Michigan special education for students 22 -26

The Michigan budget process for the 2012 fiscal year is underway with significant cuts to education on the table. In times of financial stress, special education programs that serve students from 22 -26 years old become an easy target for budget slashers, especially those who know next-to-nothing about the students served and how highly these programs are valued by both students and their families.

Special education for disabled students over 21 years old who cannot complete a regular high school curriculum has been mandated in Michigan since 1971 in a law that pre-dates the 1975 federal special education law now known as IDEA. Most of these students (there were about 3200 of them statewide in the 2009 school headcount) have moderate to severe disabilities and, were they not in school, would require intensive services from the community mental health system and other agencies. There are higher functioning students who also fall into this category for a variety of reasons, but the vast majority have moderate to profound developmental disabilities.

It is true that no other state extends special education beyond the age of 21, but if these programs were significantly reduced or eliminated, it is difficult to believe that the cost and disruption to students and their families would be worth the savings, if any, to the state. There have been some assertions that these programs impede the transition of students to their communities and the services they will need later in life. These programs, however, are not compulsory and for those who participate there are built-in protections in special education rules to assure the right to appropriate services for individual students.

The Washtenaw Intermmediate School District (WISD) offers a variety of programs for students at all levels, many of them based in local communities and focused on skills needed by individuals to move on with their lives. Students like my son Ian who will graduate in June from the program at High Point School in Ann Arbor, have benefited over the years from the remarkable skill with which the teachers, aides, and other professionals work with students with even the most profound physical and mental disabilities. 

The transition from school to our chronically under-funded and fragmented system of services for disabled adults is described by many families as similar to "jumping off a cliff". The experience would be no less painful when your child is 21or 22 than when he or she reaches the age of 26.

**************************

As far as I know, there is no bill in the state legislature yet that proposes to eliminate or change these programs, but that does not mean that it couldn't happen. There is one written proposal to significantly change educational programs for this age group that comes from the Michigan Association of Administrators of Special Education (MAASE). I will comment on this later.

Now is the time to take action!

The legislative Spring Break starts March 28 and lasts to April 11, 2011. It is important that each of us contact our legislators this week. 

• Tell them about what services are important to you and why. 
• Remind them that persons with Developmental Disabilities are among the most vulnerable in the State. 
• Tell them you are counting on them to protect programs

In addition, ask that your legislators keep you informed of any proposal to change state law and request that there be public hearings to allow students and families to make their views known if any changes are proposed.

You have the most influence with your own State Representative and State Senator. Find out who they are, if you do not already know. Click here for information on Washtenaw County state legislators.

Additional suggestions to get your message across to your legislator: Find out who in the legislator's office handles special education and other disability issues. Talk directly to that person and send written comments to relay to your legislator. Find out if there are events for constituents during the Spring Break and meet your legislator in person. Follow up later with a phone call to ask if there is any new information on legislation or hearings on these important issues.

Michigan governor's proposed budget: not all bad news for people with disabilities

On February 17, 2011, Michigan's Governor Rick Snyder laid out his budget proposal for fiscal year 2012. FY 2012 begins October 1, 2011.

There is some good news in the proposal for people with developmental disabilities. This is from an AnnArbor.com report on the highlights of the governor's budget:

• Medicaid eligibility is maintained and provider reimbursement rates are supported without reductions to preserve health care and access for those most vulnerable. 
• A Medicaid budget that is funded at $11.2 billion, reflecting the institution of a new 1 percent health care insurance assessment on all paid health care and dental insurance claims. 
• The preservation of over $1.4 billion in funding for programs that assist nearly 55,000 special education students, as well as $1.2 billion for core education programs such as services for academically at-risk students and adult education.

Schools and Universities, however, will be taking a big hit in the proposed plan. K-12 funding will be reduced by 5 % or $500 million. The state will encourage schools to adopt  "best practices" that generate savings on medical benefits for employees and reduce spending on "non-instructional" services. It remains to be seen whether there are additional savings to be squeezed out of already stressed school district budgets.

