Michigan minimum wage increase and new paid sick leave requirements go into effect

These should help improve working conditions for Direct Support Professionals who work with people with disabilities, but they don’t go nearly far enough to stabilize the workforce. For people making more than minimum wage, the increase theoretically puts upward pressure on all low wage jobs.

The Michigan minimum wage has increased from $9.25/hour to $9.45/hour. An article form the Detroit Free Press, “Michigan paid sick leave changes: What to know about new law” by Micah Walker, 3/29/19, explains the new sick leave law.

These policies would have been more generous had the voters been allowed to vote on a proposed minimum wage increase and if a paid sick leave policy that was approved by voters had not been not been almost gutted during the lame duck legislature in December 2018.

“The paid sick leave law comes after activists gathered enough signatures to get the issue on the Nov. 6 ballot. However, instead of allowing it to go on the ballot, Republicans in the Legislature adopted the proposals in September and two days after the November election introduced bills to gut the laws they had passed just a few months earlier. If the proposals had gone to the ballot and passed by voters, it would have taken a three-fourths majority to amend the laws.”

The sick-leave law applies to workplaces with 50 or more employees, which includes full-time and some part-time employees with a lot of exemptions allowed.

Employees can take paid leave for:

• A physical or mental illness, injury, or health condition affecting themselves or a family member.
• Medical diagnosis, care, or treatment of themselves or a family member
• Preventive care for themselves or a family member
• If the employee or a family member is the victim of sexual assault or domestic violence
• For the closure of the employee's place of business by order of a public official
• To care for a child whose school or daycare has closed by a public official
• The employee's or a family member's exposure to a contagious disease
• To relocate
• To obtain legal services

The Act requires an employer to pay employees at a rate equal to or greater than the normal hourly wage, base wage, or minimum wage. The employer does not have to include overtime, vacation, bonuses, commissions, supplemental pay, price-rate pay or gratuities when calculating the pay rate. 

Read the article for more details.

Notes on the Washtenaw County CMH Board Meeting of 3/25/19

When I report on meetings, it is usually from the perspective of people with developmental disabilities and their families, so I may leave out details that would stand out more to people with other disabilities or mental illness. The CMH packet of materials that is available with the agenda before each Board meeting has much more information than what I cover and is a good resource for keeping up with current issues in the CMH system. 

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The Washtenaw County Community Mental Health (WCCMH) Board of Directors met at the administration building at 555 Towner St. in Ypsilanti, MI, rather than its usual meeting place at the Learning Resource Center at 4135 Washtenaw Ave, Ann Arbor, MI.

Minutes for the last meeting of the board can be found with the agenda and packet of meeting materials.

A detailed financial report, Attachment #2, is available. There was a discussion of methodology to determine the state Medicaid rate reimbursement for services provided by CMH. The problem with the formula used is that it apparently does not take into account all the variables that cause expenses to be higher in some places than others. Washtenaw County, for example, has a higher cost of living than other areas, but that is not accounted for in the rate of reimbursement. Also, the caseload of people served by WCCMH continues to rise while it has been falling in the state overall. 

There is continuing concern about the inability of PIHPs (regional administrative agencies that pass on Medicaid funds to local CMH agencies) to save a sufficient amount of funding in reserve to provide financial stability to the CMH system.

Trish Cortes, the Executive Director of the WCCMH, said in her report to the Board, that local agencies have been getting some traction with the Michigan Department of Health and Human Services and that the state is acknowledging the problem of insufficient revenues. A midyear adjustment is being considered.

Department of Health and Human Services (DHHS) budget hearings on Behavioral Health [Community Mental Health services including services for DD] were scheduled for March 21, 2019 before the Senate Committee on Health/Human Services. Jeff Irwin is a state Senator from Ann Arbor who is on this committee.

House Health and Human Services Committee budget hearings will be held April 11, 2019 at 1:30pm or after session, in the House Approps Rm, 3rd floor Capitol.

