IS CALIFORNIA'S ADULT DAY HEALTH CARE PROGRAM "A BRIDGE TOO FAR?"

It’s sometimes difficult to remember that there actually was a time in our state’s and nation’s history when citizens and government collaborated to build bridges.  These were not just brides over waterways, but also symbolic links to a better quality of life. 

They included programs to offer bridges to a college education; bridges from poverty to employment; bridges to affordable and preventative healthcare; bridges to move people from nursing homes to independent living; and bridges to reward a lifetime of work with a secure retirement.

Today, these bridges to a better future are crumbling just like our transportation infrastructures.   Rivet by rivet, beam by beam, lawmakers are making budget cuts or eliminating these programs.

They are under constant attack and raising revenues is summarily rejected out of fear of the growing “no tax” mindset.  We forget that these programs were viewed as investments that reaped cross-societal and economic dividends.

Every engineer knows that there comes a point in time when a bridge's decaying structure cannot be saved.  A case in point is California’s Adult Day Health Care (ADHC) that provides center-based health and nursing care, therapies, transportation, and other services for low-income seniors and people with disabilities. 

California's 300 ADHC centers serve 37,000 people and give partial respite to family caregivers from their costly and time-consuming daily home care obligations for their relatives. However, advocates believe its foundation has been undermined by Governor Jerry Brown’s June 25^th veto of AB 96.

AB 96 would have created an alternative to ADHC after it lost funding in this year’s budget.  It established the Keeping Adults Free from Institutions (KAFI) program as the new bridge program.

Supporters of AB 96 believed that a deal had been made to eliminate ADHC, but to replace it with KAFI at half the cost.  The Governor stated that he vetoed it because KAFI would duplicate the exact program model he had eliminated and that made no sense. 

The Governor did sign SB 91 allowing ADHC centers to operate without Medi-Cal licensing.  There are no guarantees, but state agencies reportedly are working to keep the basic model alive for those who can pay privately.  In theory, centers could be folded into HMOs or health plans as part of a continuum of care, assuming they survive.

Yet, ADHC providers, patients, and families feel betrayed.  Most centers face closure and up to 7,000 jobs are at-risk.  Experts predict that if recipients lose ADHC services that at least 4,000 prohibitively more expensive nursing home admissions and thousands of emergency room visits will result.

The Federal government approved extending ADHC's targeted elimination date from September 1 to December 1 to help keep recipients out of institutions.  Meanwhile, a Federal lawsuit has been filed alleging that  eliminating ADHC violates Federal law and would cause irreparable harm by placing recipients at-risk of institutionalization, hospitalization, injury, or death.  

The final outcome of this bridge closure is unclear.  Yet, once dismantled the ADHC infrastructures local communities created over decades probably cannot be restored in our fragile economy.

"We Must Destroy Federal Government Spending In Order To Control It"

Seeking to avoid accountability for the Federal budget deficit they created, today Congressional House Republicans are debating and voting upon an even more ideologically extreme budget proposal.  It is called the “Cut, Cap, and Balance Act.” 

The White House's reaction has been to label it as an “empty political statement.” Many see it as a political ploy to give Republican incumbents public cover for their refusal to vote for raising the Federal debt limit. 

Fiscal analysts say it is so extreme that even the so-called Ryan Budget released earlier this year to heavy public criticism wouldn't satisfy its mandate.  Those proposed reductions would not be severe enough.

The bill would require total Federal spending to shrink to less than 20 percent of the national Gross Domestic Product by 2018 and permanently cap it there.  It would cut $111 billion commencing October 1st with the new Federal Fiscal Year and $400 billion more each year over the next decade. 

The bill would prohibit any increase in the debt limit until both houses of Congress approve a constitutional amendment for ratification by the states.  The constitutional amendment would prohibit Congress from raising any taxes without a two-third vote in both houses. 