Another problem is the "elimination of statutory revenue sharing payments for cities, villages and townships in fiscal year 2012 to be replaced with a new incentive-based revenue sharing program available to cities, villages and townships that meet state standards and adopt best practices."  This amounts to a reduction of nearly one-third of revenue sharing funding available to local governments. Local governments will have less to spend on safety, fire protection, and other local services and the mental health system will have more difficulty serving people who are not eligible for Medicaid. They will not be able to shore up the mental health system to provide services that are needed but not necessarily mandated or covered by Medicaid. This exacerbates the problem of declining revenues from property taxes for local governments. A more detailed analysis of the impact on Washtenaw County is covered in an article from AnnArbor.com.

There will also be less money available for poor people with the elimination of Michigan's contribution to the Earned Income Tax Credit (EITC). Snyder says that the money saved will go into maintaining Medicaid and other services for the poor, but Stephen Henderson, a columnist for the Detroit Free Press has a good point: while the budget calls for eliminating tax breaks for wealthier people, "poor people will take a bigger hit, relatively speaking than everyone else". This will also effect small businesses, especially in Detroit where the EITC reduction will take $330 million out of the local economy.

In an interview with the Detroit Free Press, the Governor explains the thinking behind the balancing act that his administration did to justify the changes he is proposing. Last Sunday's Detroit Free Press editorial page, not known for its support of Republican budget initiatives, is surprisingly mild in its criticism of the governor's proposals. Michigan's budget problems have been long in the making and there is a tendency to hope, perhaps beyond reason, that these proposals will help.

The Governor's non-ideological approach to Michigan's problems and his eclectic method of problem-solving are mulled over by Free Press columnist Brian Dickerson in his assessment of the governor as "A mild-mannered radical". Dickerson foresees the possibility of attacks from both ends of the political spectrum, but says that "Snyder's ace in the hole is the voters' widely shared conviction that Michigan's fiscal disease cries out for nothing less than radical surgery."

So far, the governor appears to have avoided a full-frontal Wisconsin-style assault on public employee unions, but one can expect that local adjustments will inevitably lead to losses in wages and benefits for public agency employees, if the governor's budget is adopted.

Michigan's Medicaid budget approved by Legislature

A Detroit Free Press article reports that the Michigan Medicaid budget for the 2011 fiscal year has finally passed both houses of the Legislature and awaits the Governor's signature. With $650 million of federal stimulus money, the Department of Community Health has avoided a threatened $50 million cut in mental health services and has restored dental, podiatry, and vision care for all Medicaid recipients. A 4% cut in reimbursement to physicians and hospitals has also been avoided.

In usual fashion, the Legislature has ignored the problem of future deficits starting in 2012 when the stimulus funds are no longer available. Next year, there will be a $500 million gap in the budget, but who cares? It's an election year and a large number of legislators will be gone or will have shifted to another house because of term limits. Tax increases for next year have been suggested by Republican Senator Roger Kahn from Saginaw Township, who predicts that the next Legislature will "enact a combination of spending cuts, reforms and tax increases to avoid a deficit."

The WCHO, the Governor's budget, and DD services

The Washtenaw Community Health Organization (WCHO) board met last night. The Executive Director Patrick Barrie summarized the Governor's proposed budget for the Department of Community Health for fiscal year 2011. It shows an increase in Medicaid funding for MDCH of about 3% and a small decrease in General Fund allocations. This sounds much better than the dire predictions of up to 20% cuts in DCH programs, but the proposals are based on some shaky assumptions:

• that the tax system will be restructured to lower the sales tax and imposes a tax on services;
• that large numbers of teachers and state employees will retire and be replaced with new hires at a lower pay rate and decreased benefits;
• that physicians and hospitals will be taxed to generate more federal funds that will go back to physicians and hospitals;
• and that federal Medicaid stimulus funds will be extended for another six months.

The largest reductions proposed are in funds for people with substance abuse problems. These are often the same people who end up in emergency rooms and hospitals at greater cost to the health care system and the community than if they had received treatment before they reached a crisis situation. There has been much discussion at the WCHO board and committee meetings of plans to provide better access to services for people with mental illness and substance abuse problems. Early access saves money in the long run and generally improves the quality of life for these consumers.

So far in this budget crisis, there has been almost no discussion by the WCHO board of services for people with developmental disabilities other than to say that most people with developmental disabilities qualify for Medicaid and are therefore entitled to services. It helps that Medicaid funding is available and will probably increase.

