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.

WOW! Michigan increases dental benefits for adult Medicaid recipients!

This is from the Michigan Department of Health and Human Services: As of 4/1/2023, the  State has expanded dental services and now reimburses dentists at 100% of the Average Commercial Rate for Medicaid beneficiaries

I missed this. My son Danny, who passed away last October, was most in need of this. As his seizures increased and other disabilities became more debilitating for him, his safety outside of a hospital setting could no longer be assured. For a number of years, I was so disgusted by the Medicaid dental care that was available to him that he went without. I don't think he ever had a cavity and there was no indication that he was having dental problems, but he required sedation for his teeth to be examined and X-rayed. The Medicaid provider was not willing to do this without putting us through a long period of proving he needed sedation and making us wait for extremely long periods of time for appointments. My son Ian, on the other hand, is surprisingly amenable to having a private dentist and dental hygienists clean his teeth, do X-rays, fill cavities, etc.

I'm sure it will take time for this to have full effect, especially in persuading dentists to take on difficult-to-care-for patients with disabilities, but it is very encouraging.

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MDHHS expands dental benefits for Medicaid beneficiaries
April 03, 2023

To improve access to dental services, the Michigan Department of Health and Human Services (MDHHS) has expanded dental benefits for adult Medicaid beneficiaries and increased rates for dental providers. This redesigned benefit will directly help beneficiaries by increasing access to services, enhancing care coordination and improving health outcomes. Benefit enhancements and service delivery began April 1.

“This positive change recognizes the strong correlation between oral and physical health outcomes,” said Elizabeth Hertel, MDHHS director. “With better services and closer care coordination, we can maximize opportunities to create healthy outcomes for beneficiaries of all ages while also expanding the number of providers so Michigan’s residents can get care where and when they need it.” 

The $85.1 million investment in increased reimbursement and $30 million in redesigned benefits will not result in any loss of services, and many recipients will have new services added. For beneficiaries who are 21 years and older, the following services will now be covered:

    •    X-rays
    •    Teeth cleanings
    •    Fillings
    •    Extractions
    •    Dentures
    •    Deep teeth cleanings (New)
    •    Sealants (New)
    •    Root canals (New)
    •    Crowns (New)
    •    Care to keep your gums healthy (New)
 
Changes reflect input from a broad array of stakeholders and lessons learned from the Healthy Michigan Plan and Pregnant Women dental programs. In addition to the expanded services, MDHHS has made changes to improve beneficiary access and provider participation, as well as expand access to robust care coordination services that ensure beneficiaries are supported in accessing the services they need. 

As a first step in the redesign, a policy that substantially increased reimbursement rates for Medicaid dental services was implemented Jan. 1, 2023. Providers are now being paid at 100% of the Average Commercial Rate, ensuring access and incentivizing providers to treat Medicaid beneficiaries.

“The reimbursement rates for providers were very low under the old adult dental Medicaid program,” said Dr. Vince Benivegna, President of the Michigan Dental Association. “Dentists would lose money by treating adult dental Medicaid patients. As small business owners this was not sustainable. The new rates recognize the value of quality care and will allow more dental health providers to treat Medicaid patients.”

Medicaid beneficiaries will not lose any dental care benefits with these changes; however, the way services are delivered may change slightly. Medicaid beneficiaries aged 21 years and older, including Healthy Michigan Plan beneficiaries and pregnant women who are enrolled in a Medicaid Health Plan, Integrated Care Organization or Program of All-Inclusive Care for the Elderly will receive dental benefits through their health plan. The health plan becomes responsible for the beneficiary’s dental services obtained through the health plan’s dental provider network. The health plans will continue to provide robust care coordination and ensure that beneficiaries are supported in accessing the services they need.

Dental services for beneficiaries who are not enrolled in a health plan will be provided through the Medicaid FFS program.

For questions, beneficiaries can call the Beneficiary Help Line for free at 800-642-3195 (TTY: 866-501-5656) or send an email to beneficiarysupport@michigan.gov.

Providers can call 800-292-2550 or email providersupport@michigan.gov.

