Bronx Grannies Hold Bake Sale to Save Grandparent Apartments, Threatened by NY State Budget Cuts

BY DANIEL BEEKMAN

Some Bronx grandmothers are raising money - one cake at a time - to offset more than $300,000 in state budget cuts to the funding for their unique residence.

The bake sales are a desperate attempt to sustain programs and services, from 24-hour security to after-school tutoring, at Grandparent Family Apartments.

When it opened in 2005, the Morrisania building was the first such facility in the nation for low-income grandparents raising grandchildren.

"These cuts are going to hurt," said Annie Barnes, 68, who cares for two grandchildren. "But our grandchildren need us. We'll continue to sacrifice for them."

A handful of grandmothers gathered yesterday to discuss bake sale strategy in a bright basement room of the building, where handmade Easter bunnies and colorful mobiles decorated the halls.

Most have cared for their grandchildren since birth. Their children are absent parents - sick, murdered, missing or in jail.

Read more: More

Important Medicaid Information for States: CMS' Virtual Meeting on Cost-...

Net Effects of the Affordable Care Act on State Budgets

The Affordable Care Act will affect state budgets in many ways. State Medicaid spending on low-income adults will increase between $21.1 billion and $43.2 billion during 2014-2019. But during this same period, the ACA will save states and localities between $83.8 billion and $153.0 billion by letting them (a) shift higher-income adults from Medicaid into coverage where subsidies are funded entirely by the federal government; and (b) substitute newly available federal Medicaid dollars for prior state and local spending on uncompensated care and mental health services. Altogether, net state and local gains will total between $40.6 billion and $131.9 billion.

Continue reading

Health Care Facility Inspections to be Cut if Fees Not Raised - Las Vegas Sun

Image via Wikipedia
If a panel of elected officials in Nevada rejects a proposal to increase health care facility licensing fees today as it did in October some state healthcare facilities inspectors will lose their jobs and the health care facility inspections will be greatly reduced, state officials said. The proposed fee increases are exponential in some cases, which has caused sticker shock for the facilities. Their lobbyist argues that the state, not the businesses, should bear the financial weight of protecting the public. "This amounts to what somebody calls a 'sick tax,'" said Charles Perry, president/CEO of the Nevada Health Care Association, the lobbying group for long-term care facilities.
Full Article

HCBS Reductions? What Advocates Can Do

Steve Gold's Information Bulletin # 324  (9/2010)

Has your State threatened to cut back or reduce Medicaid-funded home and community-based services ?  Has your State actually reduced HCBS Medicaid services?  What impact will these reductions have on people remaining in the community?

What can advocates do about these reductions?  What should CMS do? In addition to how the ADA and integration will be impacted if the reductions are implemented, another handle is the Medicaid statute itself?

To receive federal Medicaid funds, a State must have a written state plan that has been submitted to and approved by the Secretary of the U.S. Dept of Health and Human Services.  CMS posts state MA plans and amendments at www.cms.gov/medicaid/stateplans/

State MA plans must be amended to reflect changes in federal policy, Court decisions, and "material changes" in policy, state law, or operation of the program. 42 Code of Federal Regulations ' 430.12.  Proposed State plan amendments must be submitted to the CMS regional office which must "consult with central office staff on questions regarding application of Federal policy." 42 C.F.R ' 430.14.  CMS must make a "determination as to whether State plans (including plan amendments and administrative practice under the plans) originally meet or continue to meet the requirements for approval are based on relevant Federal statutes [including the ADA] and regulations."  42 C.F.R ' 430.15.

Hmmm.  The United States Supreme Court in 1999 in the Olmstead decision found that unnecessary segregation in institutions violated the ADA - sure sounds like a Court decision.  CMS has issued several "Dear State Medicaid Director" letters telling states that their State plans must comply with both the Medicaid and the ADA statutes, and these letters sure look like federal policy. Therefore, when your State proposes reductions in HCBS, advocates must analyze what impact the reductions will have on causing or preventing unnecessary segregation. 

