Voters in Oregon raise taxes to pay for public services

Oregon voters, who have rejected tax increases since 1990, passed a ballot measure on Tuesday to raise income taxes for households earning more than $250,000 and individuals earning more than $125,000 a year. A second ballot measure raised the income tax on corporations.

According to an article in the Los Angeles Times, the tax increases will raise $700 million to help close the state's budget gap and prevent early school closings, teacher lay-offs, and cuts to healthcare benefits.

Joel Connelly, a columnist for SeattlePI.com, says "The tax increases aren't that onerous despite wailing and gnashing of teeth on the editorial page of the Wall Street Journal. Oregon did not really soak the rich, just asked that they shower regularly."

Saint Francis Camp on the Lake - Jerome, Michigan

Check out Saint Francis Camp on the Lake in Jerome, Michigan, north of Coldwater and west of Adrian, Michigan. The camp is run by the Alhambras, a fraternal order of Catholic men dedicated to assisting persons with developmental disabilities.

The Website has an informative video to give you an idea of what the camp and campers are like, an application, and more information on contacts. The cost for one-week at camp is $450.

There will be an open house on June 5, 2010, but families are encouraged to find out more about the camp before then by contacting Mike Carpenter at mike_carp@sbcglobal.net or viewing the Website.

Michael Head from MDCH sees the good side of a tanking economy

"The opportunity to advance change and delete poor practices and service options is enhanced with the specter of large budget reductions..."

Michael Head, Deputy Director of the Mental Health and Substance Abuse Administration for the Michigan Department of Community Health, 12/16/09

Michael Head, a Deputy Director at the Michigan Department of Community Health, in his response to Michigan's economic crisis, seems delighted to have an excuse to eliminate programs he doesn't like. Unfortunately, the programs and services he targets specifically - day programs, sheltered workshops, and group homes - serve people with the most severe and complex developmental disabilities. I guess we shouldn't be too concerned, though. He plans to have them all earning incomes in integrated community settings, competing for jobs in a state that expects to have an unemployment rate of 15% this year.

If we are in for some tough times, can we at least have someone who is not completely out of his mind in charge?

Washtenaw County: CHS Vocational Services Contract Reinstated

This is an update to another blog entry from 11/19/09.

At the December 2009 WCHO Board meeting, the Board voted to rescind an earlier decision to discontinue a contract with CHS, an agency that provides supported employment and other vocational services to people in Washtenaw County. The initial decision to discontinue the contract was based on a misunderstanding regarding CHS's financial status. After CHS reported to the Board about its financial stability, the contract was reinstated.

CHS will continue to serve the same client base and provide the same skill building/supported employment services as they have been doing.

The MDCH vision of the future

Lansing is a place I do not pretend to understand. Emanations from the Michigan Department of Community Health (MDCH) about its "vision" for people with developmental disabilities seem especially murky and at times far removed from reality.

On December 16, 2009, Michael Head, a Deputy Director at MDCH, met with the directors of the state's Prepaid Inpatient Health Plans (PIHPs). PIHPs are regional affiliations of Community Mental Health agencies. (Our PIHP is the CMH Partnership of Southeastern Michigan that includes the CMH agencies from Washtenaw, Lenawee, Livingston, and Monroe Counties.)

According the PowerPoint presentation of Mr. Head's talk, Michigan's "vision" for adults with developmental disabilities is for them to have the supports and services necessary to be healthy and safe and to successfully:

• contribute to their communities
• earn an income in a non-segregated community setting
• live in their own homes
• have full community inclusion with meaningful participation and membership
• have friendships and relationships
• have fulfilling lives

According to the MDCH, people who do not conform to the state's vision of success (people who live in group homes or are unable to earn an income in non-segregated settings, for example) are now being deprived of a new-found right, "the right to live in the world".

The state's vision dovetails nicely with the MDCH proposals to deal with the state's economic crisis: eliminate the bad old "legacy" programs such as day programs, sheltered workshops, group homes, and other programs in settings designed especially for people with the most severe and complex disabilities. A principle underlying the planning process for the future is that consumers need to get used to making do with less than adequate services, but rest assured: the state is more than willing to give them ample opportunity to participate in the fight over what to do with the remaining resources.

