The American Jobs Plan and HCBS

Home and Community Based Services may be Expanded

The American Jobs Plan, announced this past March includes $400 billion for Home and Community Based Services. The expansion will improve Medicaid, support and strengthen attendant services and the direct care workers. Additionally, Congress is considering continuing the Money Follows the Person funding to assist people with disabilities to live in their own home and not an expensive institution. 

Medicaid HCBS spending is estimated to be about $114 billion in FY 2021. Each state must cover Medicaid services in Nursing homes, but the same services to eligible people with disabilities living in the community are optional. 

Most notably, HCBS assists people with disabilities with necessary daily activities like bathing, preparing meals, eating, cleaning and hygiene. The pandemic showed the need for more HCBS to prevent deaths in congregate facilities and nursing homes. No American should be forced into an expensive institution because they cannot get services in the community to help them stay at home with family.

One important part of the proposal is to expand direct support and caregiving jobs of Medicaid HCBS. A high percentage of direct support workers are female and people of color. Nationally, Home care workers earn on average $11.52 per hour or $16,200 per year (2018 figures from the Kaiser Family Foundation). Even though the senior population is growing and the need for HCBS is expanding, US states note that workforce shortages are a barrier to expanding Medicaid HCBS. 

$400 billion from the American Jobs Plan could help states expand Medicaid HCBS, improve the direct care workforce and continue to fund the successful Money Follows the Person program. This will help Americans with disabilities to stay in the workforce and remain at home with their families instead of being forced into expensive institutions. Money Follows the Person alone has helped over 100,000 seniors and people with disabilities moving from expensive nursing homes into the community.

The bill gives states an increase in federal Medicaid funds to develop a plan to improve HCBS. The state must meet annual benchmarks and goals, which should be keeping people out of expensive facilities and have a more effective program overall. Specifically the benchmarks will also have dates for compliance, expand services to HCBS populations that have low access currently and expanded direct care workers competitive wages and benefits.

TennCare Pausing Terminations durning COVID-19

TennCare also stopping involuntary disenrollments from LTSS

TennCare Advocates,

We wanted to take an opportunity to update our advocacy partners on a few decisions TennCare has made in light of the COVID-19 emergency.  To start, for the duration of the emergency, TennCare is pausing terminations for both Medicaid and CoverKids with exceptions for voluntary terminations and cases where a member is no longer a resident. Redeterminations will continue only to the extent a member can be automatically renewed through the ex parte process. The effective date for this pause is March 18 so anyone who was enrolled as of that date will maintain coverage through the end of the national emergency.  This includes members who received continuation of benefits pending appeal as of that date. Regarding the 90-day termination period, this pause will not impact that process currently. If an individual who submits information during the 90-day reconsideration period is ultimately approved, we will continue to fill any gap in coverage back to the date of termination, just as we have done voluntarily for the last several years.

We have also implemented several Long-Term Services and Supports (LTSS) policy changes including the pause of all involuntary disenrollments from LTSS programs. To ensure continued access to these important services, we are allowing all assessments (PAEs, PASRRs) to be performed remotely. We continue to work closely with our partners and have issued guidance to MCOs, AAADs, and providers, and have worked with DIDD to issue guidance to their support coordination and provider agencies. All of these updates are available on the TennCare Coronavirus webpage at  https://www.tn.gov/tenncare/information-statistics/tenncare-information-about-coronavirus.html.

TennCare has always encouraged anyone who thinks they may be eligible to apply and TennCare Connect will remain open and accessible to anyone seeking to do so.  As you know, online, phone, mail, and in person are all options to apply and we will closely monitor the availability of each of those options as we move forward.  Specific to the application process, TennCare will begin taking self-attestation of eligibility criteria, including income and resources, on a case-by-case basis when documentation is not available due to the coronavirus pandemic.  We have also temporarily simplified the presumptive eligibility process so that applications and signatures can be completed by phone during this emergency; however, anyone who gains or has recently gained eligibility through the presumptive process will still need to apply in order to maintain their eligibility status.

On the medical side, we are also in constant contact with provider groups and stakeholders on ways to support impacted providers and have already taken steps to ensure services are not disrupted.  For example, we have already significantly expanded telehealth policies and guidance regarding services is updated on our website as soon as it becomes available.  Additionally, we have authorized automatic reauthorizations for ongoing home health and private duty nursing services for at least 60 days.  This authorization is temporary and will be reevaluated as we continue to work with our health plans during this period.    