Does the two-third supermajority vote requirement sound familiar?  Yes, as has been the case in California, it would be virtually impossible for Congress to ever raise any revenues or close special interest tax loopholes.

Republicans would also eliminate protections utilized over the past 25 years that exempt core basic assistance programs for the poor from across-the-board cuts.  Instead, it would make all programs subject to them if the spending limit is exceeded.

Supporters falsely claim that they are protecting Social Security and Medicare.  And it is partially true because it doesn’t cut either program in 2012 and does not explicitly subject them to automatic cuts. 

However, lawmakers facing the challenges of cutting trillions of dollars to meet annual spending limits would have no choice other than to make those reductions.  Otherwise, key government operations simply could not function. 

Social Security, Medicare, and Medicaid are the largest programs in the Federal budget and they could not escape massive reductions.  The math does not add up.

By 2021, combined expenditures for these programs will be 45 percent greater than all other programs combined, apart from interest payments.  They would be drastically cut under any scenario.

President Obama has vowed to veto the bill and his spokesman calls it “the Ryan plan on steroids.”  Furthermore, it is unlikely to pass the Senate. 

Yet, the real story is that the endless, aggressive political assault on programs for seniors, the poor, and people with disabilities will continue throughout the 2012 election year.  The Republicans will seek to demonize Federal spending programs.

The core strategy is to generate public fear in campaign ads and Republican congressional candidate talking points by pitting middle-income Americans against the poor, elderly, and disabled:  “Cut spending for them, but don’t cut anything affecting me or raise my taxes” will be the message.

A Good Idea Gone Bad

Competitive bidding sounds like a good idea, right? Get the lowest price and the best deal. Save money. What could go wrong?

Plenty, especially when it's Medicare running the process and durable medical equipment (DME) vendors doing the bidding. The Centers for Medicare and Medicaid Services (CMS) Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) is causing havoc in the home healthcare industry.

The Medicare Modernization act of 2003 (MMA) required Medicare to replace the Home Medical Equipment (HME) payment fee schedule for certain items with a "competitive acquisition" or government contracting program. The program was implemented on January 1, 2011 in nine cities (including the Riverside/Bakersfield area) and will expand to 91 metropolitan areas later this year in round 2.

In California, round 2 cities include: Bakersfield, Fresno, LA-Long Beach-Santa Ana, Sacramento-Roseville, San Diego-Carlsbad-San Marco, SF-Oakland-Fremont, San Jose-Sunnyvale-Santa Clara and Visalia-Porterville.

So what's wrong with the competitive bidding program? Well, for starters it is driving suppliers out of business, limiting choice for consumers, lengthening hospital stays and causing much grief for consumers.

As a result of the bidding process, many vendors who provide a variety of home healthcare products and DME were awarded contracts to supply a single item or none at all. In some areas, out-of-state vendors won contracts to supply products, forcing consumers to drive long distances or rely on mail order to obtain supplies and products they previously purchased locally.

Hospital discharge planners are delaying releases because they cannot match patients to contracted providers with the appropriate products such as wheelchairs, oxygen equipment and sleep therapy devices.

One Medicare recipient was waiting for her diabetes test strips for more than two weeks and could no longer receive them from her original provider since the company was not contracted. Another patient needs oxygen 24 hours a day and relies on portable oxygen to visit her physician. Her HME company did not win a contract and the user needs physician approval to switch to a different company. She has no access to oxygen and cannot visit her physician.

So what can we do? For starters, Consumers in the Riverside-San Bernardino area who have been affected by this program need to tell their stories. At the AAHomecare’s website (http://www.aahomecare.org/) They can click on the ‘Competitive Bid Problems?’ button and provide feedback on how their access to home healthcare products and services has been affected by the program.

We also need to get behind HR 1041 and urge its passage before the program expands to round 2 later this year. HR 1041 would roll back the flawed pilot project and institute an up-to-date and fair pricing schedule defining what Medicare will pay for certain equipment. The bill has 132 cosigners, none from California. Advocates, consumers and others who are concerned, should write their representatives in Congress and urge them to cosign the bill.

