Our Vision Statement: Disability Rights California will create opportunities for satisfying work, community service, and family and social relationships

FY 2010-11
PUBLIC POLICY RECOMMENDATIONS
February 10, 2011

The goal of our recommendations is to ensure people with disabilities have the choice to move to or stay in the community ­ in the most integrated and least restrictive environments possible with the supports services they need to be healthy, safe, happy and productive. These recommendations are not reflective of the Governor’s January budget proposals.

Mental Health

  • Ensure adequate funding of and access to community based mental health services so that people with psychiatric disabilities do not end up hospitalized, conserved, committed, incarcerated, involuntarily medicated and homeless.
  • Eliminate outdated service models by phasing out locked Institutes for Mental Diseases, (which use state funds only as they do not qualify for federal Medicaid funds) and increasing the number of individuals who can move from state psychiatric hospitals to the community by expanding the Conditional Release (ConRep) program.
  • Encourage Mental Health Services Act funding of innovative programs that make a difference in the lives of people with mental health disabilities.

Long Term Care

  • Unify the State's long-term care system, with consistent goals that promote home and community based services, and a cost-effective, coordinated budget. Savings from decreased nursing facility utilization will be used to maintain and expand home and community-based services, which will yield a greater benefit to a far larger number of people.
  • Use Medicaid waivers to avoid institutionalizing people by increasing community options:
    1. Reduce state Medicaid costs for nursing homes by modifying the state’s existing Medicaid Home and Community-Based Services (HCBS) waivers so more people can avoid institutional placement;  increase the income limits for services to people who are able to leave institutions.
    2. California’s NF/AH waiver is up for renewal next year and this administration has a unique opportunity to fix problems, such as: 
    • The number of waiver slots available statewide is inadequate to meet the need
    • Level-of-care determinations are stricter for community-based services than for unnecessary placement in costly nursing facilities
    • Waiver coverage for people with need for extensive unskilled care (“between” nursing facility Level B and sub-acute level-of-care) is lacking
    • The cost-cap for community care is low when compared to the cost of institutionalization
  • Increase the Home Maintenance Income Exemption.
  • Retain Adult Day Health Care as an optional benefit within the Medi-Cal fee-for-service program.
  • Repeal the plan to offer bonus payments to Medi-Cal certified nursing homes, a plan that creates the illusion of accountability and has not been proven to improve services to residents.  As drafted, the plan could give bonuses to facilities that have been found responsible for abuse, neglect and deaths of residents.
  • Reinstate the Senior Citizens and Disabled Citizens Property Tax Postponement Law to help eligible elderly and residents with disabilities on fixed incomes remain in their homes by deferring tax payment. This was suspended in February 2009 and was reintroduced as AB 1718 in 2010 by Assemblyman Blumenfield, but was vetoed by the governor.

IHSS

  • Provide In Home Supportive Services (IHSS) so people avoid institutionalization, emergency rooms, and homelessness and remain safe:
    1. The 2010 budget mandates at 3.6% cut in IHSS services through June 30, 2012, and suspends the functional index cuts during that period.  We recommend repealing the functional index cut, which has been enjoined by the courts.
    2. Restore the maximum provider wage and benefit rate the state will fund.
  • Repeal costly requirements for which there is no benefit to the state:
    1. The consumer fingerprinting requirement.
    2. The requirement for consumers and workers to put their fingerprints on each timesheet.

Health

  • Maintain the health of people with disabilities and save the state money in doing so.
  • Ensure that care under the 1115 waiver is equivalent to care available under the fee for service system and includes the following:
    1. Choice of provider
    2. Adequate network of providers and specialists
    3. Enrollee rights
    4. Physical access standards
  • Explore ways to restore Medi-Cal optional services by:
    1. Meeting with California federal reimbursement and Medicaid experts to devise ways to fund and restore the Medi-Cal optional services eliminated or at risk of elimination as a result of budget cuts.
    2. Evaluate whether previous Medi-Cal cuts have produced real savings or have shifted costs within the state budget. 
  • Maintain current categorical eligibility requirements for seniors and persons with disabilities. 
  • Ensure adult dependent children are covered by private health plans pursuant to the Patient Protection and Affordable Care Act.
  • Advise counties about how to use state and local funds up to a Medi-Cal share of cost for California Children Services in order to bring in more federal Medicaid funds.
  • Exercise a more vigorous and proactive role to “pay and chase” after private health plans to pay for services for children with disabilities covered under their parents’ group plans.
  • Reduce state Medi-Cal expenses by accessing pharmacy benefits for low-income veterans.
  • Reduce state Medi-Cal expenses by requiring that private insurance companies cover the full cost of wheelchairs and other medical equipment without arbitrary costs caps.  Approximately 11% of people on Medi-Cal have private insurance; Medi-Cal pays for services that private companies deny, not for lack of medical necessity but because of cost caps so low as to be equivalent to no coverage at all. Department of Health Care Services (DHCS) reported spending approximately 6 million dollars in one year on durable medical equipment for people on Medi-Cal who also have private insurance, presumably because the equipment exceeded the $2,000 cap, which over 90% of California insurers impose on such items.