Advocates must ensure that CMS will disapprove the amendments based on Olmstead and its own policy requiring compliance with the ADA.

Advocates for older and younger Americans with disabilities should:

1.  Find out if your Governor has reviewed the proposed amendments, a Medicaid requirement for State plan amendments?

2. Contact your regional CMS officials and obtain copies of documents between your State and CMS regarding the amendment.

3. Unbelievably, there is no requirement for public hearing or even an opportunity for public comment.  Nevertheless, each State has a Medical   Care Advisory Committee that reviews and comments on proposed changes.    Get to them and make your voices heard.

4.  Send your comments to the CMS regional office AND to the Secretary of   HHS.  Tell them how the amendments will impact on people unnecessarily   being institutionalized.

Thanks very much to the National Health Law Program for their invaluable suggestions and observations, many of which are the basis for and incorporated in this Information Bulletin.

Steve Gold, The Disability Odyssey continues

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Related articles by Zemanta

• Medicaid costs to blow hole in state budgets (money.cnn.com)
• States face Medicaid challenge (politico.com)
• Medicaid list grew 9 percent last year (dispatch.com)
• Medicaid cuts in state 'devastating' (theolympian.com)

Retirement age strikes hit France again | BreakingNews.ie

Image by BWJones via FlickrFrench commuters squeezed on to limited public transport and fought for rare parking spots today as a second round of strikes against President Nicolas Sarkozy's plan to raise the retirement age from 60 to 62 hobbled trains, planes and schools across France.

Union leaders are hoping for a massive show of popular discontent at the 232 demonstrations planned throughout the country, and are aiming to top the turnout of September 7, when at least 1.1 million people took to the streets to protest against the planned overhaul of the deficit-burdened pension system.

As baby boomers reach retirement age and life expectancy increases, the government insists it is necessary to raise the retirement age so the pension system can break even by 2018.
Full Article

New Fiscal Year Brings More Grief for State Budgets, Putting Economic Recovery at Risk — Center on Budget and Policy Priorities

Image by dj @ oxherder arts via Flickr

By Erica Williams, Phil Oliff, Ashali Singham and Nicholas Johnson

Dismal state revenue collections caused by the severe recession are setting the stage for a new round of state budget cuts as fiscal year 2011 begins in most states on July 1. The states’ cumulative budget shortfall will likely reach $140 billion in the coming year, the largest shortfall yet in a string of huge annual gaps that date back to the beginning of the recession. Closing it will have severe effects on services and jobs.

In many states, the new fiscal year will bring immediate cuts to programs and services that are facing unprecedented demand. As of July 1, 10,000 families in Arizona will lose eligibility for temporary cash assistance; Georgia will lay off as many as 284 workers who help low-income families enroll for food stamp, Medicaid and TANF benefits; and Kansas will cut off nearly 2,800 individuals with a disability from independent living services. Education, health care, and other priority areas will also face new cuts in the coming fiscal year — on top of extensive cuts that at least 45 states have enacted over the last two years.

States are raising taxes as well for 2011. Effective July 1, Kansas and New Mexico increase their sales taxes; Hawaii, New Mexico, New York, South Carolina, and Utah increase their tax on tobacco products; Washington begins taxing soda, and Oklahoma is temporarily suspending various business and energy tax credits. Other changes have already taken effect or will take effect later in fiscal year 2011. Since 2008, more than 30 states have raised taxes or tax-like fees.

Separate and apart from dismal revenue collections, the budget situation for states just got worse. Last week, the U.S. Senate failed to pass jobs legislation that would have extended an enhanced federal match for the Medicaid program that 30 states were counting on to balance their budgets. Without these funds, states will make even deeper spending cuts and more tax increases than previously planned.
These state actions, while necessary to meet state balanced-budget requirements, will nevertheless slow the economic recovery and raise the risk that the nation will fall back into recession as the loss of Americans’ spending power ripples through the economy. States’ actions to close their $140 billion gap without more federal aid could cost the economy up to 900,000 public- and private-sector jobs.