Finally, to secure additional flexibilities related to the COVID-19 emergency, TennCare has submitted an 1135 waiver to CMS.  If approved, TennCare will gain several regulatory flexibilities targeted toward providers and designed to ensure sufficient health care services are available to serve our members.

Again you can find up-to-date information on the TennCare Coronavirus webpage at https://www.tn.gov/tenncare/information-statistics/tenncare-information-about-coronavirus.html.

Please don’t hesitate to reach out if you have any questions.

Thanks

Sarah

Sarah Tanksley Stockton

Director of Communications

310 Great Circle Rd., Nashville, TN 37243

p. 615-507-6457 c.615-767-4109

sarah.tanksley@tn.gov tn.gov/tenncare

Take Action on Work Requirments

Tennessee is asking the Federal Government to allow it to have monthly work requirements put in place for folks to receive healthcare thru TennCare.  

Please use the survey put together by the Tennessee Justice Center as an easy means to submit comments. By taking this short survey and adding your comments after you answer each survey question, your comments will be sent anonymously. 

Survey on work reporting requirements. 

February 7th is the last day to submit comments on this proposal. To learn more about this and to submit comments take this survey on work reporting requirements.

The responses to this survey would generate at least 5 separate comments (depending on how you answer) for the federal comment period. The Tennessee Justice Center submit those comments on your behalf anonymously. All you have to do is the survey. 
 
Please pass this on to your friends, even people outside of Tennessee can do it. 



https://www.surveymonkey.com/r/tenncaresurvey

A robust federal comment period helped Kentucky defeat work reporting requirements in their state.

A federal district court decided to vacate a plan from the Kentucky government to implement work requirements for able-bodied adults in the state Medicaid program. That decision calls into doubt an initiative strongly favored by the Trump administration and several Republican governors across the country. It also challenges a larger administration plan to refashion all federal welfare and means-tested poverty programs, and should kick off a flurry of court activity on the issue.

Kentucky created the work requirement in its Medicaid program back in January, after the Centers for Medicare and Medicaid Services issued official guidance encouraging “state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility.” Formerly, federal administrations had never approved state restrictions in Medicaid like work requirements or drug-testing that constrained base eligibility for the program. After expanding Medicaid to all low-income adults in participating states, President Obama’s CMS was particularly stringent about this, approving state waivers that restructured elements of Medicaid programs and even reduced benefits, but never approving a waiver from a state involving work requirements.

Medicaid Glass Ceiling

People with disabilities striving for equality

By Christina Clift

I think the Medicaid Work Requirement intends to build a road out of poverty for “able bodied” citizens but I believe it denies people with disabilities equal opportunities and paves the way for us into poverty. In a recent article published in the Tennessean, Jordan Ebert examines a bill introduced by Beth Harwell.  The bill would require Medicaid recipients to work if they are “able bodied” and do not have young children. 

The article from the Tennessean offers the point of view that requiring people to work is a bad idea and would cost the state more money than it would save. Similar requirements are required of individuals receiving SNAP (Supplemental Nutrition Assistance Program) benefits. 

James Powers, Chair of the Council on Aging of Middle Tennessee’s legislative and advocacy committee says, only about 22,300 of the roughly 300,000 individuals on TennCare would be impacted by the new requirements.  The rest are already working, are elderly or disabled, have young children, or fall under other exemptions according to the Center of Medicare and Medicaid Services guidance.

But why aren’t people with disabilities included under the requirements to work? 

Carol Westlake, Director of the Tennessee Disability Coalition said “I think that one of the most significant barriers we see in people with chronic conditions, chronic illnesses, and often times disabilities is a stamina issue. She continued “if you could get to work even a job that may involve being at a desk can be really really difficult.” 

Well, no one ever said that having a job should be easy or isn’t tiring. I believe it does more harm than good to exclude people with disabilities from these requirements.  The law that protects our civil rights requires businesses to make reasonable accommodation to include us in the workforce but there is no requirement to hire someone who is not qualified.

Yes, in order to put these types of requirements in place people with disabilities will need reasonable accommodations.  By not requiring us to work, it just lets everyone off the hook including people with disabilities. 

