Save Our Services Campaign

Photos courtesy of the ANCOR National Advocacy Campaign's "Cost of Compassion" video. Access the video by clicking on the images and learn more about issues surrounding the direct support professional workforce here.

Senate AHCA Harms IDD Supports and Services

Medicaid is essential in making sure that people with intellectual or developmental disabilities (IDD) can live in society and outside of segregated, state-run institutions.

On June 22, the Senate released its version of the American Health Care Act, now called the Better Care Reconciliation Act of 2017, 142 pages of proposed legislation that built off the House passed version from May. READ THE BILL HERE.

Intelligence that ANCOR gathered over the past week that the bill would harm disability services is now reality. A vote is expected to occur on Thursday, June 29.

This leaves very little time to try to Save Our Services.

The Senate bill proposes extreme cuts to our programs:

Medicaid fundamentally changes into a per capita cap program beginning Fiscal Year 2020.
The base year calculation in the Senate version changes use of the FY16 fiscal year to an average of 8 consecutive quarters between first quarter FY14 and third quarter FY17.
- ANCOR has made the point in the Senate that several states have decade old rates so while we appreciate the effort to address, this is not helpful.
Importantly, the Senate version DECREASES the amount to disability programs by changing the growth rate from the House version of CPI-M + 1% for blind/disabled programs to CPI-M+1% until FY2025 and then it drops off to CPI-U from thereon out.
- To understand the impact of this, check out this Urban Institute piece. In a nutshell, the CPI-M is projected to grow at about 3.7% over the next decade, CPI-U is projected to grow at 2.4% over the next decade. The Senate is creating more federal "savings" with this change.

Use the links to the right of the page to speak up for Medicaid NOW!

ANCOR's one-pager with talking points can be found here.

ANCOR's memo explaining challenges with the AHCA can be found here.

ACA Repeal and Replace / Medicaid Reform Proposals to Date:

American Health Care Act of 2017: as passed by the U.S. House of Representatives on May 4, 2017, including two amendments (on a separate tab on the linked page).
Congressional Budget Office's Score for the AHCA: Page 2 shows estimated loss of coverage, and pages 10 and 23 mention Medicaid specifically.
American Health Care Act Draft: This is the latest draft of legislation, which is slated to be marked up on March 8, 2017. Summaries of the bills are available from the Energy & Commerce and Ways & Means Committees.
Updated - February 26 Republican Governors Plan: Here is a version of the Republican Governors Association's Plan that was updated two days after the version listed below.
Leaked House Leadership Legislation: Originating from House Republicans, this draft bill proposes to repeal Medicaid and impose per capita caps. ANCOR’s summary of the bill can be obtained here, although it must be noted that House Republican Leadership says this copy is no longer viable.
Leaked Republican Governors’ Plan: Republican governors have emerged as an important group in Medicaid reform discussions, due to the challenge of conservative states that expanded Medicaid. This proposal promotes greater flexibility in how states design their Medicaid programs, including per capita caps or block grants – click here for a summary.
House Energy and Commerce Committee Bills: This posting summarizes three smaller bills which would enact more piecemeal reforms to Medicaid in order to generate savings, which would then be used to reduce waiting lists.
Senators Cassidy and Collins' Proposed Patient Freedom Act: Described as the more moderate proposal, this bill offers states the options of either: keeping the Medicaid expansion, enrolling in an alternative per-capita caps plan or not having any state-level plan.
A Better Way Health Care Platform: As part of the Republican platform during the 2016 election, Speaker Ryan released the “Better Way” report highlighting the party’s policy priorities across several sectors. This link connects to the health care platform specifically, which serves to give an understanding of the Speaker and the GOP’s goals in reforming healthcare.

External Resources to Understand Per-Capita Caps and Block Grants:

Kaiser Foundation Data Note: This analysis dating from March 2017 compares how actual Medicaid spending would compare to the funding limits that are similar to those proposed in the AHCA.
Kaiser Foundation Medicaid Page: This dedicated page contains multiple informative analyses of the Medicaid expansion and repeal/replace proposals, including: 5 Key Questions: Medicaid Block Grants and Per Capita Caps and an informative video.

Avalere Report: This report explains how capped funding in Medicaid could significantly reduce federal spending.

State by State Medicaid 2017 Per Capita Expenses Chart: This chart shows state by state 2017 federal Mediciaid expenses, at the aggregate level and then by group. The chart is from pages 6-7 of this Urban Institute report.

National Governors Association Presentation: Here is a presentation by Avalere on the ACA expansion, commissioned by the National Governors Association. Slide 24 in particular compares recent Medicaid growth with what it would be under per capita caps.

National Health Law Program Fact Sheet: This fact sheet explains differences between per-capita caps and block grants.

GAO Discussion Paper: This paper lays out key considerations for designing a per-capita cap on federal funding.

