Transcript How the budget and Budget Repair Bill Supports for People

Barbara Beckert
Disability Rights Wisconsin, Milwaukee Office Director
March 4, 2013
Disability Rights Wisconsin is the federally mandated
protection and advocacy agency for people with
disabilities in Wisconsin, designated by the Governor to
protect the rights of people with disabilities. DRW helps
people with disabilities across Wisconsin gain access to
services and opportunity through our advocacy and legal
expertise. DRW also provides training and promotes
positive legislative policy for people with disabilities.
www.drwi.org
• Last biennium: WI faced a $3.6 billion budget deficit, resulting
in significant cuts in the 2011 – 2013 biennial budget.
• Now: WI has a budget surplus expected to grow to $484
million, per LFB estimates.
• Gov. Walker’s Budget Priorities:
Creating jobs, developing our workforce, investing in
infrastructure, transforming education and reforming
government.
• February: Governor’s 1,093 page budget bill was
introduced to legislature as Assembly Bill 40.
• March: Non-partisan LFB provides detailed analysis.
• Feb. – April: Bill referred to JFC which holds public
hearings around the state, and votes to approve or
modify the Governor's proposals.
• May: Sent to Assembly and Senate for approval/
Conference Committee if needed.
• Late June: Governor reviews & signs budget; possible
vetoes.
• Late June: Possible veto overrides by the Legislature.
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Medical Assistance, BadgerCare – $650 million
Transportation Fund – $103 million GPR + bonding
Income Tax Cut – $343 million
K-12 Schools – $129 million (but equals ZERO net increase for
the 870,000 school students)
K-12 Schools – Performance Awards - $64 million
Voucher Schools – $73 million for 30,000 students
UW System – $130.7 million
Technical Colleges – $5 million
Venture Capital – $25 million
• $3.7 million in Coordinated Service Teams. (CST)
• $10.2 million in Comprehensive Community Services
(CCS) Kenosha already certified
• $1.3 million in Peer Run Respite Centers.
• $535,000 in children’s mental health – Creates Office
of Children’s Mental Health
• $524,000 in In-home counseling for children
• $12.5 million in Forensic Treatment units at Mendota
Mental Health for two additional inpatient units.
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In CY 2011, 26 counties offered CCS programs and 1,469 consumers were served statewide.
CCS is a community based program, many services are provided in home and/or community.
Typical outcomes for CCS consumers are reduced psychiatric hospitalizations, improved primary
health care outcomes, improved familial and social relationships, access to meaningful
employment, and improved reports of overall life satisfaction.
CCS is unique in that each county identifies a different array of behavioral health services
based on local resources and need. Typical CCS service plans include a mix of access to and
maintenance of psychiatric medication, counseling and supportive education, mental health
psychotherapy, and case management services. The program also allows for residential
services and other evidence-based mental health and substance abuse treatments.
The budget proposal reimburses counties for both the non-federal share and the federal share
of all eligible CCS costs if provided on a regional basis approved by the Department. The
budget assumes expansion of CCS to all counties in the 2013-15 biennium
DHS-DMHSAS believes regional service systems offer efficiencies that will assure the CCS
benefit is accessible to all eligible consumers in the state.
• Coordinated Service Teams are wraparound models
of care for children with behavioral health issues.
• CST is targeted to children and families involved in
two or more systems of care (such as mental health,
long term care, juvenile justice, child welfare, substance
abuse or special education) who have complex needs.
• Counties or tribes may operate a CST.
• Currently there are 44 programs that receive some
state funding support.
• 764 children were served by CST programs/average enrollment of 11.6 months.
• Primary referral sources: child welfare systems (30%), mental health systems (24%),
school systems (18%), and direct referral from families (17%).
• Outcomes were reported on 241 children discharged during 2011:
• 85% had no reported school suspensions or expulsions
• 79% had no involvement with juvenile justice
• Children rated as a danger to others decreased from 44% at enrollment to 17%
at discharge
• The percentage of children with permanent and stable relationships with parents
or other adults increased 21% from enrollment to discharge
• 72% of children had school performance with grades of C or above at discharge
• This proposal includes changes in statutory language to allow CST services to be
offered in regional service delivery systems; the regional service structure is
permissible, not required.
• Peer based services are delivered by people who have been successful in
the recovery process; these people embody a powerful message of hope, as
well as a wealth of experiential knowledge.
• Peer run respite services are an innovative programming concept. The
services are provided in community based residential settings that offer a
small number of beds (typically 5-8 beds) to people facing a crisis or those
having difficulty coping with mental illness.
• Provider systems and mental health advocacy organizations worked with
DHS to research the development of peer run respite centers.
• A number of states (AZ, CA, GA, NE, NY) have developed peer based
respite centers.
• DMHSAS envisions the peer respite services to be a “step-down” from crisis
stabilization sites.
• Length of stay in peer run respite programs is brief, typically 3-5 days.