There are many well-defined rights for people with disabilities, including the right to treatment and services suitable to the person's condition and the right to participate in determining those services through the Person-Centered planning process. State and local mental health agencies have the obligation to assure that rights are protected and services available to meet the needs of a diverse population. There is nothing wrong or illegal with the existence of programs such as day programs, licensed group homes, and sheltered workshops that provide for the needs of many people with developmental disabilities. No one can deny a person participation in benefits that are generally available to everyone in a community, based solely on a person's disability, but neither can a person be forced to participate in a program or service they do not need or desire. And rights do not disappear in a bad economy.

"Living in the world" is not a right, but an often unpleasant reality that we all have to cope with. Everyone, unless one happens to be a hermit, lives in a community. "The" community, however, is an ill-defined abstract notion that is open to interpretation. Attempting to eliminate an infrastructure of services that many people with developmental disabilities depend on by choice and necessity does nothing to protect rights and very likely will not save money.

There is no getting around the seriousness of Michigan's economic crisis, but placing the burden of the crisis on vulnerable people and their families who have few resources with which to fight back is not a reasonable or humane approach.

Serious problems facing Community Mental Health system in Michigan

On January 13, 2010, the CMH Boards under the Community Mental Health Partnership of Southeastern Michigan met to hear very bad news about Michigan's funding of mental health agencies. Because of the state's deflationary spiral downward and drastically reduced revenues, all local Community Mental Health agencies can expect unprecedented cuts in funds from the state.

The four CMH boards from Washtenaw, Lenawee, Livingston, and Monroe Counties braced themselves for the beginning of the 2011 budget negotiations which start in February when the Governor delivers her budget proposals to the state legislature. The meeting began with a sobering state budget overview and a presentation on finance basics and the impact of the crisis on the state's General Fund and Medicaid funding.

I am no expert on state finances, but this sure sounded bad to me:

• The current recession at 22 months ("peak to trough") is the longest since the Great Depression.
• Leading indicators point to an imminent national recovery, but Michigan has been in a longer and deeper decline than other states.
• Auto sales are going up again, but the Big Three market share has dropped from around 70% of the market in the early 1990's to 35% of the market now. (Nationally, fewer people today work in manufacturing jobs than did in 1941.) Michigan Vehicle employment dropped 78% from 2000 to 2010. Overall, 1 million jobs have been lost since 2000. The forecast for 2010 is a Michigan unemployment rate of 15.3%.
• In good times, Michigan's personal income relative to the U.S. was 122%. We have fallen to 87% of the national average.
• States revenues in the General Fund for 2010 are equal to the General Fund level of 1965, when adjusted for inflation. All the rumors about how our taxes keep going up are not exactly true: Michigan taxes as a percent of personal income have declined since 2000.

After significant cuts in spending for the 2010 fiscal year, the state has told all agencies that they must submit program reduction proposals for fiscal year 2011 equal to 20% of their General Fund appropriation and the Department of Community Health also wants agencies to submit proposals for 20% reductions in Medicaid spending. (This is especially troublesome, because Medicaid pays for most of the specialty services for people with developmental disabilities.)

If the threatened cuts were to be fully implemented, Washtenaw County would have to cut $1.9 million from its General Fund authorization. Even though Medicaid-enrolled consumers are entitled to needed services, Medicaid funds would be cut by $8.8 million.

The four-county affilliation that includes Washtenaw County is developing a strategy to make sure that the CMH Partnership of Southeastern Michigan takes a leadership role in influencing how the state will respond to this crisis. They have been disappointed in the past by the lack of leadership from their state association (the MACMHB) and plan to take more direct action.

From the discussion this week, it appears likely that the short-term strategy to get us through the next 18 months will be to push for an expansion of Medicaid and tap into other sources of federal funding while developing a long-term strategy for remaking the community mental health system. If the healthcare reform legislation makes it through Congress, it will open possibilities for funding through numerous demonstration projects. The affiliation, rather than focusing solely on the money, will focus on changing the system and serving consumers.

How to survive to twenty-five: Ian B. has finally arrived.

Happy Birthday, Ian!

Ian was born a few weeks early by an emergency C-section at Stanford Hospital in 1985. He was found to have an alpha strep infection that he contracted in utero, a very unusual occurrence. A medical student made a little project out of this and found only 30 mentions in the medical literature of this happening.