Abuse and Neglect

Ensure the health and safety of elders and dependent adults by the following:

  1. Amend the Mandated Reporting Act to require reporting of abuse and neglect of elders and dependent adults to law enforcement and the Long Term Care Ombudsman.
  2. Develop a system for reporting and tracking abusive staff.
  3. Ensure prompt and thorough criminal investigation of abuse and neglect in long-term care facilities, including development of specialized prosecution units to address elder and dependent adult abuse; have courts prioritize elder and dependent adult abuse cases.
  4. Require staff training regarding working with people with disabilities for all agencies involved in the abuse response system; ensure that people with disabilities who are abused are connected with Victim Assistance Programs and that staff of those programs are properly trained.

Education

  • Streamline and increase funding for the AB 3632 mental health special education program by:
    1. Transitioning to a new, more efficient system based on recommendations from a legislatively funded study expected in June 2012.
    2. Drawing down new federal Medicaid funds for mental health services for special education students (AB 3632) via a new Medicaid waiver.
  • Ensure access to safe, integrated and local community education programs by:
    1. Using seclusion and restraint as a last resort to prevent harm rather than as a way to address problematic behaviors; ensure the appropriate implementation of behavioral intervention planning.
    2. If the California Supreme Court rules that the Nurse Practice Act requires administration of medications by licensed personnel only, change it to allow administration of medications in accord with health care provider and pharmaceutical company recommendations.
    3. Ensure students with disabilities have access to charter schools by monitoring charter school compliance with federal and state special education and antidiscrimination laws.
    4. Make legislative changes so that students who have disability related absences or disability related behaviors attend IEPs to address the absences before being referred to SARB.

Development Disability Service System

  • Achieve state savings by expanding federal Medicaid reimbursement:
    1. Expand 1915i State Plan Amendment to cover early intervention services.
    2. Explore a provider fee to generate additional revenue to increase federal financial participation such as a provider fee for some regional center services including independent living, supported living and respite.
  • Consolidate state licensing and quality assurance functions for the developmental disabilities system in Department of Developmental Services (DDS) to conserve resources and improve services.
  • Achieve state savings and promote integration and inclusion by reducing reliance on institutions and increasing the movement of individuals with disabilities to quality community living arrangements.
    1. Implement the legislative approved plan to close Lanterman Developmental Center and develop enhanced community services.
    2. Develop plans for closure of two other developmental centers and the small state run community facility.
    3. Expand the availability of specialized health care service homes statewide and increase homes specializing in behavioral models.
  • Expand the tax base by increasing employment and post secondary education options for individuals with developmental disabilities
    1. Improve post secondary education options for youth with developmental disabilities.
        • Work with the Community College Chancellor’s Office to provide appropriate accommodations and supports.
        • Work with local school districts and Department of Rehabilitation to develop meaningful transition plans which, when appropriate, identify post-secondary education as a transition option.
      • Improve employment options for people with developmental disabilities.
          • Provide technical assistance to assist employers in the development of integrated employment alternatives; provide tax breaks to employers who hire persons with disabilities and pay them a minimum wage.
          • Restrict new placements of youth and young adults into segregated employment and day programs.
          • Develop transition plans for individuals who are currently working in segregated employment or day programs to move into more integrated options.
  • Promote choice through development of a more flexible service delivery model.
    • Continue work to expand self directed services either through a federal waiver or a state operated program which promotes individual budgeting, flexibility and choice.
    • Expand the options for seniors with developmental disabilities.
    • Address diversity and purchase of service disparities in the regional center system.
      1. Ensure appropriate representation by communities of color in stakeholder groups.
      2. DDS and regional centers should ensure the delivery of culturally competent services.
      3. Ensure appropriate data collection of unmet needs.
    • Address problems relating to home nursing when children age out of Early Periodic Screening, Diagnosis and Treatment (EPSDT) services.
      1. DDS and DHCS should meet and develop a protocol for a timeframe and process to coordinate on individual cases.
      2. DDS and DHCS should issue a timely and adequate notice informing the individual of his or her right to file for a Medi-Cal or regional center administrative hearing, and about the availability of aid paid pending the hearing decision.
      3. DDS and DHCS should issue written directives and provide training on this protocol for In-Home Operations staff and regional centers. 
    • Require that private insurance companies cover essential durable medical equipment and pay for other medically necessary therapies and not shift the cost to regional centers.   

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