Monday, November 19, 2018

Michigan 2018: Making Sense of the political landscape for people with disabilities, Part 1

Alan Bolter, Associate Director of the Community Mental Health Association of Michigan (CMHAM), gave a presentation on 11/15/18 at a Town Hall meeting of the Washtenaw County Community Mental Health Association. A Power Point of his talk, “Looking Back, Looking Forward and How to Make Sense of it All” is available on-line. Here is a sampling of the topics he discussed: 

The 2018 Election

Democrats flipped ALL state constitutional officers (first time since 1938 one party flipped all statewide offices in a single election)
  • Governor – Gretchen Whitmer (D) 
  • Lt. Governor – Garlin Gilchrist (D) 
  • Secretary of State – Jocelyn Benson (D) 
  • Attorney General – Dana Nessel (D) 
Democrats picked up 5 seats in each legislative chamber

Republicans retained their majority in the State House of Representatives by a margin of 58 – 52 (currently the margin is 67 – 43).

Republicans retained their majority in the State Senate by a margin of 22 – 16 (currently the margin is 27 – 11).

All three ballot proposals were approved by voters (marijuana, gerrymandering, easier voting)

U.S. Senator Debbie Stabenow won re-election.

Democrats picked up 2 Congressional seats. Democrats Elissa Slotkin (D-8th) and Haley Stevens (D-11th) won their congressional races flipping two seats previously held by Republicans.

Democrats have won majorities on all statewide elected education boards, including the State Board of Education.

This is the first time in 16 years that the Governor in Michigan will have legislative experience.

2019 Michigan Legislative Leaders

Senate Republicans

  • Majority Leader: Senator Mike Shirkey 
  • Majority Floor Leader: Senator Peter MacGregor 
  • Appropriations Chairman: Senator Jim Stamas (appointed not elected) 
House Republicans
  • Speaker of the House: Rep. Lee Chatfield (R-Levering) 
  • Majority Floor Leader: Rep. Triston Cole (R-Mancelona) 
  • Speaker Pro-Tempore: Rep. Jason Wentworth (R-Farwell) 
Senate Democrats
  • Senate Minority Leader: Jim Ananich 
  • Senate Minority Floor Leader: Stephanie Chang 
  • Minority Vice Chair, Appropriations Committee: Curtis Hertel 
House Democrats 
  • House Minority Leader: Christine Greig 
  • House Minority Floor Leader: Yousef Rabhi 
Committee assignments will not be announced until late January/early February.

The 2018 Lame Duck Session

A Lame Duck session occurs when one legislature meets after its successor is elected, but before the successor’s term begins.

The Michigan Lame Duck session runs from November 27 - December 20 (4 weeks/12 session days.)

Why Lame Ducks are dangerous:

  • The Legislative process is in fast forward 
  • Condensed timeframe so things move quickly, in many cases little if any public participation of legislation (committee / public meetings) 
  • Bills do not have to go through the committee process, can get referred right to House or Senate floor. 
Three most important numbers 56, 20 , & 1 (votes needed to pass a bill). 

Article IV, section 26 of the Michigan Constitution states: No bill shall be passed or become a law at any regular session of the legislature until it has been printed or reproduced and in the possession of each house for at least five days.

A bill’s intent can be completely changed in lame duck as long as it still amends the same section of law…

Possible Lame Duck issues

  • FY19 supplemental budget 
  • Republicans looking for ways to tie Governor’s hand with spending State 
  • Budget Surplus fund 
  • Minimum Wage & Sick Time changes (from legislation passed in September) 
  • Auto No-Fault reform 
  • School Safety Grants - $30 million in FY19 budget 
  • Implementation bills for proposals 1-3? 
(to be continued… )


See also Michigan CMH Facts and Figures 

Sunday, November 18, 2018

Michigan's Community Mental Health System: Facts and Figures

Alan Bolter from The Community Mental Health Association of Michigan (CMHAM) gave a presentation on 11/15/18 at a Town Hall meeting of the Washtenaw Community Mental Health Association (more about that later). He distributed a flyer with basic information about the Michigan Community Mental Health system. It describes what CMH agencies do, how they are funded, and who they serve. The flyer does not appear to be available on the internet, but if it does become available, I will provide a link to the complete document.