Continue Reading

Related articles by Zemanta

• Fiscal 2011 could be hardest yet for states (reuters.com)
• Editorial: Bad News Back Home (nytimes.com)
• Gov. Patrick signs $27.6B 2011 Mass. state budget (seattletimes.nwsource.com)
• Ariz. Lawmaker: Cuts a Must Without Stimulus Cash (abcnews.go.com)

Medicaid Expansion in Health Reform Not Likely to “Crowd Out” Private Insurance — Center on Budget and Policy Priorities

By Matt Broaddus and January Angeles

Contrary to claims by some critics, the Medicaid expansion in the new health reform law will overwhelmingly provide coverage to people who otherwise would be uninsured, rather than shift people who already have private coverage to Medicaid.

Under the new law, beginning in 2014 Medicaid will cover non-elderly individuals with incomes up to 133 percent of the federal poverty line — about $29,000 for a family of four.[1] The Congressional Budget Office (CBO) estimates that by 2019, 16 million more adults and children will enroll in Medicaid and gain access to affordable coverage as a result.

Some critics claim that a large share of the insured individuals who become eligible for Medicaid will drop their existing employer or individual market coverage and instead enroll in Medicaid. This claim does not withstand scrutiny: there has been only modest substitution of public for private coverage, or “crowd-out,” in similar state-level expansions of public programs in the past.[2]

• In states that have raised Medicaid income eligibility limits to levels similar to those under health reform, the shares of low-income residents who have private coverage are virtually identical to the shares in states that have not expanded Medicaid coverage.
• An extensive body of research finds that among low-income children enrolled in Medicaid, the proportion that previously was privately insured is between 10 percent and 20 percent, nowhere near the 48 percent rate assumed, for example, in a dubious analysis commissioned by the state of Indiana that some health reform critics have cited (see below).
• The vast majority of low-income individuals who will become eligible for Medicaid under health reform do not have access to affordable private health insurance coverage.

Continue Reading

Download Report PDF

U.S. GAO - Nonprofit Sector: Treatment and Reimbursement of Indirect Costs Vary among Grants, and Depend Significantly on Federal, State, and Local Government Practices

GAO-10-477 May 18, 2010

Nonprofits are key partners in delivering federal services yet reportedly often struggle to cover their indirect costs (costs not readily identifiable with particular programs or projects). This raises concerns about fiscal strain on the sector. To provide information on nonprofits' indirect cost reimbursement, especially when funding flows through entities such as state and local governments, GAO was asked to review, for selected grants and nonprofits, (1) how indirect cost terminology and classification vary, (2) how indirect costs are reimbursed, and (3) if gaps occur between indirect costs incurred and reimbursed, steps taken to bridge gaps. GAO selected six Departments of Health and Human Services and Housing and Urban Development grants and 17 nonprofits in Louisiana, Maryland, and Wisconsin. GAO selected these agencies for their historical relationship with nonprofits. GAO reviewed policies and documents governing indirect costs and interviewed relevant officials. GAO also reviewed research on nonprofits' indirect costs.
Continue Reading

50 New York City Senior Centers Expected to Close - NYTimes.com

Image via CrunchBase

By DAVID W. CHEN

Convinced that the deteriorating budget situation in Albany leaves it no other choice, the Bloomberg administration plans to close as many as a quarter of the city’s more than 300 senior centers by July 1, with Manhattan being hardest hit.

Lilliam Barrios-Paoli, the commissioner of the Department for the Aging, said in an interview on Thursday that 50 senior centers would definitely be closed — selected largely on the basis of three criteria: the fewest meals served, the fewest hours open and the most maintenance or management problems. She also said another 25 centers would be notified soon that they could be closed on July 1 if the city received less money from Albany than it currently anticipates.


Continue Reading

SAMHSA’s Weekly Financing News Pulse: State and Local Edition April 21, 2010

Image via Wikipedia

Alabama Legislature Approves Budget, Medicaid and CHIP Funding Maintained

On April 13, the Alabama House of Representatives and Alabama Senate approved a $1.6-billion general fund budget for state agency operations that maintains Medicaid and Children's Health Insurance Program (CHIP) funding at their current levels. The budget relies on a $197-million Federal extension of American Recovery and Reinvestment Act funding that Congress has not yet approved.