It is important for legislators to hear from provider agencies, consumers, and families about the impact of insufficient mental health funding. If there is no relief, it is possible that WCCMH and other CMH agencies will be in the position of being unable to provide mandated services to consumers. 

This is from an email from Alan Bolter, Associate Director of the Community Mental Health Association of Michigan (CMHAM) on DHHS Budget Hearings: 
 
“Over the past few weeks, Bob [Sheehan] and I have had several encouraging meetings with the administration and legislators and believe there may be an opportunity to make some progress on our funding challenges. We believe the DHHS budget hearings would be a perfect opportunity for our members to back up the message lawmakers are hearing from CMHAM. With that said, we strongly encourage you to participate in either or both of the upcoming hearings, especially if you have a member from your community on the committees.”

The following is the message from CMHAM to legislators on budget issues:

1. Medicaid rates set to match demand and costs: Set the Medicaid rates to the state’s public mental health system (the process that provides over 90% of the funding for this system) to reflect the actual and projected growth in demand for and the real costs of providing the services associated with Michigan’s Medicaid mental health benefit.

2. Medicaid rates to include contribution to risk reserve: Include, in the Medicaid rates to the state’s public mental health system the federally required contribution to risk reserves at a level sufficient to allow for the fiscal soundness of the public mental health system,

3. Allow the public mental health system to hold sufficient risk reserves: Allow the state’s public Medicaid mental health/specialty health plans (the Prepaid Inpatient Health Plans; PIHPs) to hold risk reserves of the size that would be held by any risk-bearing organization. With the earmarking of the risk reserve contribution in the rates (see 2 above), allow the CMHs to retain and reinvest any Medicaid savings that they generate through efficiencies and effective clinical practices.

4. Free up local dollars to meet unmet non-Medicaid needs, by halting the inappropriate drain of local dollars to fulfill state Medicaid obligations: eliminate the Local Match Draw Down requirement (section 928); assume the appropriate state role in ensuring the soundness of the state’s Medicaid mental health system by halting the demand that counties close the Medicaid gap caused by the systemic underfunding of Michigan’s public mental health system. 

5. Restore General Fund dollars to the public mental health system: Restore the lion’s share of the State General Fund dollars cut from the CMH budget to ensure that persons, not covered by Medicaid, have access to needed mental health services.

If you as a family member are testifying before a legislative committee or sending in written comments, you may have other concerns or want to express some of the same concerns in your own words. Advice from CMHAM: If you plan on attending, you should plan on bringing around 20 copies of your testimony and arrive at least 10 minutes early to fill out a card...

These are members of the house and senate committees considering appropriations for the Health and Human service budget: 

State House Health & Human Services Committee -- Whiteford (C), Green (MVC), Inman, Allor, Yaroch, Glenn, Huizenga, VanWoerkom, Hammoud (MVC), Hoadley, Love, Brixie, Cherry. 

State Senate Committee on Community Health/Human Services -- Sen. MacGregor (Chair), Sen. Bizon (Vice Chair), Sen. Schmidt, Sen. LaSata, Sen. MacDonald, Sen. Barrett, Sen. Hertel (Minority Vice Chair), Sen. Irwin, Sen. Santana

Community Mental Health Partnership of Southeastern Michigan (CMHPSM) Regional Update

[The WCCMH belongs to the Community Mental Health Partnership of Southeast Michigan (CMHPSM) along with CMH agencies from Livingston, Lenawee, and Monroe Counties. The CMHPSM is one of ten PIHPs (Prepaid Inpatient Health Plans) in Michigan. PIHPs are regional administrative agencies that pass Medicaid funds from the state to local CMH agencies.]

The CMHPS recently commissioned an evaluation of their Chief Executive Officer Jane Terwilliger. The results were not good. She has been CEO of the PIHP for four years and before that was the Executive Director of the Monroe County Community Mental Health Authority. There were many complaints about her job performance. The agency staff were especially upset that she has discontinued holding staff meetings. Directors on the Board from the four counties were the most critical of her performance.

