2023 Disability Policy Webinar Series from the ARC Michigan

The ARC Michigan is sponsoring a two-part Webinar on Disability Policy 2023. The first session was held on June 9, 2023. The second session is scheduled for Friday, June 16, 2023. A recording of the Webinar and written handouts are available for the first session. A recording and handouts for the second session will be available after Friday, 6/16/23.

During the first session, Emily Henderson, Government Affairs Consultant, gave a broad overview of state issues and a rundown of who is who in state government. David Goldfarb covered federal policy and issues regarding Long-Term Supports and Services. The second session focuses more on Home and Community Based Services and the federal settings rule.

Although I disagree with some of the policies that the ARC Michigan promotes, I found the Webinar to have plenty of useful information and food for thought.

June 9, 2023
9:00am – 10:00am

Emily Henderson, 
Government Affairs Consultant
McCall Hamilton Advocacy
& Public Affairs

Emily Henderson is a government affairs consultant at McCall Hamilton, Lansing’s only all-female lobbying firm. Following graduation from Michigan State University’s James Madison College, Emily joined the team and began working closely on state legislative and regulatory health and human services issues as well as grassroots and coalition advocacy.

In this presentation, Emily will discuss Michigan’s new political landscape and provide an advocacy update on all of the items the Arc Michigan is following in Lansing. Emily will also share what it means to be an effective advocate and how to connect with your legislators.
 
10:30am – 11:30am

David Goldfarb
, Director of Long-Term Supports and Services Policy
The Arc of the United States

David Goldfarb is The Arc of the United States’ Director of Long-Term Supports and Services Policy. Prior to joining The Arc, he spent nearly 8 years at the National Academy of Elder Law Attorn eys (NAELA), where he oversaw NAELA’s advocacy initiatives. He currently co-chairs the Disability and Aging Collaborative and the Consortium for Constituents with Disabilities (CCD) Financial Security & Poverty Task Force. He began his public policy career as the Economic Policy Fellow for Senator Bill Nelson of Florida.
 
June 16, 2023
9:00am – 10:00am

Belinda Hawks, 
Director of Home and Community Based Services
& Lyndia Deromedi
, Manager of Federal Compliance Section, Division of Adult Home & Community Based Services, Behavioral and Physical Health and Aging Services Administration 

Belinda Hawks has given 30 years to working in the Michigan Behavioral Health system as a provider of services, in a community mental health organization, and the last 9 years at the state in the Bureau of Specialty Behavioral Health Services.

She will provide us with updates from MDHHS – Behavioral Health on Conflict Free Access and Planning and Implementation of the Home and Community Based Services Rule.

Lyndia Deromedi is the manager of the Federal Compliance Section in the Adult Home and Community Based Services Division and has been in this role for almost 3 years.

The Federal Compliance Section oversees the Habilitation Supports Waiver [for people with developmental disabilities] and 1915(i)SPA services for adults receiving Medicaid behavioral health services. This includes the oversight of the site review process, person-centered planning, self-determination and the Behavioral Health Home and Community Based Services (HCBS) rule implementation. Lyndia has been working in the Michigan behavioral health system for over 25 years.

Lyndia will provide an update of the HCBS rule implementation for behavioral health services in Michigan.

Click Here for more information on Home and Community-Based Services Program Transition
 
10:30am – 11:30am

Lindsay McLaughlin & Phillip Kurdunowicz
Bureau of Children’s Coordinated Health Policy & Supports, Behavioral and Physical Health and Aging Services Administration

Links to Webinar recordings and written materials are here.

Review of the 2022 Disability Policy Webinar Series from the ARC Michigan

I have been in semi-hibernation during the COVID pandemic and have not been following state and local disability policy as closely as I should. With regard to policy affecting people with Intellectual and Developmental Disabilities (I/DD) and their families, one way to catch up is to follow the ARC Michigan’s 2022 Disability Public Policy Webinar Series on Zoom. The Webinars are held every Friday in June with each week featuring a different topic and speakers. The Webinars are also archived for viewing later.

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