A lot of Californians are already experiencing difficulties as a result of this program. Many more will unless we join the national effort to stop it. The time to advocate is now!

WRITE TO ASK GOVERNOR BROWN TO SAVE THE ADULT DAY HEALTHCARE PROGRAM

URGENT: ADULT DAY HEALTHCARE IS A VITAL AND COST-EFFECTIVE SERVICE FOR PEOPLE WITH DISABILITIES AND THEIR FAMILIES

California's Adult Day Healthcare Program serves the health, respite, social and nutritional needs of 35,000 California seniors and people with disabilities. It has been a model program replicated across the nation, and provides unique services that are not available through other programs.

California has a responsibility to provide cost-effective home and community-based services to its citizens with disabilities; it must not force people out of their homes and into nursing homes. In addition, the Lewin consulting group has estimated that cutting Adult Day Healthcare will directly cost the state $53 million more than it saves.

Eight centers that provide these services have already closed because of previous cuts to the program, turning the lives of people and families upside-down. Without action, all Adult Day Health programs will be forced to close their doors. The Sacramento Bee has called this program "Well worth saving," and the California Legislature has voted to restore part of the funding. The final decision now rests with Governor Brown.

Please join us in asking the Governor to take two steps to save the Adult Day Healthcare program:

• Sign AB 96 to Continue the Program
• Retain the Legislature's $85 Million Budget Appropriation to Fund the Program

Go to our website http://ab96.cfilc.org/ to Take Action and send a message to Governor Brown, urging him to save Adult Day Healthcare for the 35,000 Californians who depend on these services.

-Contributed by Laurel Mildred, MSW, CFILC Olmstead Advocacy Direct</span>

CFILC UPDATES ITS 2011 LEGISLATIVE AGENDA

Following recent legislative deadlines for bills to be reported out of their policy and fiscal committees, CFILC’s 2011 Legislative Agenda has been updated.  The following are the ACTIVE and INACTIVE bills.  The 2-year bills remain active, but must be passed under an expedited schedule in January 2012.

The bills that are INACTIVE are shown in RED.   

ACCESS

AB 410 (Swanson) State Agency Regulations: Accessibility to the Blind and Visually Impaired
CFILC Position: Support.

Description: Requires state agencies, upon request from a blind or visually impaired person, to provide a narrative description of proposed state agency regulations. 

Status:      ACTIVE.

DIVERSITY

AB 9 (Ammiano) Pupil Rights: Bullying
CFILC Position: Support.

Description: Requires school districts to adopt policies prohibiting discrimination, harassment, intimidation, and bullying, including pupils with disabilities.  

Status:      ACTIVE.  

AB 519 (Hernandez) Pupil Discipline: Restraints and Seclusion
CFILC Position: Support.

Description: This bill prohibits schools and school employees from using chemical restraints, mechanical restraints, physical restraints, or physical seclusion to control the behavior of special education students. 

Status:      ACTIVE.  AB 620 is now a 2-year bill.

AB 533 (Yamada) Continued Funding for Area Agencies on Aging and Independent Living Centers During State Budget Impasses
CFILC POSITION: Support.

Description: This bill would have enabled Area Agencies on Aging and Independent Living Centers to continue to receive Federal funding during state budget impasses. 

Status:      INACTIVE  

AB 620 (Block) Postsecondary Educational Institutions: Policies Intimidation and Bullying
CFILC Position: Support.

Description: This bill requires state institutions of higher education to adopt policies prohibiting students from engaging in acts of intimidation or bullying. 

Status:      ACTIVE.

HOUSING

AB 264 (Hagman) Transitional Housing: Notice Requirements
CFILC Position: Oppose.

Description: AB 264 would have required new transitional housing projects for the homeless to provide advance notice to all residents living within 300 feet of a project. CFILC opposed the bill because it was discriminatory. 