Canadian wildfires cause breathing problems in Michigan

I am jumping in here after too many months of silence on my blog with a report on poor air quality in Southeast Michigan. This is one of those issues that can leave people with disabilities and their families especially vulnerable to bad health effects. The Detroit Free Press covers this story in an article by Christina Hall, "Smoke from Canadian wildfires creates respiratory hazards for southeast Michigan residents", 6/7/23. The article includes a survey of local health systems that are experiencing increases in emergency department visits along with expert advice on how to avoid the worst health outcomes from poor air quality:

"Dr. Lawrence MacDonald, chief of pulmonary medicine at DMC Huron Valley-Sinai Hospital in Commerce Township, said most people shouldn’t be affected because their body can handle added dust or allergens in the air.

"However, these air conditions can exacerbate respiratory issues, especially asthma or chronic obstructive pulmonary disease.

"'You can end up sick. You can end up wheezing and coughing and short of breath. If you’re sick to begin with, you could end up in the hospital. So, the best therapy would be it’s always best to avoid things that trigger lung disease,' MacDonald said." 

...

"The Southeast Michigan Council of Governments recommends people and businesses do what they can when high levels of ozone are expected, because breathing high concentrations of ozone can cause health problems, particularly for elderly people, children and people with asthma or other respiratory issues."

Here are SEMCOG's recommendations:

• Delay mowing lawn until evening or the next day.
• Avoid refueling your vehicle during daylight hours.
• Drive less, telecommute, bike or walk.
• Delay or combine errands to reduce traffic congestion and air pollution.
• Reduce electricity use. Adjust your thermostat a few degrees higher and turn off lights, computers and other electrical devices when not in use.

Another piece of advice from the CDC (U.S. Centers for Disease Control and Prevention) is to wear an N95 mask, as recent research found those masks reduced hospitalizations from wildfire smoke by 30%.

I will not point out the irony of opponents of mask-use during the COVID pandemic, who, because of their own health vulnerabilities, are donning masks and staying indoors, except to assure everyone that these warnings are not a hoax!

Ohio: A Joint Committee finds the current system of protection and advocacy intentionally fails to protect and advocate for all individuals with disabilities

The Federal Developmental Disabilities Assistance and Bill of Rights Act of 2000, (The DD Act), establishes Protection and Advocacy agencies in all 50 states and territories. According to the Federal Administration on Community Living, "Protection & Advocacy agencies (P&As) comprise the nation's largest provider of legally-based advocacy services for people with disabilities."

P&As have the legal authority to:

• Investigate suspected abuse or neglect and seek justice for victims and their families.
• Have access to records and facilities necessary to investigate abuse or neglect or to monitor the treatment and safety of residents.
• Pursue litigation and all other appropriate remedies under federal, state, and local law.
• Provide information and referrals regarding entitlements to services and other legal rights.
• Educate policymakers on needed reforms to disability-related laws and services.

The names of these organizations vary from state to state: In Michigan, the designated agency is Disability Rights Michigan. In Ohio, Disability Rights Ohio is the State's P&A agency. In Illinois it is "Equip for Equality" .  The National Disability Rights Network represents P&A systems nation-wide.

The P&A systems often advocate for people with disabilities beyond developmental disabilities. In Michigan, according to the Website, "Disability Rights Michigan (DRM) is the federally mandated protection and advocacy system for Michigan, which receives part of its funding from the HHS-Administration for Community Living, DOE-Rehabilitation Services Administration, HHS-Substance Abuse & Mental Health Services Administration – Center for MH services, Social Security Administration, and the State of Michigan".

The hearings held by the Ohio Joint Commission were mainly focused on people with Intellectual and Developmental  Disabilities, many of whom live in Intermediate Care Facilities for people with IDD. P&A organizations have been at the forefront of trying to close or drastically downsize these facilities for decades, despite the fact that these are highly regulated facilities, sanctioned and funded by Medicaid. Attempts to close them down have been met with fierce opposition from the people benefiting from these services and their families.They provide treatment and residential services to people with severe and profound disabilities. 