Michigan's Shiawassee County Considers Bond Issue To Refinance CMHA

The Shiawassee County Board of Commissioners is considering putting together a bond issue to refinance the Community Mental Health Authority (CMHA) facility. The proposal under consideration requires the board to issue bonds and use the proceeds to acquire CMHA's facility, which it would then lease to CMHA. CMHA would make payments equal to the amount of debt service on the county's bonds for 23 years, at which point the bonds would be paid off and CMHA would take back control of the title from the county. CMHA would be responsible for all costs and maintenance of the building for the duration of the lease. The CEO of CMHA says that the plan would save them $15,000 annually.

Nevada Governor Agrees To Allocate Funds To Prepare for Medicaid Expansion

On April 14, Governor Jim Gibbons (R) agreed at a Nevada Board of Examiners meeting to spend $279,119 in state funds to establish a planning unit to prepare for the expansion of Medicaid in 2014. Nevada currently only allows families with incomes up to 100 percent of the Federal Poverty Level (FPL) to enroll in Medicaid, but under the Patient Protection and Affordable Care Act, adults without children will become eligible for Medicaid and the income eligibility expands to up to 133 percent of the FPL. The funds will allow Nevada Department of Health and Human Services Director Mike Willden to hire staff and a consultant to determine how much additional staff and funding will be necessary for the state to comply with the new requirements. Willden projects that under the new law, Nevada will add 150,000 to the 260,000 currently on its Medicaid rolls.

Virginia Governor Proposes Budget Amendments on Mental and Substance Use Treatment

Governor Bob McDonnell (R) proposed two budget amendments that would affect behavioral health treatment in Virginia. The first would authorize the expansion of the state's Medicaid managed care program to cover community mental health and substance abuse services and residential treatments. The second would add behavioral health drugs to the Medicaid Preferred Drug List, a proposal that legislators rejected under previous administrations. Lawmakers will vote on the measures on April 21. To continue reading these articles and see all articles included in this week's State and Local Financing News Pulse
Click Here

Obscure New York Budget Proposal Threatens Senior Centers - NYTimes.com

By DAVID W. CHEN

The Bloomberg administration is scrambling to come up with contingency plans to close as many as one-fifth of the city’s 321 senior centers after being caught off guard by an obscure state budget proposal that would slash the centers’ financing by nearly 30 percent.

Describing what the loss of state money would mean for the centers, Lilliam Barrios-Paoli, the city’s commissioner at the Department for the Aging, was blunt. “Catastrophic,” she said.

Only in the last couple of weeks have city officials and advocates for the elderly become fully aware of Gov. David A. Paterson’s decision because it was not the typical budget reduction that becomes part of the annual jousting between Albany and New York City.

Instead, the proposal would alter an arcane formula and redirect $25 million in federal money that has traditionally been set aside for senior centers toward state programs to combat domestic violence and elder abuse.
Continue Reading

STATE AND LOCAL GOVERNMENTS’ FISCAL OUTLOOK

Image via Wikipedia

What GAO Found
The state and local government sector continues to face near- and long-term fiscal challenges which grow over time. Although the sector’s near-term operating balance remains negative, increases in federal grants-in-aid—largely from the Recovery Act—alleviated some near-term pressure. As shown in the insert to the figure below, the March 2010 operating balance measure (including 2009 Recovery Act funds) shows an improvement compared to the January 2009 simulation. In the near-term, the sector’s fiscal position can be attributed to several factors, including steep revenue declines.