• Peer respite centers should work in close collaboration with law
enforcement and mental health crisis services and serve in the
continuum of crisis programming.
• Peer respite services typically offer services beyond respite to
include: peer supports, 24/7 warm lines, wellness activities.
• DMHSAS anticipates three peer respite centers would be
developed across the state. The centers would be designated
to serve regional areas.
• DMHSAS will work with Division of Quality Assurance (DQA) to
determine applicable licensing or certification requirements.
• Family Care expansion not included.
• 15 counties still do not have Family Care/IRIS; some are ready
to come into the system.
• 1600 people continue to wait for daily supports.
• There is a budget initiative to triple the # of individuals who
self-direct their LTC services.
• For the 2nd biennium in a row, no new long term supports
funding for children with significant disabilities.
• There are approximately 3000 children and youth with
significant disabilities and their families waiting for long term
support.
• Note: An additional $5 million GPR per year would reduce wait
lists by 1,000 per year.
Background on Medicaid Expansion Under the ACA
• Under the federal law, states may receive funding to provide
coverage for adults whose incomes do not exceed 133% of the
federal poverty level. If Wisconsin were to expand coverage, the
Federal Government would cover 100% of the cost of insuring the
additional adults through 2016. Beginning in 2017, the Federal
Government’s share of the Medicaid costs reduces from 100% to
95%, and by 2020 the Federal share will drop to its permanent level
of 90%.
• The plan presented by the Governor would forgo the Federal funding
to cover adults with incomes up to 133% of poverty. It eliminates
coverage for parents currently covered by BadgerCare whose
incomes are above the poverty line.
• Adds about 80,000 childless adults below the poverty level
• Ends coverage for about 89,000 parents and 6,000 childless adults above the
poverty level
• Moves those adults into the new insurance exchange, where cost-sharing will be
much higher and many are likely to become uninsured
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• Cost neutral in the 2013-15 budget, according to DHS
• Preliminary Fiscal Bureau analysis concluded that expanding coverage to
childless adults below 133% of poverty would cost the state far less and cover
far more people – by utilizing federal health care reform $s.
• Option that would cover childless adults to that level and would limit parent
coverage to 133% could save as much as half a billion dollars from 2014
through 2020.
• Aging and Disability Resource Centers: increased
funding ($295,900 GPR in FY 15) to reflect a
reestimate of ongoing costs for ADRCs.
• SeniorCare: Reestimates SeniorCare costs to reflect
changes in caseload and the cost and utilization of
prescription drugs. He proposes a reduction of
$10,196,400 GPR in FY 14 and a reduction of
$9,307,300 GPR in FY 15.
• MAPP is a Medicaid program that provides Medicaid to people
who have been found “disabled” by SSA or Medicaid but have
income or assets that are too high for traditional EBD Medicaid.
• There are three primary eligibility requirements for MAPP:
(1) a disability determination;
(2) income that is below 250% of FPL and countable assets
below $15,000; and
(3) the person meets the work requirement. MAPP is premium
free if the person has gross income below 150% of FPL. For
people that are receiving large SSDI checks, the MAPP premium
is often prohibitively high.
• Can currently meet work requirements by performing in-kind
employment that does not require that person receive a formal
pay check. The Budget bill requires the person to be working
at a job that requires withholding of Social Security and
Medicare taxes. This will eliminate MAPP as an option for
people whose disability is so significant that working in formal
employment arrangement is not possible.
• Currently people with large unearned income such as SSDI may
have a premium under MAPP that is prohibitively high. The
Budget Bill changes the way unearned income is treated for
premium calculations. The changes will reduce the premiums
significantly for people with large SSDI checks.
• Medigap Helpline: The Governor recommends increasing
($37,100 in FY 14 &$13,100 in FY 15) expenditure authority
to create a Medigap Helpline database to replace the current
obsolete system and improve the efficiency of Helpline
operations. The Medigap Helpline provides assistance to the
elderly with questions about all types of health coverage,
including Medicaid, Medicare and private health insurance.
• Ombudsman Relocation Specialist: The Governor recommends
funding the relocation ombudsman position with general
purpose revenues ($81,500 in each year of the biennium) to
replace program revenues, which are no longer available for
this purpose.
• The Governor recommends additional funding to increase the
amount of job training and employment assistance services
provided to individuals receiving FoodShare including providing
job training and employment assistance services to
approximately 38,000 recipients.
• "Able-bodied adults" without dependents (ABAWDs) will be
limited to 3 months of FoodShare in a 36-month period if they
do not meet work or job training requirements. It is not clear
how "able bodied" is defined and how this might impact people
with disabilities who do not meet that definition. There is very
little information about what type of job training and
employment assistance services will be provided.
• No increase in special education categorical aids from the last
biennium; will result in a cut based upon estimated cost
increases.
• Over the last two decades, the state’s share of special
education funding has dropped from 44% to 26%.