There was also testimony supporting facility-based employment for people who could not otherwise compete for jobs in integrated employment. P&A along with many other advocacy organizations are attempting to close down these programs, despite support for them from people with IDD and their families who benefit from them.

Testimony was also heard from supporters of DRO. Many described abusive conditions that they had endured in residential facilities, but mostly these were  nursing homes or psychiatric facilities that are not specialized for people with IDD. 

This is from the VOR Weekly Update for April 14, 2023:

Ohio - Joint Commission Recommends Redesignating State's Protection and Advocacy Agency

On April 11, 2023, Ohio's Joint Commission to Examine the State Protection and Advocacy System and Client Assistance Program recommended to the Governor that the state "redesignate" its P&A, having found Disability Rights Ohio for "intentionally not protecting and advocating for all individuals with disabilities."

The report came in response to hearings on Nov. 1 and Nov. 15, 2023 in which families testified about their dissatisfaction with the DRO's actions and biases against people in ICFs and sheltered workshops.

Excerpted from the report:

"[T]estimony given by parents, guardians, and family members expressed concerns over DRO’s administration of its service system. Specifically, the testimony described DRO’s excessive litigation against the State to which families objected. It also described DRO’s efforts to promote transfers of residents out of ICFs, sheltered workshops, and facility-based day programs into community settings without regard to individual choice and parental rights. 4 Those efforts included DRO staff meeting privately with ICF residents without their guardians or parents present to encourage them to leave their ICF placement.

"Furthermore, the testimony indicated unilateral actions taken by DRO to target ICF settings, day programs, and workshops, without seeking cooperation from families and ignoring families’ advocacy to preserve these settings. Witnesses stated DRO’s actions run counter to health and safety needs and disregard the informed decision-making of families. Moreover, witnesses emphasized the importance of the specialized services and expertise offered in ICFs to support individuals with complex physical, medical and/or behavioral needs.

"The witnesses also touched on the issue of aging caregivers, and the importance that families have access to intermediate care facilities to appropriately address the needs of their loved ones when they are no longer able to provide that care. In addition, witnesses stated that it is vital for policymakers to underscore and promote a multi-dimensional strategy, which includes access to ICFs, sheltered workshops, facility-based day programs, and community-based residential and work settings. However, witnesses stressed that DRO takes a one-size-fits-all approach preferring community settings to the detriment of other options. In its adherence to this approach, families are concerned that DRO acts adversely to their disabled family members’ interests who require higher levels of specialized care."

Download the report here

The hearings may be viewed here:

November 1 Hearing: https://ohiochannel.org/video/ohio-joint-committee-to-examine-the-protection-and-advocacy-system-11-1-2022

November 15th Hearing: https://www.ohiochannel.org/video/ohio-joint-committee-to-examine-the-protection-and-advocacy-system-11-15-2022

Ohio has a provision in its state code that calls for hearings before the state legislature every two years allowing families to testify about the state's Protection and Advocacy agency.

This section of the State Code may be found at https://codes.ohio.gov/ohio-revised-code/section-5123.603

We hope that other states will follow Ohio's lead and add such provisions to their own state codes.

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More information on DD Act Programs from The DD News Blog: DD Act programs, "for better and for worse"

Inaugural Michigan Legislative Disability Caucus - April 21, 2023 at 9:30 a.m.

 From the Michigan Developmental Disabilities Council:

The Inaugural Michigan Legislative Disability Caucus Meeting is 

Friday, April 21, 2023, at 9:30 a.m. 

The Michigan Legislative Disability Caucus will hold its first meeting on Friday, April 21, 2023, at 9:30 a.m. via Zoom. This platform is a place where legislators, people with disabilities, family members, advocates, and self-advocates can come together to talk about issues important to people with disabilities as well as learn from our lawmakers about the disability issues that are important to them.

The first meeting we will hear from lawmakers and staff sharing what their legislative priorities are regarding disability specific issues. We look forward to hearing how we, the disability advocacy community, can work collectively with our Michigan legislature to enhance the lives of people with disabilities throughout the state. 

To join the meeting, click the link below.

DISABILITYCAUCUS

We hope to see you on Friday, April 21, 2023, at 9:30 a.m.  