Jane Terwilliger’s contract was extended for six months, but the CMHSP board has put conditions on her employment for immediate improvement with time requirements for changes. If these do not occur, her contract may be terminated. 

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Well, folks, that’s about all the excitement I can take from one more WCCMH Board meeting. The next meeting is April 19, 2019 4135 Washtenaw Ave, Ann Arbor LRC Room Michigan 9:30-11:30am .

Washtenaw Coalition for Community Choice Meeting - 4/9/2019

Join us for a meeting to get started on creating a housing community in Washtenaw County for Adults with I/DD including ASD based around a working farm, but still in Ann Arbor/Saline area. 

Tuesday, April 9, 2019 

6:30 – 8 PM 

2144 S. State St. 

Ann Arbor, MI 

Keller-Williams offices top floor 


Show Map

 

Hosted by the Washtenaw Coalition for Community Choice (WCCC)

Increasing Options and Decreasing Barriers to Housing Choices for those with Intellectual and Developmental Disabilities (I/DD) in Washtenaw County 

This will be a parent/caregiver lead group. Email Kerry at kerrykafafian@gmail.com with questions .

Michigan: Medicaid eligibility is not the only way to qualify for services for people with DD and other disabilities

A letter of clarification from the Michigan Department of Health and Human Services, dated 12/14/2018, was sent to Executive Directors of Prepaid Inpatient Health Plans (PIHPs) and Community Mental Health Services Programs (CMHSPs) concerning misinformation about eligibility for mental health services, including services for people with intellectual and developmental disabilities. The letter is from Jeffery L. Wieferich, the Director of the Michigan Bureau of Community Based Services. [PIHPs are the regional administrative agencies that pass on Medicaid funding to local Community Mental Health agencies (the CMHSPs).] 

The body of the letter clarifies access and eligibility for Community Mental Health (CMH) services and corrects inaccurate information being provided to the public. Some CMH agencies and PIHPs have been misinforming the public that their agencies will serve only people eligible for Medicaid. This is not correct.

For one thing, many people do not apply for Medicaid until they are in need of services. There is some funding to serve people not eligible for Medicaid, and they are placed on a waiting list, if funds are not available. Services must be provided to all Medicaid eligible individuals. Everyone who contacts a CMH agency is entitled to an evaluation to determine his or her level of need. 

The letter makes these clarifications:

• Staff from a CMHSP may not state that the CMHSP only serves Medicaid beneficiaries. For those individuals that do not have Medicaid coverage, the Mental Health Code…is clear that a CMHSP must serve anyone in an emergent (crisis) situation…Following that, an assessment is required to be completed so that level of need is determined. If an individual’s level of need is not as severe as other individuals, then the CMHSP may determine that it does not have sufficient general funds to provide services and the individual is to be placed on a waiting list for CMHSP services (non-Medicaid only) and the CMHSP should maintain the list.
• CMHSP Access Center staff must screen anyone that calls for a crisis and then assure that applicants are offered appointments for assessments with mental health professionals of their choice within the…contract-required standard timeframes. For those individuals without Medicaid coverage, the Mental Health Code also states that a waiting list must be maintained for anyone that is determined not as severe as other individuals…
• When an individual with mental health needs [including people with intellectual and developmental disabilities] is denied community mental health services, for whatever reason, he/she is notified of the right under the [Mental Health Code] to request a second opinion and the local dispute resolution process…
• CMHSP websites should not be conveying only Medicaid eligible beneficiaries are served.
• When an individual has private insurance, this is not solely a reason to deny CMHSP services. The CMHSP is required to complete an assessment of the individual’s needs and then prioritize based on the [Mental Health Code]. The CMHSP shall not deny an eligible individual a service because of individual/family/income or third party payer source…

Another source of funding for children under the age of 18 is the Michigan Children's Waiver Program (CWP).