Further Background - Intellectual/Developmental Disability Services, Workforce and Changes in the Medicaid Program:

By assisting individuals with intellectual and/or developmental (I/DD) with their employment, daily care, social outings, medication and other health needs, I/DD services facilitate individuals’ active and engaged lives in the community, near their loved ones and friends instead of segregated state-run institutions. These services are offered across individuals’ lifespans and are almost entirely funded by Medicaid. In the Medicaid federal-state partnership, the federal government covers a share of the budget laid out by state, and states set fix reimbursement rates that I/DD service providers cannot negotiate. Currently, Medicaid rates are too low for service providers to be competitive employers. The resulting low wages are the lead cause of a workforce crisis in the direct support occupation, with a 45 percent turnover rate nationally.

This means individuals’ needs are unmet because there are not enough direct support professionals to staff them, leading to waiting lists across states. Individuals can wait for years to receive supports, which can take a large toll on their and their families’ well-being. Because the Bureau of Labor Statistics has identified demand for this occupation as one of the fastest-growing in the country, the seriousness of the crisis is unlikely to subside. Providers want to be able to employ more staff, but changes to Medicaid funding could affect their ability to do so and exacerbate the work crisis if proposals do not take into account providers’ need to strengthen the workforce.

In order to further understand challenges already faced by IDD supports providers even before any proposed Medicaid cuts are factored in, please read ANCOR’s suggestions to preserve and strengthen the Medicaid system while helping people with IDD succeed in the following documents:

ANCOR's Letter to the Senate Finance Committee; and

ANCOR's Letter to U.S. Health and Human Services Secretary Price and Centers for Medicare and Medicaid Services Director Verma.

Take action through our links to the right of the page to bring attention to this critical issue.

Photos courtesy of ANCOR member PAR's "Fix the DSP Crisis" campaign video. PAR represents Pennsylvania providers statewide. To learn more and see the video, click on the images.

Use this site as a resource as you navigate proposed changes to the Medicaid system and its potential impact on I/DD services, especially our workforce.

Speak Up for Medicaid!

The Senate has issued its own version of the American Health Care Act with extreme cuts that would decimate IDD supports. Call your Senators NOW to ask them to vote NO on the AHCA!

If your Senators already oppose the AHCA, then please ask your families, friends and networks in AK, AZ, CO, FL, ME, NV and WV to contact their Senators, who are deemed key votes, and ask them to vote NO.

Further Resources to TAKE ACTION:

Schedule an In-District Meeting: To help you with advocacy in your home states, we have prepared a new sample in-state meeting request that you can download in Microsoft Word, personalize and then copy into an email. It can be used by self-advocates, families and providers alike. We also prepared a list of in-state scheduling staff whom you can write to in order to schedule a meeting.

Attend a Town Hall: Because of the opportunity to interact directly with your Member of Congress and ask them questions, participating in town halls is a very effective way to bring attention to your concerns. You can find out when the nearest town hall will be held next to you through the Town Hall Project. Please consult our townhall instructions and a sample comment to prepare. The comment was updated to reflect the same messaging as the one-pager on the AHCA above.

Invite Your Member of Congress to Visit Your Agency: Senators are always on the look out for photo opportunities with their constituents, so one way to make your advocacy compelling is to invite them to visit your agencies. Please consult our template for a site visit invitation, also in Microsoft Word so you can easily download and personalize it in the highlighted areas. Use the contact list of schedulers shared above to invite your Senators to come see your work firsthand. You may also benefit from inviting in-district staff to visit.

If you can come to DC to advocate: Use this list of DC Senate schedulers to request meetings with your Senators at least two weeks in advance. You may also want to consult this list of Congressional staff who work on health issues and cc them in your meeting request so they can join the meeting. They are the ones who are knowledgeable about the issues. Here is a sample DC meeting request you can use. Please keep in mind that you will be a more effective advocate if you treat these staff and staff lists with respect and courtesy. Contact Ms. Doris Parfaite-Claude, Government Relations Manager at dparfaite-claude@ancor.org for more information on advocating in DC.

Resources to Understand and Explain the Issue:

The AHCA - Areas of Concern for Providers: This short memorandum outlines some of the main concerns regarding the fundamental changes proposed to the structure of Medicaid financing.
Why the AHCA is Harmful to the Disability Community: This one-pager explains how the House version of the AHCA affects people with disabilities and providers. Use it to learn about the issue and print out extra copies to give when you meet with Senators and/or their staff.
Easy to Understand Medicaid Explainer: Courtesy of ASAN, here is a plain-language toolkit which explains Medicaid (including what it does, pays for, and what are waiver services).
ANCOR Introduction to Advocacy Webinar: Slides that will help you prepare for any Congressional meetings, including what to expect and messaging you can use. This will be particularly useful for those planning on flying into D.C. for ANCOR's June 6 Advocacy Day.
Additional Resources - protectmedicaid.org put together a large collection of informative materials on the AHCA and additional coalition efforts, which will further enrich your understanding of the issue.

On June 6, 2017, ANCOR asked the Senate to "vote no on the AHCA" through a simultaneous Capitol Hill advocacy day, call-in day, and the #SaveMedicaid rally with over 40 partner organizations. Click here for links to photos and more!

Stay tuned for more advocacy content and opportunities!