These are excerpts from the flyer with a few modifications to make it easier to understand in the way I am presenting it here: 

How Community Mental Health agencies are funded

  • $2.319 billion from “Medicaid Mental Health” 
  • $299 million from “Healthy Michigan” [Michigan’s Medicaid expansion under Obamacare] 
  • $175 million from “Substance Use Disorder” 
  • $192 million from Autism funding 
These funds go to Prepaid Inpatient Health Plans (PIHPs), behavioral health managed care entities. These are the regional administrative agencies that distribute Medicaid funds to local CMH agencies.] PIHPs are responsible for oversight and compliance (Federal & State), Administration, and Utilization Management.

These funds are passed on along with $125 million from the State General Fund [GF] to Community Mental Health Centers and their provider network covering all 83 counties. CMHs are responsible for service provision, coordinating the local service network, and ensuring compliance (Federal & State).

Who Community Mental Health serves

  • Children with Serious Emotional Disturbance [examples: Obsessive-Compulsive Disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD)] 
  • People with Substance Use Disorders [SUD] 
  • People with Developmental/Intellectual Disabilities 
  • Adults with Mental Illness 
Michigan is the only state that serves all 4 populations in a managed care setting.

How the Money is Spent
  • 49% on People with Intellectual/Developmental Disabilities [45,000 people served] 
  • 36% on Adults with Mental Illness [155,000 people served] 
  • 9% on Children with Serious Emotional Disturbance [45,000 people served] 
  • 6% on People with Substance Use Disorders [70,000 people served] 

Other pertinent information

The percentage of dollars spent on actual care in Michigan’s PIHP system has a statewide average of 6% spent on administrative Costs. This is a 94% “medical loss ratio”, an indication that Michigan Medicaid dollars are spent very efficiently for the actual care of the people served.


Community Mental Health Association of Michigan (CMHAM) is a trade association representing the 46 Community Mental Health Boards, 10 Prepaid Inpatient Health Plans, and more than 90 provider organizations that deliver services to adults with Mental Illness, children and adolescents with emotional disturbances, persons with Intellectual/developmental disabilities, and those with substance use disorders in every community across the state. 

Friday, November 9, 2018

VOR Notes on the October 2018 Together For Choice Conference

I was unable to attend the Together for Choice Conference last month and appreciate hearing from others who were there. 

I'll start with the last paragraph of an article from the VOR Weekly News Update for 11/2/18 first. I have toured the Misericordia campus and encourage anyone who wants to find out about the Misericordia community to ask for a tour if they are in Chicago.

"The true highlight of the conference was the guided tour of the Misericordia campus, wherein attendees were shown an amazing array of services, residential models, and employment opportunities. Misericordia is a model for services for individuals with I/DD. Our warmest congratulations to Sister Rosemary and the thousands of family members, volunteers, Direct Support Professionals and donors who have made this facility such a beacon of hope for so many."


from the VOR Weekly News Update for 11/2/18:

Notes on the Together for Choice Conference
Oct. 17 - 19, Chicago, IL

Nearly 200 advocates for individuals with disabilities from 30 states came together for the 2nd annual Together for Choice Conference held at Misericordia, a non-profit organization in Chicago Il. Among them were about a dozen members of VOR. There was a notable lineup of speakers at the conference. Here are just a few:

Sister Rosemary Connelly, Executive Dir. (Misericordia, Chicago Il.) delivered the welcome and opening statements She specifically exposed the “one size fits all” philosophy that has been going on since the 1970’s in which larger facilities are threatened with closure, simply because they are bigger. Sister said: “our purpose is to redefine what community really means. Within that definition, individuals and their families should have choice of where to live, where to work, and who their friends are.” As one of the leaders of Together for Choice, Misericordia led a group of providers, families and self-advocates to D. C. in November of 2017 to meet with their Il. Congressional delegation. One of the self-advocates in the group had previously lived in the larger community, but made the choice to return to a campus setting because she felt isolated. She asked one of the legislators: “How can I make you understand that we are not an institution, we are a community!” Sister Rosemary summed up her comments: “our families asked their elected officials to come and tour Misericordia. When they come, their response is: the bureaucrats don’t like you? You should be a model for the country!” In 2017, due their persistent legislative efforts, Misericordia received a continuum of care license from Springfield.