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It is important that they hear from a broad spectrum of the disability community including people with more severe disabilities and their families who are often left out of policy discussions.

Micki Edelsohn's book "Mom with a Megaphone" is now available on Amazon

"Mom with a Megaphone" by Micki Edelsohn is now available on Amazon! 

See the review by Jill Escher from the National Council on Severe Autism:

The Homes that Micki Built: "Mom with a Megaphone" by Micki Edelsohn

A 2022 Appeals Court decision in a Washtenaw County case restored a favorable ruling in an administrative hearing to a DD adult.

FYI: (This case was decided in February 2022.) The guardian of a DD adult requested an administrative hearing to determine whether an increase in the adult's budget from CMH was necessary to allow him to achieve his goals written in an Individual Plan of Service. Ultimately, an administrative law judge in an appeals hearing sided with the adult with DD and his guardian. WCCMH appealed the decision to the Circuit Court. It turns out the law says that the administrative law decision is final and WCCMH had no right to appeal the decision. Here is a summary and explanation of the case from the Website of Disability Rights Michigan.

Wiesner: Making sure that when Michigan Medicaid recipients win administrative appeals, the win is final.

Case Status: Resolved

Case Filed: March 2019

Main Concern

Under federal Medicaid law, Medicaid recipients have the right to challenge decisions made by the state Medicaid agency and its contractual agents, like local community mental health organizations (CMHs).
These challenges come in the form of administrative appeals. The concern in this case was that the recipient won his administrative appeal, but the CMH then appealed the favorable hearing decision to a judicial court. [emphasis added]

Summary 

Kevin Wiesner receives services from Washtenaw County CMH (WCCMH). In 2019, Mr. Wiesner’s guardian told WCCMH the budget given for his services was not enough to do what those services were supposed to according to Mr. Wiesner’s individual plan of service (IPOS). Mr. Wiesner’s guardian asked for more money, which WCCMH denied. Mr. Wiesner appealed that decision, and an administrative law judge (ALJ) found Mr. Wiesner was right: his budget was indeed insufficient. 

WCCMH then appealed that decision to the Washtenaw County Circuit Court, even though, WCCMH is a contractual agent of the Michigan Department of Health and Human Services (MDHHS), and ALJ decisions are the final decisions of MDHHS. The Circuit Court reversed the ALJ’s decision. Mr. Wiesner then appealed from the Circuit Court to the Michigan Court of Appeals, which held that Medicaid agencies like WCCMH do not have the right to appeal ALJ decisions. This reinstated the ALJ’s decision.

Outcome

The Michigan Court of Appeals held in a published decision that Medicaid agencies (MDHHS and its contractual agents) do not have the right to appeal ALJ decisions, because ALJ decisions are the final decision of MDHHS. This reinstated the ALJ’s decision in favor of Mr. Wiesner.

Details

March 2019
Mr. Wiesner requests an increased budget from Washtenaw County CMH (WCCMH), to achieve the goals in his individual plan of service (IPOS). WCCMH denied the request. Mr. Wiesner would later request an internal appeal.

July 2019
After the internal appeal, WCCMH upholds its own denial of Mr. Wiesner’s requested budget increase.

November 2019
Mr. Wiesner appeals WCCMH’s internal appeal decision to the administrative court.

January 2020
The Administrative Law Judge rules in favor of Mr. Wiesner, finding that his budget is not enough to achieve the goals in his IPOS.

May 2020
WCCMH appeals the ALJ’s decision in favor of Mr. Wiesner to the Circuit Court.

November 2020
Circuit Court denies Mr. Wiesner’s arguments that WCCMH has no right to appeal the ALJ’s decision and reverses the ALJ’s decision.

March 2021
The Michigan Court of Appeals grants Mr. Wiesner leave (gives him permission) to appeal the Circuit Court’s order.

April 2021
Mr. Wiesner appeals the Circuit Court’s decision to the Michigan Court of Appeals.

February 2022
The Michigan Court of Appeals reverses the Circuit Court and reinstates the ALJ’s decision, holding that WCCMH has no right to appeal the ALJ’s decision.