Arkansas Governor's Council on Developmental Disabilities

FEDERAL Policy Update (As of February 27, 2020)

UPDATE FROM THE GCDD EXECUTIVE DIRECTOR:

Immigration - In late January, the US Supreme Court upheld the Department of Homeland Security’s updated rule expanding the criteria the government can use to determine visas or long term status of legal immigrants.  Specifically, it widens the definition of a “public charge,” an existing term describing individuals who may utilize government assistance. An applicant’s health status, education and employment levels will now be considered.  In addition, while previously only use of income assistance programs like Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF) could be considered, broader programs like food stamps, Medicaid, Section 8 housing and others will now be part of the review process. These changes will particularly impact poor immigrants and those with health conditions or disabilities. 

Medicaid - On January 30, The Department of Health and Human Services issued guidance, called Healthy Adult Opportunities, to states regarding the Medicaid program.  It offered 1115 Demonstration Waivers as a vehicle to cut and cap state Medicaid health programs in exchange for wide latitude in program changes: eligibility, service array and quantity, prescription drugs, work requirements and more.  Medicaid, established 55 years ago, is a federal-state partnership providing health insurance to those who qualify. States have added optional services, including Home and Community Based Waiver Services (HCBS). 

Currently, states receive a federal match for every dollar spent. Arkansas receives just over $2.40 for every $1.00 it spends. States that opt to participate in either a block grant (lump sum) or per capita cap (funding for each enrolled individual) as outlined in the guidance, would lose that federal match and be solely responsible for cost overruns. While HCBS services are not specifically included in the guidance, they could be vulnerable to counteract state shortfalls.

Trump Administration Budget - President Trump released his fiscal blueprint for fiscal year 2021 on February 10.  Although this budget does not have the force of law, it outlines policy and fiscal priorities held by the administration, including cutting the Medicaid and Affordable Care by over $1 trillion dollars over 10 years, cuts to the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs, 30% cut to Supplemental Nutrition Assistance Program (SNAP) also known as food stamps and more.  Various national stakeholder groups are preparing in-depth analyses at the time of this publication.

Social Security Administration (SSA)  - The SSA sought comments through the end of January regarding its proposed rule to expand the use of continuing disability reviews (CDR) for Old Age Survivors and Disability Insurance (OASDI) and Supplemental Security Income (SSI).  It takes years for many beneficiaries to become eligible, and often requires professional expertise. This rule would increase the frequency of certification, likely adding to adjudication wait times and errors.

New HCBS Infrastructure Bill Introduced - The HCBS Infrastructure Improvement Act has been introduced in the Senate by Senator Bob Casey (D-PA). This bill would provide funding for critical infrastructure in states’ Home and Community-Based Settings (HCBS) systems, including around workforce, employment, integrated housing, and transportation. A House version of the bill is also in the works and is expected to be introduced next month. NDSC is supporting this bill and will ramp up advocacy efforts for it in the near future.

Medicaid Waivers for Block Grants Approved - The Center for Medicare and Medicaid Services (CMS) recently released a proposal, called Healthy Adult Opportunity (HAO), to invite states to restructure their Medicaid funding into block grants. Currently, Medicaid is financed by a federal-state partnership with an unlimited federal match tied to a state’s needs and funding levels. This new proposal would allow the federal government to cap the amount of funding it provides to states for certain Medicaid beneficiaries, including some people with disabilities, many direct support professionals, and other allies of people with disabilities who obtained Medicaid through the Medicaid expansion in the Affordable Care Act (ACA). We have serious concerns about this new model because states would be allowed to restrict eligibility, provide limited health care benefits, reduce access to prescription drugs, impose burdensome work requirements, and make other changes that could be detrimental to all Medicaid beneficiaries. If a state’s Medicaid needs exceed the federal funding cap, then states would be responsible for shortfalls, causing them to potentially cut other services (including long term services and supports for people with disabilities).

The ABLE Age Adjustment Act - (S. 651/HR 1814) would raise the age of onset of disability from 26 to 46 for people with disabilities to have ABLE (Achieving a Better Life Experience) accounts. This change would enable six million more people with disabilities to become eligible to open an ABLE account. It would also greatly enhance the sustainability of all ABLE programs nationwide.

The Transformation to Competitive Employment Act - (TCEA) will address barriers to employment and expand opportunities for competitive integrated employment for people with disabilities while phasing out subminimum wage certificates under Section 14(c) of the Fair Labor Standards Act over a six-year period. In addition, for those who choose not to work, work part-time, or for whom their disabilities make it too difficult to maintain work in a competitive integrated setting, the TCEA includes individualized wraparound services that provide them with opportunities for meaningful training and social activities in the community.

Voting -The Accessible Voting Act (S.3206) was introduced in the Senate on January 16.  Click here for details outlining ways this bill aims to decrease barriers to voting for citizens with disabilities.

Census 2020 - Every 10 years, the US Constitution requires the United States to count the number of people living in the country.  Why is the census important to people with disabilities?

Census data is used to figure out how much money programs, state, and local governments will get from the Federal Government to pay for certain services. Census information is also used to figure out how many members each state should have in the US House of Representatives. The census helps to direct more than $675 billion annually in federal funding. Census data is used by businesses, governments, and civic organizations to inform decision-making about what services should be available in local areas. Ninety-five percent of American households will receive instructions on how to participate in the census by mid-March. If people do not respond by the end of April, Bureau staff will follow-up in person between May-July. The Bureau will release the census data collected sometime in November 2020.  Click here for a brief synopsis of the 2020 Census process you can listen to or read.

Eric P. Munson, Executive Director
Governor’s Council on Developmental Disabilities