We know, however, that the Michigan Department of Community Health is targeting for elimination programs for people with the most severe disabilties - group homes, sheltered workshops, and day programs. One might logically think that the state is motivated by a desire not only to save money, but to shift more of the responsibility from serving people with severe and complex disabilities from the state to local mental health agencies. But the state claims to have a higher moral purpose: specialized programs that serve only people with disabilities discriminate against them by isolating and segregating them from people who are not disabled. By eliminating these programs the state serves the noble purpose of rescuing people with disabilities from discrimination.

The mental health system fully supports people with mental illness and substance abuse problems in joining together in clubhouse programs and recovery and support groups. Other parts of the system encourage a full array of options for senior citizens, including group living in independent and assisted living facilities. But when it comes to people with severe developmental disabilities, the state is set on saving them from the horrible fate of having to associate with people like themselves. Now that's discrimination!

Michigan Medicaid cuts: foolhardy or fiscally responsible?

According to an article in the Traverse City Record-Eagle, the Michigan Health & Hospital Association, the Michigan State Medical Society, and the Health Care Association of Michigan are some of the groups concerned about further cuts in Medicaid reimbursement rates for the 2011 fiscal year. The Michigan Senate Majority Leader Mike Bishop, R-Rochester, wants to reduce Medicaid spending by $160 million to $500 million by dropping so-called optional Medicaid services or the number of people eligible for Medicaid.

As people have lost jobs and health care benefits, the state has come to rely more and more on Medicaid: 1.7 million people or 1 in six are now enrolled in the program. As reimbursement rates decline, the number of doctors accepting Medicaid has also decreased, making access to health care more difficult for some Medicaid recipients.

Medicaid funding is a confusing and complex subject. As budget proposals are offered by the Governor and the legislature, I hope there will be some wise people who know a lot more than I do, who will help us understand the comparative wisdom of the choices our legislators will have to make.

Medicaid is a shared state and federal program where the federal government matches state money according to a formula that varies from state-to-state and year-to-year, depending on the state's economic condition and need. Michigan is a very needy state indeed. For every dollar that the state spends on Medicaid, the state gets three dollars from the federal government. While this is not free money, in many respects, Medicaid services are a real bargain. I assume that by maintaining or increasing Medicaid spending, the money could go a long way toward maintaining and increasing jobs in health care and specialty services in the community mental health system and would have a positive effect on the economy.

That the Senate Majority Leader is considering dropping optional Medicaid services, could be a scary proposition. Don't let the word "optional" fool you. These services are lifelines for people with developmental disabilities and their families, as well as for the other populations that Medicaid serves. Here is partial list of optional Medicaid services that people with developmental disabilities have come to rely on:

• Prescribed drugs
• Medical care or remedial care furnished by licensed practitioners under state law
• Diagnostic, screening, preventative, and rehabilitative services
• Clinic services
• Dental services
• Prosthetic devices
• Eyeglasses
• Physical therapy and related services
• Intermediate care facility for the MR
• Home health care
• Case management
• Respiratory care services for ventilator-dependent individuals
• Personal care services
• Private duty nursing services
• Hospice care
• Home and community-based waiver services

Reducing spending on Medicaid and the services covered, looks more like folly than fiscal responsibility to me.

For more information on Medicaid services, including a more complete chart of mandated and optional services, see the VOR 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?

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.

Update on Washtenaw County programs and other budget news

Donna Sabourin, the Director of Community Supports and Treatment Services, attended the last Friends of the Developmentally Disabled meeting on September 24th, 2009 and was able to give us an update on CSTS vocational services to people with DD.

Without knowing how much the Washtenaw Community Health Organization will be getting from state general funds, the WCHO granted an extension of the contract with CSTS for 90 days. Some cuts to CSTS were made final by the Washtenaw County Board of Commissioners, but these cuts did not affect vocational and skill-building services.

According to Donna, the WCHO would like CSTS to continue providing vocational services and to take in two other programs that were contracted to other providers. A work skills program that has provided supported employment services to one group of consumers for 10 years would go to CSTS along with a program for another group of consumers that has has had three providers in 5 years. By taking in these two programs, there will be less choice in providers for employment programs, but it will give the second group of consumers more stability. CSTS has also said that the agency can provide these services without increasing staffing, saving money for the WHCO.

