
is to advocate, educate, and empower
individuals with developmental disabilities and
their families, partnering with the Agency for
Persons with Disabilities (APD), to bring quality
services to individuals for dignity and choice

 

I received this e-mail exchange one of our readers had with APD regarding his brother’s services.  I have named the writer:  concerned brother
When the Tier Ruling first came down, I wrote the State about how this would
affect my brother’s services.
 
I find this response (below) concerning. He basically told me that he could
not speak to me about my brother without a signed release. However, he did go on to say everything would be fine. I can only assume it was based on the
information I gave him and not on him looking at my brother’s case. He would have been in violation of HIPPA then.
 
We get so accustiomed to the back and forth and the free flow we have with my brothers’ support coordinator (wonderful support coordinator at that). There are times we have to deal with the State. I am going to seriously consider having an annual release signed at my brother’s annual support plan.
 
If you have any thoughts I would be interested.
 
Thanks. 
signed
concerned brother
 
—–Original Message—–
From: Ronald Drake [mailto:Ronald_Drake@apd.state.fl.us] On Behalf Of Mac
McCoy
Sent: Thursday, September 10, 2009 3:00 PM
To: concerned brother
Cc: Lorena Fulcher
Subject: your email of 08/27/09
 
 
Dear Mr. Concerned Brother:
 
Thank you for your e-mail of August 27, 2009 regarding services for your
brother. Due to confidentiality regulations, we are unable to discuss
services for individuals without written consent from the individual or
their legal guardian, when applicable.
 
However, after receiving your e-mail, we researched the situation; and I
believe that the specific concerns have been resolved.
 
With regards to your questions about tiers rules, the court’s opinion on
the tier rule created some uncertainty about tiers and their administration. APD is continuing its evaluation of the effects of the ruling and the Agency’s options to respond. For now, APD is placing all tier related actions on hold except emergencies. Additional information can be found on the APD website at http://apd.myflorida.com/default.htm.
 
Thank you for your advocacy on behalf of your brother. If you have additional questions, please contact me or Lorena Fulcher by e-mailing
 
Sincerely,
 
Mac McCoy, M.A. BCBA
Interim Deputy Director of Operations

“They are acting like spoiled children who haven’t gotten their way” was the interesting comment of an insider commenting on APD’s reaction to the court’s rejection of the Tiers.  I found Jim DeBeaugrine’s comments this week fascinating because he said nothing would change.  In other words, APD will disregard and ignore the courts.

What other agency would have the gall to disregard and ignore a federal court? 

On the other hand, the state is out of money and revenue is dropping as people are moving out of Florida.  As interested person said, “It doesn’t matter what the courts say.  APD will find some way to keep taking things away from those who need it most.” 

While the state is out of money and must find ways to cut corners, why does the most vulnerable population seem to be the people who must burden the brunt of the sacrifice?