Status:      INACTIVE  

AB 1198 (Norby) Land Use: Housing Element: Need Assessment
CFILC Position: Oppose.

Description: This bill would have repealed existing law requiring the Department on Housing and Community Development to identify existing and projected regional housing needs. CFILC opposed the bill because the State must continue to play this role. 

Status:      INACTIVE  

OLMSTEAD

AB 66 (Chesbro) Taxation: Vehicle License Fees
CFILC Position: SUPPORT.

Description: This bill would raise the Vehicle License Fee (VLF) to the levels they were prior to Governor Schwarzenegger’s fee reduction. It would provide $4 billion annually to offset budget cuts.

Status:      ACTIVE.  AB 66 is now a 2-YEAR BILL.

AB 594 (Yamada) California Department of Aging and Adult Services
CFILC Position: Support.

Description: This bill creates a new single state agency to coordinate all state-administered home and community-based programs for independent living.

Status:      ACTIVE.  AB 594 is now a 2-YEAR BILL.

AB 889 (Ammiano) Domestic Workers

CFILC Position:  Oppose, Unless Amended.

Description:  This bill would give Domestic Workers, including personal attendants serving seniors and people with disabilities, certain labor protections and benefits, including overtime compensation and accrued vacation time.  Currently, it would include  low-income, non-IHSS eligible disabled persons who pay for their personal attendants, so CFILC is seeking to exempt them.

Status:  ACTIVE.

SB 21 (Liu) Long-Term Care: Assessment and Planning
CFILC Position: SUPPORT.

Description: SB 21 would have reformed the long-term care system to make it easier for aged or disabled persons to access supportive services post-hospitalization by requiring counties to provide case management and transitional services.

Status:      INACTIVE 

SB 33 (Simitian) Elder and Dependent Adult Abuse
CFILC Position: Support.

Description: This bill would make the Elder Abuse and Dependent Adult Civil Protection Act that requires financial institutions to report suspected financial abuse permanent law.  

Status:      ACTIVE.

SB 930 (Evans) IHSS: Enrollment and Fingerprinting Requirements
CFILC Position: SUPPORT

Description: SB 930 repeals the mandatory fingerprinting of IHSS recipients and a prohibition for the use of post office boxes to receive their checks. 

Status:      ACTIVE.

TRANSPORTATION

AB 441 (Monning) State Transportation Planning
CFILC Position: Support, if Amended

Description: This bill would have required local transportation plans to include “health equity and health issues.” CFILC was seeking amendments to encourage Olmstead implementation in that planning. 

Status:      INACTIVE  

VOTING

AB 346 (Atkins) Polling Places in Higher Education Institution Campuses
CFILC Position: Support.

Description: This bill requires the establishment of polling places on the campuses of state funded higher education institutions to increase student voter turnout in elections. 

Status:      ACTIVE.

UPDATE ON PG&E'S ELECTRICITY RATE INCREASES THAT HURT PEOPLE WITH DISABILITIES

In my last posted Blog, I had issued a BAD NEWS ALERT that warned Pacific Gas and Electric (PG&E) customers about a May 26^th California Public Utilities Commission (CPUC) Meeting where they would hear public testimony and vote on two new proposed rate increases.  The first will assess a fixed charge for all of its customers and the other will lower the “baseline” above which they would pay higher rates for electricity.  The rate increases were approved by the CPUC.

I testified on behalf of people with disabilities to follow up on a CFILC letter of opposition we sent to the CPUC.  We were asked by The Utility Reform Network (TURN) and Disability Rights Advocates to give a disability community perspective to the proposal.  Consumer and utility advocates argued that the rate increases violate state law that only allows moderate increases over time for low-income customers.

I was disappointed to learn at the last minute that my 3 minutes of allotted time was reduced to 2 minutes! It forced me to scramble to cut my well-rehearsed presentation, so I spoke quickly and violated the public testimony speed limit.