As long as we are left out then public entities are not forced to address barriers that have existed for decades that keep people with disabilities out of the workforce and dependent on a government check.  These barriers include inadequately funded public transportation, access to equipment and assistive devices, expanding the HCBS services, and dispelling the idea that people with disabilities can’t work.  If we are really serious about nothing about us without us then people with disabilities will need to get in the game and off the sidelines. 

 Do you remember your first job?  Do you remember what it felt like when you received your first paycheck?  I do. My first job was working as a camp counselor at a camp for blind kids.  I was payed $250, all while having fun and earning college credit. 

I moved on to having other jobs with Time Warner, Clovernook Center for the Blind and Visually Impaired, and for the past 15 years at the Memphis Center for Independent Living.  But I know that my story is the exception and not the norm when it comes to employment of people with disabilities.  Unfortunately the national unemployment rate for people with disabilities in June 2017 was 10.5 percent, twice that of non-disabled people. 

But our legislators up in arms about high unemployment for people with disabilities.  I know that there are barriers to working because I encountered them and had to find a way to continue working. But perhaps another obstacle in our way is ourselves and the programs that exempt us from working.  For some people volunteer work is how they build a resume.  It’s how you learn what you would like to do or what you can do. 

Do people with disabilities want equality and eat their cake too?  In other words, do we want equality when it comes to employment, educational opportunities, and the ability to participate in community life but when it comes to being held to the same rigid requirements proposed to keep Medicaid or SNAP benefits we are okay with being left out just because we have a disability?  I believe that people with disabilities should be held to the same standards that able bodied individuals must meet to continue receiving these types of government benefits.  After all we aren’t special and we shouldn’t expect special treatment only a reasonable accommodation. 

I’m not sure whether it’s sadder that we are automatically excluded by our legislators or that people with disabilities are okay with being left out.  Are we really okay being thought of as second-class citizens unable to do the same work as able bodied folks?  I don’t want people to think that I got my job because I have a disability. 

The bill introduced by Beth Harwell to require able bodied individuals receiving Medicaid to work will once again exclude people with disabilities from having to work and that will do nothing more than continue to perpetuate the myths that we can’t work.  People with disabilities should be included in every aspect of community life that includes being gainfully employed. 

Some individuals with disabilities count on being excluded from this piece of legislation.  In some case reliance upon social security benefits has become welfare for people with disabilities.  I say no.  It’s human nature to take the easy road, but sometimes the best results come from challenges we face, the obstacles we overcome, and changes we must make in order to continue to strive towards a better life and ultimately true equality.  Enforcing a requirement of persons with disabilities to work in these programs will begin that process.

Food Stamps to begin a work requirement

MCIL’s Timothy Redd is a national panelist

By Timothy Redd
On Feb 21, 2018 the Food Stamp work requirements will be reinstated for most of Tennessee.  Gov. Bill Haslam said Monday that Tennessee will re-establish federal Supplemental Nutrition Assistance Program (SNAP) benefits work requirements in 70 counties for able-bodied adults without dependents.  The work requirement was waived in 2008 during the recession and will continue to be waived for sixteen economically distressed counties.
 
Haslam states it's now difficult to justify the waiver amid record-low unemployment rates and substantial job growth. The governor's office also points out that other states have similarly restored work requirements. The change affects 58,000 of about 1 million Tennesseans on food stamps. The administration says Haslam also will propose legislative changes to reduce welfare fraud, waste and abuse.
 
"According to the most recent census data,” said US Rep. Steve Cohen, “the Memphis metro area has the highest poverty rate of metro areas with at least one million people. We need to be making nutrition assistance more available, not less.”
 
Yesterday my coworkers and I had a discussion about the work requirement with various viewpoints. I would agree with Cohen that we need to make food assistance more available but I also don’t think there is anything wrong with a work requirement. I did notice that people with disabilities are exempt from this requirement.
 
Historically people with disabilities are more likely to be unemployed and that is where the issue is for me. According to the Department of Labor, in 2016, the unemployment rate for the general population was 4.6 percent, but for people with disabilities it was stuck around 10.5 percent. Finding employment for people with disabilities is extremely challenging and if our community could truly take advantage of skill training and employers were more accommodating I think people with disabilities could make our workforce stronger. What do you think?
 