GAO projects that the sector’s long-term fiscal position will steadily decline through 2060 absent any policy changes, as shown in figure 1. The decline in the sector’s operating balance is primarily driven by rising health care costs. The fiscal challenges confronting the state and local sector add to the nation’s overall fiscal difficulties. Because most state and local governments are required to balance their operating budgets, the declining fiscal conditions shown in GAO’s simulations suggest the fiscal pressures the sector faces and the extent to which these governments will need to make substantial policy changes to avoid growing imbalances.
Read More

States' Retiree Benefits Underfunded By At Least $1 Trillion

From Medical News Today

State governments' retiree pension and health plans are severely underfunded, according to a new report from the Pew Center on States.
Continue Reading

Related articles by Zemanta

• THE TRILLION DOLLAR GAP: A Pew Report on State Pension Systems. "Forty states were classified as n... (pajamasmedia.com)
• States Face Huge Retiree Medical Shortfall (businessweek.com)
• Illinois' Pension Liability Worst In Nation, Could Sink State Economy (huffingtonpost.com)
• States Sink in Benefits Hole (online.wsj.com)
• States Face a $1 Trillion Shortfall for Retirees (dailyfinance.com)

SAMHA Financing News Pulse: State and Local Edition

Image via Wikipedia

Inside This Issue

Georgia DBHDD Hires Consultant To Improve Mental Health System, Avoid Federal Takeover

Stemming from U.S. Department of Justice (DOJ) investigation of Georgia’s mental hospitals, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) hired an independent consultant to help improve the state’s mental health system and avoid a costly Federal takeover. DBHDD will pay Dr. Nirbhay Singh and his associates up to $3.5 million for 1 year of consulting and training services beginning October 2009. DBHDD also retains the option to extend Dr. Singh’s contract for several years. The DOJ has already requested an independent overseer for the state’s mental health services.

Update: Tennessee DMHDD Faces $9.4 Million in Cuts

As a result of Governor Phil Bredesen’s (D) proposed budget, the Tennessee Department of Mental Health and Developmental Disabilities (DMHDD) is facing a $9.4 million budget cut. The governor’s proposed Medicaid cuts compound direct DMHDD funding reductions, though DMHDD officials note that it is difficult to project the effects of the Medicaid cuts until the Centers for Medicare & Medicaid Services officially approves the changes. Under the proposed budget, DMHDD will preserve $21.5 million to fund the Behavioral Health Safety Net, which provides mental health services to severely mentally ill residents who do not qualify for TennCare, the state’s Medicaid program.

New Mexico House Rejects Bill Allowing Judges To Sentence Drug Offenders to Treatment

On February 12, the New Mexico House rejected the Substance Abuse and Crime Prevention Act (HB 178) that would have allowed judges to sentence drug-involved offenders to substance abuse treatment rather than jail. Under the rejected bill, the offender would pay for treatment and the state could pursue charges if the offender failed to complete treatment. Proponents of the bill argue that it would have saved New Mexico $22 million annually.

To continue reading these articles and see all articles included in this week’s State and Local Financing News Pulse, download the complete issue.

Related articles by Zemanta

• Focus on Georgia's Mental Health Crisis (psychcentral.com)

Perdue's hospital tax strongly opposed | ajc.com

Image via Wikipedia

By Craig Schneider

Several key lawmakers say Gov. Sonny Perdue’s plan for a hospital "bed" tax -- to help fund a $608 million shortfall in Medicaid -- is going nowhere fast. They say they won't support a new tax that could add to the burden of already struggling hospitals and possibly raise medical costs for patients.
But that hardly ends the discussion.

Several proposals are swirling around: the hospital bed tax, a higher tax on tobacco, a Medicaid rate cut, and good old-fashioned spending cuts. For Georgians, the result could mean paying a dollar more for a pack of cigarettes, or seeing a decrease in state services, or seeing their medical costs rise as hospitals and doctors pass on the pain.

Continue Reading

A Balanced Approach to Closing State Deficits — Center on Budget and Policy Priorities

By Iris J. Lav

As states head into their third year of fiscal crisis most continue to face severe revenue shortfalls that require closing huge deficits. [1] As states prepare and consider budgets for the fiscal year that begins July 1, 2010 in most states, the choices they make about how to close those deficits have serious implications both in the short and long term. States that rely solely or primarily on widespread budget cuts to close deficits are harming residents and businesses that need immediate assistance; they also are reducing demand in the economy and impeding their state’s economic recovery.