Ian started his life deathly ill with a six-week stay in the neonatal intensive care unit at Stanford. After the strep infection subsided, he was left with severe brain damage. A CT-scan showed a large cyst at the back of his brain that should have left him blind. As it turned out, he does see, although his vision is not normal, but it is useful to him and for this we can be grateful.

Ian has severe cerebral palsy, severe mental retardation, and is unable to communicate in any specific way. He is, however, a charming young man with many fans. One teacher at his school told me once that Ian is the nicest person she has ever met. The effect he has on people is pretty amazing considering that he has no specific way of telling them what he thinks of them or any way of doing things for them except to cheer them up.

From the very beginning, Ian had high expectations that the world is a happy and kind place. When it disappointed him, everyone in his sphere of influence seemed to know that it was his or her job to fix things for him, to restore his faith in the world as it should be. Life for Ian has not always been easy, but he retains an innate cheerfulness when things are going well.

About the only thing that Ian can actively do is move his left hand so that he can bang on a toy piano. The piano in this picture was a piano/xylophone that had an octave and a half worth of keys. For Ian's twenty-first birthday, John took it apart to give it a really good cleaning and discovered that our daughter, at a very young age, had stuffed gummy bears and other debris into the innards of the piano. Sadly, the piano disintegrated about a year later and was replaced with another that is perfectly adequate, but just not the same. But Ian keeps plunking along.

Michigan Medicaid Helps (sometimes)

A quick call yesterday to the Michigan Medicaid help line to check on authorization for Danny's new wheelchair, turned into a twenty minute tour of elaborate menu options and no answers to my questions. I did speak to two actual human beings, however, and found out that without authorization to communicate on behalf of my son, their lips are sealed.

I fell into possession of a Medicaid phone number to help providers (doctors, venders, wheelchair providers, etc.) and a tracking number for the wheelchair authorization that had been requested two months ago.(Wheelchairs, other expensive medical equipment, some medical procedures, and some medications need prior authorization before they can be ordered and paid for by Medicaid.) I called the number and was quickly connected with a woman who asked where I was calling from. When I revealed that I was a parent checking up on what had happened to the wheelchair order and offered her the tracking number, she said darkly that I was not supposed to have that information. I love to have information that I am not supposed to have, so she had trouble shaming me into apologizing for being involved in whatever potential fraud I was attempting to commit.

I must admit, I began to feel sorry for the people who have to answer these phone calls. The woman said that there is a terrific backlog, case loads are extremely high, and all they can do is work on orders as they come in. Her office is short-staffed and they were closed for 4 days over the holidays. More than a year ago, before Michigan's economy became even worse than could be imagined at the time, I stood in line at the local Department of Human Services waiting to straighten out a problem with my other son's food benefits. It was a miserable sight to see so many jobless people signing up for benefits and the problems have gotten much worse.

The woman told me to call the Medicaid Beneficiary Help line at 800-642-3195, although she didn't know that it would do much good. The wheelchair provider is in a better position to find out what is happening with the authorization. I called anyway, and after trying a few menu items, ended up with Michigan Enrolls. Michigan Enrolls is generally for enrolling people who have Medicaid in a managed health plan, I think, but in this case the man who answered the phone was also taking other questions to help beneficiaries. I explained that I was calling for my son and wanted to find out what was happening with the wheelchair authorization.

Then the man (Derek) asked if Daniel was available to speak with him. Danny was at his group home and, available or not, he has never spoken an intelligible word. He can be loud and obnoxious when he needs to be, but I don't think that would be very helpful to the poor man from Medicaid. Then Derek said that his computer did not show that I was Daniel's "authorized representative" and he could not give me any specific information. I asked if anyone else was listed as Danny's "authorized representative", and he replied he could not say. His lips were sealed.

Here is what I did find out:

If you are the guardian of person receiving Medicaid benefits and want to be listed as the authorized representative of a beneficiary, you need to write a letter to the Privacy Officer. Include in the letter the date of birth and Medicaid ID # of the person who receives the benefits, and your phone number. Send with the letter a copy of your driver's license showing your photo, license number, and signature, and a copy of the relevant guardianship papers. Sign and date the letter. Send it to:

Privacy Officer
Michigan Department of Community Health
201 Townsend St.
Lansing, MI 48913

You have a nice day, Derek. Thank you for the information and next time maybe we can speak more freely.