I have my differences with the ARC and other large advocacy organizations. Too often they do not represent the spectrum of views held by people with disabilities and their families. Many policy makers find it convenient to accept the views of well-funded advocacy groups as a proxy for individuals with I/DD and their families, thereby avoiding controversy and the unsettling reality of differences of opinion that they would otherwise have to confront. Nevertheless, the ARC policy seminar offers a variety of topics and includes knowledgeable speakers on state and federal issues affecting people with disabilities.
The ARC Michigan 2022 Public Policy Webinar #1: June 3rd, 2022
ThIs is the PDF handout for the first Webinar with Belinda Hawks from the Behavioral Health and Physical Health & Aging Services Administration (BHPHASA), Remi Romanowski-Pfeiffer from TBD Solutions, and Al Jansen, Senior Advisor to Director Hertel, Michigan Department of Health and Human Services (MDHHS)
This is the link to the Youtube video of the Webinar.
The BHPHASA is new. It is the result of combining agencies under the MDHHS.
From the Website:
“The Health and Aging Services Administration (HASA) was created under Executive Order 2021-14 combining Aging and Adult Services Agency and Medical Services Administration under one umbrella within MDHHS. Michigan's Medicaid Office is also part of HASA and the designated State Unit on Aging function will be fulfilled by HASA.”
The topics that I was especially interested in include the Direct Care Workers (DCW) crisis and the “Heightened Scrutiny” of settings receiving HCBS (Home and Community-Based Services) funding to assure that they provide access to “the community” based on the wishes and needs of the people living in these settings. There are other issues that will also be of interest to providers, local agencies, and people with disabilities, such as how the state is planning for recovery from the COVID pandemic and various scenarios to consider.
The Direct Care Workers (DCW) crisis - Allen Jansen, Senior to Elizabeth Hertel Allen Jansen, Senior Advisor to Elizabeth Hertel, Director of the MDHHS.
[Allen Jansen’s presentation begins at around 43 minutes on the Youtube video.]
National Data on DCWs (also known as DSPs or Direct Service Providers):
- 4.5 million direct care workers in the U.S.
- 40 to 60% rate of turnover
- 84% have no retirement benefits
- In 2019, 53% were women of color
- 47% qualify for public funded benefits
- In 2020, $20,200 was the median income
- By 2030, the predicted shortage of DCWs will be 151,000.
Michigan has a shortage of 36,000 care workers out of a workforce of approximately 165,000.
A state Direct Care Task Force has been created to establish priorities and make recommendations to the state.
Also involved in discussions is the Quality Improvement Council (QIC).
From the Website:
“The Quality Improvement Council directs the development and implementation of the behavioral health managed care programs and serves as the primary point of prioritization and integration of quality improvement activities.
“The Quality Improvement Council includes quality and administrative staff representatives from MDHHS, the PIHPs, CMHSPs, provider organizations, quality vendors and advocacy members.”
There are many job titles that fall under the broadly defined category of Direct Care Worker. Current efforts focus on improving wages and benefits for DCWs. The broad strategy for improvement includes establishing competency standards for the professionalization of the DCW workforce, designing a career pathway, elevating the value of DCWs (specifically identifying them as providing an essential service), and collecting data to demonstrate their impact:
The Governor’s proposed 2023 budget includes funding to stabilize DCW wages. At the time of the Webinar, a supplemental budget that includes additional wages for DCWs was stalled.
Recommendations for improvement include setting a starting wage at $17 - $18/hour for DCWs and adjusting funding to cover added expenses to providers to pay supervisory personnel.
There is also a proposal to expand “residential models”. Belinda Hawks clarified that this is referring to the need for facilities to house people who are stuck in emergency rooms and hospitals with no place to go or are in nursing homes and want to get out. These would be home environments aligned with a psychiatric treatment facility model. The estimated need for such facilities is 48 beds for adults and 12 for children.
“Heightened Scrutiny”
Heightened scrutiny is a process to determine whether a setting receiving HCBS funds allows sufficient access to the community to be eligible of funding under the CMS (Centers for Medicare and Medicaid Services) settings rule.
Michigan does not set limits on the size of a setting. According to Belinda Hawks, no settings so far have been determined to be ineligible. The state is still reviewing settings. Compliance with the settings rule must be complete by March 2023. The Department expects to be finished reviewing settings by August or September 2022 to give providers enough time to make changes to comply or find other arrangements for residents of these settings.
Providers have been notified if they under the HS process. The final determination is up to CMS.
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See also:
DCW commentary from ARC Michigan
Michigan’s mental health system is failing many with severe autism
Thursday, May 16, 2019
1 comment:
I fully agree with you"I have my differences with the ARC and other large advocacy organizations. Too often they do not represent the spectrum of views held by people with disabilities and their families. Many policy makers find it convenient to accept the views of well-funded advocacy groups as a proxy for individuals with I/DD and their families, thereby avoiding controversy and the unsettling reality of differences of opinion that they would otherwise have to confront"
IDD Advocacy has many more problems though. Nearly all their funding has a conflict of interest element. All IDD advocacy gets a large amount of their funding from state and federal sources. Also in Texas this funding conflict of interest in Advocacy funding extents to the private sector. The Arc of Texas supported the Texas bill, SB 7 of the 83rd, to put Medicaid for people with IDD under private managed care corporations control. This has proved to be horrible for people with IDD and their families as every dollar these corporations "screw" the family out of goes to their bottom line. I tried to organize a repeal of the law but all IDD advocacy in Texas refused to help as they are all take money from "managed care corporations".
As you could guess I am not well liked by IDD advocacy in Texas or even at the Federal level for that matter. They do not like having their "warts" being pointed out.
At the federal level I filed a formal CMS/OCR complaint against the CMS new Settings rules. I had some success with this as I got the "new settings rules" changed/clarified on two points. (see CMS clarification letter of March 22, 2020, last two issues). I also attempted to get the CMS new setting rules into Federal Court for a Judaical Review. This really stirred up an IDD Advocacy "hornets nest". The reason for this is that CMS/US HHS and all the high level advocates in national IDD advocacy know the CMS new settings rules are not even legal because they are not supported by the Social Security act they were supposedly written under. They all know they would likely fall under a Federal Judicial review. The "CMS new settings rules" are oppressive and violate my son' Civil rights under the ADA and the FHA. They are just another "institutional oppression" people with IDD have to suffer under.
Sincerely,
Joe T. Potts
joetpotts@gmail.com
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