Melissa Harris traveled by train from her Baltimore office so that she could speak on behalf of Centers for Medicare and Medicaid Services. She told the family members in the audience: “My goal is to answer your questions or take them back and get an answer.” She also said: “you won’t hear from any of us that we know better than you.” Ms. Harris explained the Home and Community-Based Settings Regulation and she left her e-mail for further questions.

Bill Choslovsky gave an inspired presentation on the history of I/DD services from 1960 to present. He spoke of the early progress in development of ICFs and the problems that have arisen since the waiver was introduced. He noted that we should not balk at the definition of an ICF as an institution, that institutions are good, despite how our adversaries debase them. His Olmstead presentation was the centerpiece of his narrative, including Judge Kennedy’s prescient comment, “It would be unreasonable, it would be a tragic event, then, were the American with Disabilities Act of 1990 (ADA) to be interpreted so that States had some incentive, for fear of litigation, to drive those in need of medical care and treatment out of appropriate care and into settings with too little assistance and supervision.” Olmstead, at 610.

Mr. Choslovsky singled out VOR’s Caroline Lahrmann as a shining example of advocacy at its best for her countersuit against Disability Rights Ohio for trying to close down ICFs in her state.

Rodney Biggert, of Seneca Re-Ads Industries, detailed the Kafkaesque persecution initiated by Disability Rights Ohio and the Department of Labor against his company for paying specialized wages under the 14(c) certificate. The judge in this case made some unbelievable pronouncements, including the determination that the workers must be proven “disabled for the work to be performed”, a concept that is literally impossible to prove in accordance with the judge’s own criteria.

Other speakers included Douglass O’Brien, the regional director for the Chicago area for the U.S. Dept. of Health and Human Services , David Axelrod, former campaign adviser to President Barack Obama,and Phil Peisch and Chris Lowther, lawyers who worked with TFC and others in standing up to CMS Settings Rule for the limits it imposes on choice in community settings. Representatives from Noah Homes and the Arc of Jacksonville spoke of their work in building intentional settings that stand up against the “Heightened Scrutiny: requirements of the Settings Rule. Congressman Peter Roksam of Illinois’ 6th Congressional District gave encouragement noting the importance of 1:1 visits to legislators and their staff. He said: “personal anecdotes are powerful; continue to build a network, and get them (the legislators) on campus.”
Patricia Peterson and Hugo Dwyer


See also,

Saturday, October 27, 2018

Michigan's Direct Care Worker Staffing Crisis

Michigan’s Community Mental Health system serves people with intellectual and developmental disabilities, mental illness and substance use disorders. Crain's Detroit Business featured an article on 10/21/18 on the "Staffing Crisis of direct care mental health workers faces clients, families" by Jay Greene. The article covers a Crain’s health summit panel that was chaired by Robert Stein, the general counsel for the Michigan Assisted Living Association (MALA). MALA represents providers of assisted living and similar services including mental health services to people with developmental and other disabilities. [note: direct care workers are also known as Direct Support Professional or DSPs.]

According to Stein, “We have a real crisis with support services to people with disabilities…Wage levels are not competitive with retail companies, fast food restaurants and others. The funding levels have been constrained for many years.”

A MALA survey found “the average turnover rate for agencies providing staff is 37 percent, the starting wage is $10.46 per hour and the average number of open positions for full-time staff is 12 percent, 20 percent for part-time staff.”

Although the legislature “approved $64 million in additional funding in the fiscal 2018 budget to increase the average hourly rate by 50 cents..”, the panel characterized this as a “drop in the bucket”.