From the CWP Website: "To be eligible for the CWP, the child must have a documented developmental disability and need medical or behavioral supports and services at home. In addition, the child must have behavioral or medical and habilitative needs at home on a consistent daily basis that meet requirements for the level of care for an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)."

The CWP waives the requirement that the family qualify for Medicaid and allows the child to be considered for services regardless of the family's income. There are a limited number of children's medicaid waivers, but it is worth getting on the needs-based waitlist.

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See the letter of clarification for references to the Michigan Mental Health Code.

See also Michigan Protection and Advocacy Service on eligibility for services.

Group Living in Ann Arbor: OK for Young Professionals and Students, but not for Adults with Disabilities???

This is about an article in the Ann Arbor News, “Group-living townhouses with co-working space will target young professionals in Ann Arbor” by Ryan Stanton, 2/23/19. 

You may detect a note of sarcasm on my part, when I describe what is being proposed here in Ann Arbor to much acclaim. If this were proposed by families of adults with intellectual and developmental disabilities, as a housing and service solution for their family members, some advocacy groups would denounce the effort as an attempt to re-institutionalize people with IDD and segregate them from society by providing services where they live targeted to their specific needs. 

Because this project is designed for young professionals, with the idea of helping them save money and share services with other like-minded adults, we are unlikely to hear cries of righteous indignation and accusations that it is just a scheme to oppress and infantilize young professionals. This is a complaint you would inevitably hear if this was built for people with disabilities. I think it would be a fine idea to have an option like this for people with disabilities who prefer group living and can benefit from it.

To be clear, housing people with disabilities was not an issue in this article, and I don't mean to imply that there was any hint of discrimination by the city or developer against any particular group of people. This is just me, struck by the contrast in how we think about non-disabled people just living their lives, and people with disabilities being caught up in controversies over other people wanting to decide for them how they should live.

The Housing Project for Young Professionals:

A developer will build 11 six-bedroom units, that city officials initially assumed was for students used to dorm-like living: 

“This is emphatically not a student housing project,” said developer Heidi Mitchell of Prentice Partners of Ann Arbor.

“It is actually a co-living, co-working space with (shared) vehicles targeted toward young professionals.” 

Here is what is planned:

“The apartments are conceived as three-story walkups, with the first floor being a common area with kitchen/dining and living/gathering spaces, four bedrooms, each with a bathroom, on the second floor, and two bedrooms with a shared bathroom on the third floor.

“‘Each townhome is designed to be a standalone unit, sharing only the exterior areas as collective commons space,’ the plans state, noting there will be a row of five units and a row of six units, with a ‘mews’ design that allows for communal access and gathering between."
...

“Bedrooms will be about 150 square feet, giving each tenant what Mitchell calls their own ‘cocoon suite.’

“Each townhouse will have its own front door access, as well as a second access from the communal area.”

The project is designed to allow people to live without owning their own car and to share workspaces so they can work from home if they want.

“The site is within walking and bicycling distance of downtown, the UM campus, a grocery store, CVS, and other destinations, including a bowling alley and UM athletic facilities, with nearby access to public transit.”

“'Obviously we’re not allowed to say you can’t rent if you’re a student, but I can promise you all of our marketing efforts will be directed toward people who are in the workforce,' she said, calling housing for young professionals 'definitely an area of need in the city.'

“'..all of our marketing efforts will be directed toward people who are in the workforce,' says the developer and not at students. "

Do I detect a whiff of discrimination here, not to mention segregation? Definitely not! This is for normal people choosing to live together who also lead their own lives and find it easier and less expensive when so many of their needs can be met in one place.

But six bedrooms in one townhome??? That sounds suspiciously like a group home, congregate living, an intolerable predicament if the people who were living there were disabled. And there is no doubt about it, 11 town homes in close proximity to each other with six people living together in each unit definitely makes it an institution. 

Oh, the horror! Bring on the Young Professional Self-Advocates who know exactly how every young professional should live and will work tirelessly to stop this project in its tracks! 