• No increase in the high cost fund for 7th consecutive year. It was
intended to provide relief to support the education of students
with the most significant disabilities – with a promise to
reimburse a district at 90% of costs above $30,000/student –
the state’s support to these districts is expected to drop to 40%
in 2014.
• $21 million in funding for special needs vouchers to be used in
private schools anywhere in the state.
• Funding “follows the student” and comes directly out of
neighborhood public school budgets, negatively impacting the
students with disabilities who remain in those districts.
• Private school can choose who they serve. Students with the
most significant needs are likely to remain in public schools
which will have reduced funds to serve them.
• Parents and students lose special education rights and any
guarantees to special education or related services such as
therapies, assistive technology and access to qualified staff.
• The Governor proposes funding Transit operating aids from the
General Fund, rather than the Transportation Fund, beginning in
fiscal year 2014-15.
• Advocates and the Commission on Transportation Finance &
Policy urged keeping Transit in the segregated Fund which
provides greater stability and protects this revenue which is so
essential to economic development and access to jobs. If moved
to the General Fund, transit will compete with other critical
program priorities and at much greater risk for cuts.
• Protecting transit funding and maintaining transit services is
essential to the independence of people with disabilities, older
adults, and direct care workers.
• Continue funding transit operating at the current level, which continues a
10% cut that was implemented in the previous budget. (a reduction of $11.8
million statewide, $6.8 million for Milwaukee Co.)
• Specialized transit 85.21 funding continues at current levels.
• The new segregated paratransit program 85.205 created in the last
biennial budget will continue to be funded at $5 million for the biennium
statewide.
• There are no funds to address the 2% - 3% annual inflation for transit
operating costs, mostly fuel
• There is no mention of Regional Transit or Transportation Authority
• There is no mention of a transit capital program to replace the federal
programs that were eliminated in the new federal transportation bill, MAP21.
• $500 million to continue construction of the Zoo Interchange project (on accelerated
path)
• $50 million to support continued reconstruction of the I-94 North-South Corridor,
between the Mitchell interchange and the Illinois border
• $236 million for the reconstruction of the Hoan Bridge and I-794 freeway
• $80.8 million increase to preserve pavement quality throughout the state
• 38.4 million above the base to address highway expansion needs.
• $55 million for increased funding for routine maintenance agreements w/counties
• $2.7 million for two new state patrol recruiting classes and $3.8 SEG
• $10.7 million in bonding authority for the Harbor Assistance Program
• $60 million for the Freight Rail Preservation Program over the biennium.
• Realign federal funding to consolidate Transportation Enhancement Activities, Bicycle
and Pedestrian Facilities, and Safe Routes to School federal appropriations into a
single Transportation Alternatives appropriation.
• $200 million in general fund supported bonds to support the
accelerated Zoo interchange. Debt service on the general fund
supported bonds will be partially supported by the sale of
surplus government property
• $70 million over the biennium to continue to deposit 0.25
percent of all general fund revenues into the Transportation
Fund (instituted in last state budget)
• $23 million one-time transfer from the general fund to the
Transportation Fund
• $32 million in Petroleum Inspection Fund revenue transfer
• $106 million per year in transit operating aids transferred to
the general fund beginning in fiscal year 2014-15
• The Commission is working with City of Racine and Racine
County to prepare a short-range, five-year public transit plan.
• http://www.sewrpc.org/SEWRPC/Transportation/TransitDevelo
pmentPlans/RacineCounty.htm
• Public meetings: Tuesday, March 5, in Burlington and
Wednesday, March 6, in Racine.
• Options include an alternative system for the City’s Belle Urban
System (BUS), to make the BUS more efficient by combining and
realigning poor-performing routes. Also potential service
improvements and expansion or potential service reduction
alternatives – all dependent on funding.
• LogistiCare is not submitting a bid due to financial concerns.
• Only two companies submitted bids, Access2Care and MTM Inc.
• New contract tentatively expected to be awarded by April
15th.
• An external ombudsman may be added.
• February: Governor introduced budget.
• Feb – March: JFC members study the budget, LFB analysis
becomes available.
• April: JFC hearings.
• April – May: JFC meets in executive session to discuss and
amend the budget.
• May - June: Assembly & Senate each debate & amend the
budget. Differences are addressed by a conference committee.
• June: Conference Report is voted on and goes to Governor for
his signature or vetoes.
• July: Legislature can override Governor’s vetoes with 2/3 vote.
What you can do to make
your voice heard
1. Develop relationships w/your legislators and
policy makers. Share your views and stories
regularly – follow up.
2. Write letters to the editor
3. Participate in Madison Advocacy Day, JFC
hearings, DHS Town Halls, etc.
4. Work in coalition with other advocates.
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Board for People with Developmental Disabilities
Disability Rights Wisconsin
Michael Blumenfeld and Associates
Transit Now
Wisconsin Council on Children and Families