Projections suggest that states collectively will need to close over $140 billion in deficits — beyond the federal funding being provided through the recovery legislation enacted in February 2009 to help states support education, health care, and other programs. If states were to close the entire $140 billion in deficits with budget cuts, the economy could lose as many as 900,000 jobs.[2] While there might not be any perfect choices for closing deficits in a recession this deep and long, it is clear that a balanced approach — rather than one that relies heavily or exclusively on spending cuts — is useful in mitigating the damage.

There are options available to states outside of the often cited “either-or” framework of tax increases and spending cuts. And while tax increases and spending cuts are important components of a balanced approach, how they are structured is critical for both residents and the state economy. This report examines seven components of a balanced approach to dealing with state deficits. They are:
Continue Reading

Download the Full Report (19 pages)

Related articles by Zemanta

• Gregoire signs 3 bills that save state money (seattletimes.nwsource.com)
• White House 'Projects Record US Deficit' (news.sky.com)
• Fiscal Red Alert (andrewsullivan.theatlantic.com)

Calif. Budget Cuts Will Hit Adult Day Care Centers, Prison Health Care; Texas And Kansas Weigh Medicaid Cuts

from Medical News Today

The Los Angeles Times, on adult day care centers in California: "Under the most recent cost-saving budget proposals, 327 adult day healthcare centers throughout California would be eliminated. Cuts could save the state $135 million in fiscal 2011, state projections show. But advocates and center operators said care for many of the 37,000 low-income participants -- who suffer from diabetes, brain injuries, dementia and other chronic conditions -- would cost the state even more money if the centers close. More than 40% of participants would end up in nursing homes, said Lydia Missaelides, executive director of the California Assn. for Adult Day Services. Others would be hospitalized" (Gorman, 2/11).

Continue Reading

Podcast: The ABCs of State Budgets - Center on Budget and Policy Priorities

In this podcast the ABCs of state budgets, and the problems that many states face today because of the recession will be discussed.

02-09-10-state-budget-process-final.mp3 (audio/mpeg Object)

Governors’ 2011 Budgets Propose New Round of Cuts — Center on Budget and Policy Priorities

As states begin preparing for the third year of a fiscal crisis brought on by the recession, governors’ new budget proposals contain cuts to core services — like education and health care — and state workforces well beyond those they have already made, according to a new report from the Center on Budget and Policy Priorities. The proposals threaten to increase hardship and unemployment and weaken the economy by reducing overall demand.

Nearly half the governors have now submitted their budget proposals for the upcoming 2011 fiscal year, which begins on July 1, 2010 in most states. Due to the recession, states are already projecting a combined budget gap of $102 billion for the upcoming fiscal year, and that figure is likely to reach $180 billion.

“It will be harder than ever this year for states to balance their budgets without inflicting serious harm on vulnerable residents and the state economy,” said Nicholas Johnson, the Center’s Director of State Fiscal Policy and co-author of the report. “States will need to take a balanced approach that includes revenues, because these shortfalls are too big to close with cuts alone.”

Education, Health Care, Help for Poor and Disabled Among Proposed Cuts

While state legislatures must approve (and may significantly change) the governors’ proposed cuts, the new budgets demonstrate the scale of cuts that are likely to be needed, the report notes. They include:

* Arizona: cancellation of health coverage for 310,000 low-income childless adults and 47,000 low-income children, elimination of cash assistance for 10,000 poor families, and elimination of the Department of Juvenile Corrections.
* California: a $1.5 billion cut in K-12 and community college education funding, elimination of the state’s welfare reform program, and large Medicaid cuts.
* Hawaii: elimination of a program that provides financial assistance to poor seniors and people with disabilities, and layoffs for 1,200 state workers.
* New York: a $1.1 billion cut in K-12 education and $1 billion in cuts to payments for health care providers.
* Mississippi: a 9 percent cut in K-12 funding and a 12 percent cut to most agencies’ budgets.

Continue Reading