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See also, "Saline, Michigan: Families take the initiative in creating new housing for people with DD", The DD News Blog, 2/13/18 

"...Dohn Hoyle thinks the Saline project falls short. Hoyle is the public policy director for the ARC Michigan. Because the condos will have 24-hour care and house only residents with disabilities, Hoyle sees less independence than what’s being marketed…'It will be their own place in the sense of their own condo, but remember what you’ve done is you’ve set up a group-living situation [by] having everybody who lives there have a disability,’ Hoyle said.”

Words Matter: The Language of Disability

The article below is from the November 9, 2018 VOR Weekly News Update by VOR’s Executive Director Hugo Dwyer. VOR, a “Voice Of Reason”, represents families and friends of people with severe and profound intellectual and developmental disabilities (IDD), including people with complex behaviors that put them at risk for seriously harming themselves or others. 

Most of the disabled individuals represented by VOR families and friends require an institutional level of care, whether the care is provided in an actual institution for those with the highest needs or in a community setting often funded by Home and Community-Based Services (HCBS) Medicaid Waivers. 

VOR supports choice from a full array of high quality options based on individual need. Many influential advocacy organizations, such as the ARC, promote “Community for All” and the elimination of institutional and other congregate settings, despite evidence of systemic problems and underfunding of community care. The results of poor quality community care lead to abuse, neglect, exploitation, and isolation, the very characteristics that have arbitrarily been assigned to institutions, regardless of the quality of care and the appropriateness of the setting to meet individual needs. 

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On Language: The "R" Word, the "I" Word, and the Subtext of Discrimination

by Hugo Dwyer

11/9/18

While attending the meeting of the President’s Committee for People with Intellectual Disabilities (PCPID) in Washington D. C. last month, I heard a number of participants mention their strong dislike of the “R” word. The general consensus was that the "R" word is hurtful, that it had been used to insult and marginalize people with intellectual disabilities. One speaker compared using the "R" word to using the "N" word.

We can all agree that the "N" word has always been a term associated with ignorance, racism, and hate. We can all pretty much agree that the "R" word has deviated from its original clinical usage to describe an intellectual condition, mental retardation, to become a derogatory, insulting, and disenfranchising term. As a result, we have stopped using the "R" word.

What struck me was the fact that most of the participants freely used the "I" word, Institution, as a demeaning term, without ever seeing the irony of their using this term in a manner that is hurtful, and disenfranchising to those who believe that Intermediate Care Facilities (ICFs) are the best solutions for a minority of individuals with intellectual and developmental disabilities, complex medical problems, and behavioral disorders.

ICFs are a legitimate, valuable component of our full continuum of care. They deliver a higher level of service for people with higher levels of need. ICFs are certified by CMS, and are thereby held to a much more stringent set of guidelines than HCBS waiver settings.

When members of the I/DD community derogatorily refer to ICFs as "institutions", their intent is often to invoke memories of the past, where people with I/DD were cruelly warehoused without treatment in places like New York's infamous Willowbrook State School or Pennsylvania’s Pennhurst State School and Asylum. Modern day ICF's bear no resemblance to those institutions. The use of the "I" word is just as hurtful, just as demeaning and marginalizing to our families as the use of the "R" word might be to theirs.

The families of people with severe and profound disabilities support the goals of inclusion and competitive employment for those who have the ability to participate in these environments. But we cannot help but feel marginalized and discriminated against by others in our own community, when we hear the word "institutions" used in a demeaning manner, when we are told that equivalent services are available in "the community",. Families who support these choices are often told that we are uninformed, afraid of risk, or that we just don't care enough for our loved ones to put them into waiver settings. That is hurtful. That is demeaning. That marginalizes us.

It's time for us all to acknowledge the breadth of the disability community, and work to support one another in our individual goals of making better lives. Please don't allow others to use the "I" word to demean and marginalize those who make this choice.