Nevertheless, I testified that the rate increases would be a substantial financial hardship for people with disabilities.  They would come on top of recent state budget actions that reduced income benefits, required copayments for medical appointments and prescriptions, and lowered Medi-Cal coverage for Durable Medical Equipment and medical supplies.  These rising costs are challenging the ability of the disabled to afford living independently.

Lowering the baseline will also hurt people whose medical conditions require maintaining constant air conditioned temperatures or medical equipment usage.  Others live in subsidized housing that uses electricity for heating. 

The proposals allegedly would encourage energy conservation, but these customers have no such options and will only end up paying more. It’s likely that many will find the increases unaffordable and may be forced to default on their utility bills and risk electricity shutdowns.

It was apparent that CPUC President Michael Peevey, who sponsored the proposal, had paved the way for its approval.  It was smooth sailing because a new commissioner appointed by Governor Brown could not vote because his prior advocacy was a conflict of interest. 

Nevertheless, TURN and other advocates negotiated some minor improvements to the original proposal.  They were able to extend the rate increase phase-in period.  Sometimes political success means working hard to make a devastating proposal merely alarming.  It is admittedly a subtle nuance.

It’s ironic that the rate increases were proposed to “level the playing field” between rates paid by low-income customers and businesses and higher users.  It was claimed that low-income rates needed to be increased because they had been exempted by state law that expired in 2009. 

Of course, that philosophy is consistent with the kind of thinking that is going on in Congress today in the Federal Budget debate.  Republicans claim that stimulating economic recovery requires lowering taxes and fees for the wealthy and corporations.  They advocate for the elimination of programs assisting seniors, the poor, and people with disabilities and to force them to pay more out of their shrinking household budgets. 

And so it goes. 

PG&E Proposes Electricity Rate Increases That Harm People With Disabilities

BAD NEWS ALERT: If you are a person with a disability and a Pacific Gas and Electric (PG&E) customer you may be finding that your electricity bill soon will be more expensive.

On May 26th, the California Public Utilities Commission (CPUC) will be hearing public comments on two new proposed rate increases. The first would assess a fixed customer charge for its entire base of residential utility customers.  The second would lower the "baseline" above which customers would pay higher rates for electricity usage.

CFILC recently signed on to a joint letter opposing the rate increases circulated by The Utility Reform Network (TURN), a consumer watchdog group.  The letter states that the proposal, which proposes to "balance" previously-approved rate increases for businesses and higher-usage customers by requiring residential customers to pay more, violates state law.  Current law only allows modest increases over time for lower income customers. 

TURN and Disability Rights Advocates have asked CFILC to testify about why the new fixed charge and lowering of the baselines will disproportionately impact people with disabilities.  The argument is that they would come on top of recent state budget actions that have lowered disability benefits and SSI monthly grants, required Medi-Cal copayments for prescriptions and doctor visits, and require more out of pocket expenses for Durable Medical Equipment and medical supplies.

Lowering the baseline will especially harm people with disabilities who have multiple or complex medical conditions.  Many of these customers with Multiple Sclerosis or heart and lung disabilities are heavily dependent on air conditioning and electricity to filter their air and operate their medical equipment.  These customers have no realistic options to lower their electricity usage.  The simple truth is that many will be unable to afford the increase rates and may default on their bills and face electricity shut downs.

The proposal is designed to conserve electricity, but it is an unrealistic goal for people with disabilities who tend to be low- to moderate-income earners with very basic electricity use needs.  Others who live in HUD-subsidized housing that use electricity as heating sources simply cannot control home energy conservation.

It is possible that votes on the proposal may be postponed until early June.  However, if you act NOW you can send an email to the CPUC by May 26^th to oppose the rate increases.  Just go to the CPUC website at www.cpuc.ca.gov and link the Public Advisor tab that gives you easy-to-follow instructions. 


There is still time for your voice to be heard.  Those who can least afford even more household budget increases should not be forced, once again, to bear unfair burdens.