The article quotes Robert White, a parent advocate who has two adult sons with autism, as commenting that "Paying [direct service professional] $2 above the minimum wage (of $10 per hour) prevents more people from leaving the system. …We also need a supplemental budget in the lame duck session and future budgets to come [that] must have non-negotiated budget items. We can't kick the can down the road. It is an infrastructure requirement, a civil and constitutional right to have these services like good roads, good education and clean water to drink." [emphasis added]

Here is a quote from State Rep. Christine Greig, D-Farmington Hills, the Michigan House Democratic Floor Leader:

"I get really frustrated by state government and how we fund things,…We talk about integration. We should be talking about great quality care, not about money. You start from an outcomes standpoint. What does the provider, patient need in services. The money flows from that."

[I agree, and I wish more legislators and advocates would support this approach to funding services, rather than promoting the idea that full inclusion in the “community” is the highest and only worthwhile goal of our our system of services.]

The panel also discussed the kinds of things that direct care givers do:

Robert White says in response: ”My older son has high medical needs, 24-7 supervision, in taking the meds he needs, bathing ... nutrition, safety, socialization in the community…The home he is in is currently understaffed. Managers are actively taking shifts. Many caregivers work many shifts. There is mental and physical fatigue, possible errors. It is not their fault. They are truly their lifeline."

John Williams, executive director of Progressive Lifestyles Inc., pointed out that "A lot of staff work two and three jobs. It is unattractive to get involved. …in many cases, it is a very physical job with wide spectrum of disabilities. One day you will lift somebody from a wheelchair to a bed. (The next day) help people move in, repair a stove, fix a washing machine. It's a very demanding job."

According to the article, Stein said MALA and others are “starting a grass roots effort to lobby state legislators to add a line item in the Medicaid supplemental budget that would amount to an increase of 75 cents per hour.”

Wednesday, October 24, 2018

Vote411: Voter information from the League of Women Voters

Here's how to get the information on candidates and ballot issues that you need before you vote on November 6, 2018.

Go to VOTE411 and enter your street address, city, state, and zip code. Up pops your personalized ballot. Click away to find out more about candidates and other issues on your ballot. For example, here is the page that popped up when I entered my address in Washtenaw County, MI. Further clicking revealed my personalized ballot information .

There’s a lot to read, so allow time to study your ballot. 
In addition, here are local Washtenaw County videos of Forums and presentations.  

Two of the statewide ballot proposals on voting and redistricting are especially important. Here is a video presentation about them. 

This is a recorded discussion on Proposal 2, the Redistricting ballot proposal (a.k.a. Voters Not Politicians) that would create an independent citizens commission to draw the lines for legislative districts in Michigan. 

Here is another recorded discussion on Proposal 3 that seeks to make voting in Michigan more convenient, accessible and secure with 8 common sense improvements that would be secured in the Michigan constitution.

Sunday, October 14, 2018

2018 Together for Choice Conference, 10/17 - 10/19

Together For Choice is a national non-profit organization formed "to protect and advance the right of individuals with intellectual and developmental disabilities (I/DD) to live, work, and thrive in communities and settings of their choice." TGF is sponsoring a conference in Chicago, October 17 to 19, 2018. I regret that I will not be there, but I hope that others will attend and that there will be plenty to share with people who could not be there in person.


Please join us October 17-19, 2018 on Misericordia's beautiful campus in Chicago.

Together for Choice is a national grassroots advocacy organization formally incorporated in 2017 with over 800 members in 47 states. Our mission is to protect and advance the right of individuals with intellectual and developmental disabilities (I/DD) to live, work, and thrive in communities and settings of their choice. We work with national networks, self-advocates, families, and service providers to advance choice, quality, and increased resources for the I/DD population. Since our incorporation, we have been educating the public and governmental officials on the need for Medicaid funding of choice-based housing and employment/developmental training models, as well as increased resources at the federal and state levels to ensure quality services. Our continued focus is to develop policy reform initiatives addressing the myriad of I/DD community needs.