This past Tuesday, September 12, I took part in The American Public Human Services Association Conference’s, Improving Access to SNAP for People with Disabilities panel discussion at the Hilton Hotel.  I shared the panel with Oregon’s Belit Burke, Self Sufficiency Design Administrator Oregon Department of Human Services and Massachusetts Brittany Manini, Acting SNAP Director Department of Transitional Assistance. 
 
My contribution to the discussion was about barriers. It’s hard to schedule transportation for SNAP benefits because waits are so long at the office, kiosk are not accessible, emergency responses for replacement benefits have not been very accommodating to folks with disabilities; these are some of the areas I addressed.
 
Belit Burke shared that for a long time Oregon system had not been the friendliest for people with disabilities. Advocates are a big reason why things have improved. Today Oregon offers same day benefits, program evaluations, feedback on websites, and even focus groups to improve service.

Much has changed in Massachusetts on the heels of a now settled lawsuit. Harper vs Massachusetts Department of Transitional Assistance was a class action lawsuit brought by disabled clients alleging that the Department violated the Americans with Disabilities Act by failing to provide clients with disabilities with equal access to Department benefits.
 
The plaintiffs alleged that the Department fails to provide clients with disabilities the special assistance needed to ensure that they can maintain their benefits. Today there are system enhancements, screen prompts and scripts for employees, built in tracking to maintain customer documentation, mobile alerts, and employees assist in filling out paperwork and reading notices through home visits for people with disabilities. The offices now have at least one director of Disability Access in each office whose goal is to keep disability access in the discussions as well as collaborate with community liaisons and other agencies.
 
Massachusetts currently partners with the aging commission and other agencies. There is also an Elder Unit being developed that will cater to seniors 60 and older and also provide a direct line for them to call with no automation.
 
At the end of the discussion I met Lisa Cowell, Tennessee SNAP Director. She informed that she submitted a ticket to have the kiosk lowered which will make them more accessible and she forwarded my information to Shelby County’s Field Management Director Yolanda Shegog-Wright.  Ms. Cowell also advised that Tennesseans can now send emails for a 48 hour response, apply for SNAP benefits online and also take advantage of live chat by accessing the website at https://www.tn.gov/humanservices/article/supplemental-nutrition-assistance-program-snap.  

After hearing some of what is happening in other places I am convinced that a better system for accessing SNAP benefits is possible if we as a community continue to speak and make demands when we see barriers.

Renewal Season is Here

Please do not forget to renew

By Timothy Redd
If you are a recipient of Medicare Part B you may have received a renewal packet in the mail. Do not throw it away or ignore the renewal. You are eligible to time limited equitable relief if you are enrolled in a QHP and you are enrolled in premium Par A and you have an initial enrollment period that began April 1. 2013 or later or you were notified of retroactive premium free Part A on October 1, 2013 or later.
 
The Equitable Relief for Part B allows beneficiaries enroll in Medicare Part B with no penalty, eliminates part B late enrollment penalty in part B if the enrollment was delayed. 
In order to qualify for equitable relief for Part B:

1. You must gather the appropriate documentation. Proof of your QHP enrollment is required which can be a letter showing that you are enrolled in both Medicare and a Marketplace plan. Proofs of premium payments and bills, IRS form 1095—A that shows months of coverage and subsidy amount.
2. Call the SSA at 1800-772-1213 or www.ssa.gov to find a local Social Security office that you can visit in person.
3. Once on the phone or in the office with a representative request to use limited equitable relief to enroll in part b and or eliminate Part B.

The deadline for the equitable relief for Part B is September 30, 2017. Because of the Affordable Care Act, the Bureau of TennCare handled the application  process for Medicare Savings Program effective January 1, 2014.  Enrollment was postponed because a computer system was not in place the verify eligibility. 

When the renewal packet comes in the mail you will have a letter informing you your due date in bold. It is recommended that you fax it back to prove Tennessee Health Connection received it. The fax number is 1-877-430-0843.
You can also call the TennCare Renewal Packet Number at 1-844-337-3348. You should wait at least 10 days before calling to verify the packet was received.

The Bureau of TennCare has 35 business days to process a pocket once it’s been received. If additional documentation is needed another 35 days can be added onto the processing time.