At the time of the Friends meeting, Donna said that a tentative agreement on concessions from the employees union had been reached. According to Annarbor.com, October 7, 2009, Washtenaw County workers union gives up raise to save jobs, the membership of AFSCME Local 2733 has indeed agreed not to take a previously agreed on 3% raise in 2010 and to forgo a salary adjustment in 2011. The agreement will save $5.2 million over the next two years and 120 - 150 county jobs. The union has also agreed to take 8 "bank days", similar to furlough days.

Bob Guenzel, Washtenaw County Adminstrator, according to Annarbor.com, had high praise for the union:

I want to give a special pat on the back to our labor partners...They really came through and, remember, they didn't have to sit down to the table with us at all. They stepped up and, in my mind, really put the county first and put services first.

The Washtenaw County Board of Commissioners also voted unanimously to restore over $442,750 in human services funding in exchange for $450,000 in capital expense reductions. It appears that the county is on the verge of having a balanced budget for the next two years.

The state is operating on a continuation budget for 30 days while the legislature continues to negotiate a balanced budget. At the September WCHO meeting, there was discussion of the likelihood of severe and unprecedented general fund cuts to the Michigan mental health budget. The state seems unwilling or unable to come up with a long term solution to deficits in mental health funding. The impact of reduced general funds for mental health will be felt more by people with mental illness than by those who are developmentally disabled.

The WCHO October meeting is scheduled for Tuesday, October 20th, 2009 from 6 - 8 p.m. at the LRC, 4135 Washtenaw Ave, Ann Arbor. For a schedule of official meetings in Washtenaw County, you can view the calendar of events here.

Constitutional challenge to budget cuts?

This is from the MARO Employment and Training Association weekly update:

MPAS CONSIDERS FILING SUIT AGAINST STATE

Michigan Protection and Advocacy Service (MPAS) stated this week that it is pulling together the agency's legal talent needed to consider filing a Constitutional Challenge against the state of Michigan if the State Legislature and governor move forward with the anticipated massive cuts in services to people with disabilities.

Elmer Cerano, executive director of the nonprofit agency stated, "In our frequent and intensive visits with State officials the answer is always the same, 'we have no money.' Of course we recognize the very real fiscal crisis facing the state; however, we take very seriously the promises of Michigan's Constitution, Article 8, Section 8, which provides:

Institutions, programs and services for the care, treatment, education, or rehabilitation of those inhabitants who are physically, mentally or otherwise seriously disabled shall always be fostered and supported.

Mark Cody, the organization's legal director stated, "Further reductions in General Fund appropriations for mental health services will place the most vulnerable of Michigan's citizens at risk. The state of Michigan is, or may soon be, in violation of the Michigan Constitution by failing to adequately fund services for individuals who are physically, mentally or otherwise seriously disabled."

Cerano has directed the agency's legal team to investigate the feasibility of bringing a Constitutional Challenge against the State for its failure to meet this constitutional requirement. "We will be carefully monitoring the impact of the budget cuts on the lives of people with disabilities," he says.

Elmer Cerano is the Keynote Speaker at the 2009 Michigan Rehabilitation Conference, October 21-23 at the Amway Grand Plaza in Grand Rapids.

Let the Whacking Begin

The Detroit Free Press has a series of editorials on the seriousness of the state budget crisis. If something doesn't happen soon, the cuts will begin in earnest ...

So let the whacking begin. And maybe, when all the Secretary of State's branches are closed for a week or two, and people can't get driver's licenses, and the trash is piling up at unkempt rest areas on highways leading to closed state parks, and businesses can't get anyone at the state to answer their calls, and the court date for which someone has been waiting two years is abruptly postponed, and people are bleeding in emergency rooms way longer than 29 minutes because the places are filled with Medicaid patients whose doctors have quit the system -- maybe then the depths of this state's financial problems will alarm the public enough to compel some action.

What a shame that will be. But Michigan is running out of options for much else.

What are you willing to accept? If the legislature raises taxes, what is the fairest way to do that? Should past tax breaks be revoked? Can we afford to raise taxes? Can we afford not to raise taxes? More money is not the answer to every problem, nor is reducing taxes and spending to the point of destroying government programs that we all rely on. Let your state legislators and the Governor know what you think. Contact your State Representative, State Senator, and the Governor.