Agenda and Conference Schedule

The conference includes an impressive array of speakers:

David Axelrod, Keynote Address

Rodney Biggert, "The Trials and Unanswered Questions of the 14(c) Certificate"

Taylor Brose, "The DSP Workforce Crisis: Finding Solutions"

William Choslovsky, "Protecting the ICF Entitlement: the Real Meaning of Olmstead"

Sr. Rosemary Connelly, RSM, Conference Opening Statements

Michael Diaz, "Creating Sustainable Community Partners to Enhance Service Options"

Jill Escher, "The National Council on Severe Autism: What is an Essential Care Non-Profit?"

Melissa Harris, "HCBS Regulation and Implementation"

Rob Johnson, Keynote Address

Jim Kokoris, Keynote Address: "A Special Life"

Paul C. Landers, "The DSP Workforce Crisis: Finding Solutions"

Christopher B. Lowther, "CMS's Medicaid Home- and Community-Based Settings Regulations: How We Got Here and Where We're Headed"

Crystal Makowski, Ed.D., "Where Do We Go From Here? Best Practices!"

Patrick Mannix, "America’s Workforce: Empowering All – Updates from the Office of Disability Employment Policy"

Molly Nocon, Housing Model Discussion

Philip J. Peisch, "CMS's Medicaid Home- and Community-Based Settings Regulations: How We Got Here and Where We're Headed"

Tuesday, October 9, 2018

Meet VOR: A Voice of Reason

This description of VOR, an organization that I have belonged to for over 15 years, was part of the packet of materials passed along to every member of the US House of Representatives and the US Senate in June 2018. Regretfully, I missed this year's VOR conference, but VOR's message is clear: even though we represent a small minority (about 5% of the I/DD population), we support a full range of services and residential options to meet the needs of all people with I/DD. 

"The goals of one group should never be placed at odds with the needs of the other. "


Meet VOR:  A Voice of Reason, speaking out for people with Intellectual and Developmental Disabilities

For 35 years, VOR has advocated for high quality care and human rights for all people with intellectual and developmental disabilities (I/DD). Our membership is mostly comprised of families of individuals with severe or profound intellectual disabilities, often complicated by significant medical, psychological, or behavioral conditions. Many of our loved ones are non-verbal or non-ambulatory. Many engage in self-injuring behaviors. They often require 24/7 care, provided by well-trained and caring direct support professionals. Our family members constitute a minority within a minority. They represent about 5% of the entire population of individuals with I/DD. The home and community-based settings that work for many people with I/DD often fail to meet the needs of these severely disabled, vulnerable individuals.

To acknowledge the extensive range of needs and aspirations of all members of this diverse population, VOR supports Individual and Family Choice, and a Full Continuum of Care. In order to have choice, there must be a full range of quality options available, tailored to meet the intellectual, psychological, behavioral, and physical needs of this diverse population. One size never fits all. 

We support the goals of those who aspire to integrate into the society around them in their choices of residence, education, and employment. We also support the needs of those who would be endangered in an under-protected environment, who can never integrate fully because they cannot even perform the simplest of daily skills, like brushing their teeth, washing, toileting, or verbalizing their needs, their desires, their agitation, or their anger. The goals of one group should never be placed at odds with the needs of the other. We support all residential options, including the individual’s own home, family home, group homes, intentional communities, and larger congregate settings, such as public and private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF’s/IID, or ICF’s).

By the same principle, we support a full range of employment opportunities for people with I/DD. We support the drive for integrated, competitive employment and laud the proliferation of programs aimed at helping people with intellectual disabilities achieve their full potential. But we oppose the movement to eliminate center-based employment, sheltered workshops, and the movement to eliminate compensatory wages by eliminating Section 14(c) of the Fair Labor Standards Act. People who cannot compete in the open job market need this opportunity. They enjoy this level of work, the peer environment, and the opportunity to be productive. The movement toward competitive employment for some should not mandate the elimination of programs that work for others. 

There is no singular solution that is appropriate to all individuals with I/DD. Yet, this is the underlying premise of policies promoted by many powerful advocacy groups. This is a dangerous assumption, especially for the most vulnerable... 


For more information on VOR, read more of the 2018 conference materials