If you need further assistance contact State Health Insurance Assistance Program (SHIP) for Medicare participants at 1-877-801-0044. SHIP staff can verify the packet was received.

If you miss the deadline your premium will be deducted from SSA check and may be multiple months.  You will have 90 days to submit you packet in order to make your benefits retroactive. Premiums will be deducted until determination.

Where in the World is Senator Lamar Alexander?

ADAPT Demands Sen. Alexander protect the health care of Tennesseans

By Allison Donald

 
The Senate has delayed the vote on a replacement to the Affordable Care Act. However, this week remains critical as Senate leadership will continue trying to cut deals with senators to get to 50 votes. People with disabilities need to make it clear that Medicaid is essential to us remaining in ours homes and in the community and should not be part of any reform or replacement. The bill at its core is a tax cut for wealthy at the expense of healthcare for the rest of us.

Mid-South ADAPT along with allies from the Tennessee Justice Center, Indivisible Memphis, Black Lives Matter, and the Memphis Coalition for Concerned Citizens visited the office of Senator Lamar Alexander.  We were there representing the 1.6 million Tennesseans who get comprehensive affordable health coverage through Medicaid.  Our demand is simple.  We want Senator Alexander to vote no to the Better Care Reconciliation Act and protect the liberties of Tennesseans especially Medicaid. 

“The proposed cuts to Medicaid,” said Mid-South ADAPT activist Michael Heinrich, who was arrested and dragged out of Speaker Mitch McConnell’s office last month, “will result in people paying more for healthcare coverage, but receiving less services.”


Fourteen activists filed into the office of Senator Lamar Alexander and took seats on the floor. We began to demand to speak with someone in the Washington DC office that had a direct line to Senator Alexander.  Mary Wooldridge the constituent representative took notes as each individual explained how the proposed cuts to Medicaid would affect their life.  Ms. Wooldridge, who is retired, said the healthcare issue doesn’t affect her because her coverage is from the phone company. The issue did not concern her.

After all of the personal testimonials were done Allison Donald repeated the demand for Ms. Wooldridge to get someone from the Washington DC office on the phone.  She then stated that she could not do so. 
“I will make 201 Poplar my home,” said Allison Donald the organizer for Mid-South ADAPT, “before I go into a nursing home.”

At that point the exchange ended. The sit-in began and ADAPT was not going anywhere.  We were in the office for about 30 minutes a security officer and an officer from the Department of Homeland Security entered and informed us that there were too many people in the office and that only four of us could be in the office at a time. Four people choose to stay: Tim Wheat (ADAPT), Michael Heinrich (ADAPT), Allison Donald (ADAPT), and Karen Spencer McGee (BLM). 

Ms. Wooldridge, who claimed that she was not able to get in contact with the Washington DC office, had her phone ring and Senator Alexander’s Washington DC office was on the other end. Allison Donald made arrangements to speak with Brandon Morton the scheduler for Lamar Alexander.

Officer James of Homeland Security informed us that we could not wait for the final arrangements in Senator Alexander’s office while Ms. Wooldridge conducted business.  He also stated that we could not protest inside of a federal building.  About fifteen minutes passed and Officer James issued his first warning for us to leave the office or be arrested. 

With the contact information in hand, the ADAPT activists met our colleagues downstairs to discuss the next steps. 

Rally to Protect Healthcare.

Memphis supports Medicaid

By Allison Donald
(Memphis, June 28, 2017) Mid-South ADAPT and The Memphis Center for Independent Living, along with Copper Coalition, CBTU, Indivisible Memphis, and other groups held a resist rally and press conference on Wednesday morning at 10:AM near Madison Avenue and McLean.  Mid-South ADAPT came to voice our concerns to Senators Lamar Alexander and Bob Corker about proposed cuts to Medicaid in the (BCRA) that will negatively impact long term supports and services that make it possible for people with disabilities in Tennessee to live in the community. 

The Senators said they wished to repeal Obamacare, but they have created legislation to cut Medicaid instead. The large cuts in federal funding for Tennessee’s Medicaid program, known as TennCare, would put health coverage at risk for many Tennesseans. The cut in federal funding hurts Tennessee more than other US states. Because Tennessee did not expand Medicaid under the ACA, there is less federal funding and that funding will be capped.

TennCare enables low-income seniors, children, and people with disabilities to get needed health care, work and live in the community. It helps parents and other adults stay healthy, keep employment, and avoid medical debt.  

Tennessee is one of 44 states participating in Medicaid’s Money Follows the Person program, which helps TennCare beneficiaries safely and successfully transition from expensive nursing facilities to their own homes. Tennessee’s program has helped more than 600 people transition to the community, and has produced significant state savings by reducing unnecessary expensive nursing home stays in the state.  

Cuts to Medicaid also will not reduce the tax burden on Tennesseans. While other states have built an insurance market for low-income working adults, Tennessee state, county and local taxpayers will have to shoulder the cost of uncompensated care. Healthcare is the best investment in the US worker.

The message of the rally is clear: Get involved.  Do not give in because our lives and liberty depend on it. If you would like more information on how you can join the resistance and Save Our Medicaid contact Allison Donald and Tim Wheat of Mid-South ADAPT 901-726-6404 or www.midsouthadapt.org   

“Healthcare is a Human Right!” 

#SaveOurMedicaid
#ADAPTandResist

IL Centers exempted from Day Services License

PART ONE: Tennessee begins a state program that leaves out the state’s Centers for Independent Living

The state of Tennessee developed a unique service with the new Employment and Community First initiative. Tennessee Amendment 27 was the first attempt in the U.S. to bring integration and independence to Americans that were often trapped on waiting lists for programs. All of the state’s six IL Centers were asked to be a part of providing the tools to help people with disabilities all over the state to live independently and to work for employment and self-sufficiency.

July 1, 2016 the program went live and MCIL had done the work to build our program and services from scratch. In the ECF program we offer: Peer-to-peer Self-Direction; Community support, development, organization and navigation; Health Insurance Counseling (Forms Assistance) and Independent Living Skills Training. At the time we were also offering Personal Attendant Services and Supportive Home Care through our existing PAS Services department.

MCIL desperately needed more service hours for our PAS program and those two ECF services seemed to be in demand. Increasing our capacity with ECF Personal Attendant Services and Supportive Home Care seemed just what the Center needed to continue consumer oriented home and community services. MCIL did not get any of the first ECF referrals and by October we had paid for all necessary training and background checks for our staff and we had been certified by both Managed Care Organizations.

To date, MCIL has not received a single appropriate referral. We have heard from five people and some “Support Coordinators” from the MCO’s, but none were looking for services that MCIL had agreed to provide. One referral may have included services we offer, but it was from a county outside our area.

Since the beginning of 2017, it has been very hard here at MCIL because our PAS program dipped below the hours needed to keep it sustainable and keep the dozens of Direct Support Professionals employed. In March MCIL had to end the program and two additional professionals who administered the program lost their jobs. The state’s ECF program said they had 1,700 slots in the first year but not one appropriate referral came to MCIL.

MCIL did not end its ECF program however, although clearly we could not offer Supportive Home Care and Personal Assistance services because we no longer had a PAS program. The MCOs did not call for any of the other services that MCIL had to offer.

From the beginning, we had assumed the IL Skills would be our bread-and-butter. MCIL has more than 32 years of IL experience in the community and it is our calling-card, it is in our name.

The Memphis Center for Independent Living never removed the service “IL Skills Training” from our Policy and Procedure Manual but the Managed Care Organizations apparently could not approve us to provide IL Skills because, they claimed, an IL Skills provider must have be a “Licensed Day Habilitation Provider” in order to be credentialed by the Managed Care Organizations.

The MCO’s did not have any problem with us continuing to list IL Skills as a service we provide, because they could not coherently explain why we would need a Day Services license. It did not make any sense. The IL Skills according to the state regulations could not be provided in a facility and had to be one-on-one services offered in the least restrictive setting.

From early on in this process, the Statewide Independent Living Council and other CILs in the state were advocating to get rid of the Day Services license. The other Tennessee CILs were working on developing ECF programs of their own and saw the license as a barrier. One-by-one the CILs dropped out of the ECF program for a variety of reasons, including the burden of the unnecessary license.

PART TWO: Changing the license requirement

LETTER: Tim Wheat, Program Director Memphis Center for IndependentLiving to Dr. Wendy Long, Director of TennCare

LETTER: Patti Killingsworth, Assistant Commissioner and Chief of Long Term Services and Supports to Tim Wheat