Government Report 

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The House and Senate approved their budget resolutions for Fiscal Year 2000 on March 25 along party lines. The budget resolution is Congress’ overall framework for decisions on how to spend money collected from taxes and other revenues. This year’s budget will likely have a devastating impact on domestic discretionary programs. With plans to stay within the budget caps set in 1997, to provide major tax cuts and to increase spending in defense and for education programs, Congress may need to cut non-defense discretionary spending by as much as $46.4 billion next year and $10 billion more the following year.

According to Sen. Pete Domenici (R-N.M.), chair of the Senate Budget Committee, the Senate’s budget resolution would save Social Security (by putting it off-budget), save Medicare (by creating a $133 billion reserve fund), reduce the national debt, increase spending on defense (by $10 billion), elementary and secondary education ($3.3 billion), farm support ($6 billion over five years), and veterans programs (about $1 billion), and cut taxes by almost $800 billion over the next decade ($15 billion next year and $142 billion over 5 years). At the last minute, funding was reserved within the Senate budget resolution to fund the Work Incentives Improvement Act.

If this budget is enacted, non-defense discretionary programs – including many disability programs, job training, and low-income housing programs -- will have to be cut about 15% from this year's level. While it is good news that education spending will be increased, it is unfortunate and unnecessary that it will be at the expense of other discretionary programs.

Another major concern with the Republican plan is that it contains no specific plans to bolster Medicare, due to run out of money in 2008. For example, the Senate plan to reserve $133 billion for Medicare is actually a reserve fund that can be used for things other than Medicare like debt reduction, or "emergency" spending. The House plan would reserve even less money, $97 billion, and is even less specific about what the money should be used for. The House budget resolution also establishes a "lock box" to protect Social Security funds from being used for anything other than Social Security.

Both Senate Budget Chairman Domenici and House Budget Chairman John Kasich (R-OH) leave most of the hard choices about where to make the cuts to the members of the 13 appropriations subcommittees. Since the House and Senate budget resolutions are not identical, a House-Senate conference will be needed to resolve the differences and final action will not occur until after the spring congressional recess (March 26-April 11).

The Arc has joined with Invest in America, a coalition of over 200 other national non-profit organizations concerned about the lack of adequate public investment in human needs, to oppose the budget resolutions.

HUD has published a number of important Notices of Funding Availability (NOFA) for housing for people with disabilities within the last month. These NOFAs cover tenant-based rental assistance for people with disabilities, supportive housing, fair housing initiatives, lead-based paint initiatives, and community development technical assistance.

Section 811 Supportive Housing

The SuperNOFA published in the Feb. 26 Federal Register announced $87 million for the capital advances component of the Section 811 Supportive Housing for Persons with Disabilities Program. Capital advances may be used to construct, rehabilitate, or acquire structures to be developed into a variety of housing options. Repayment of the capital advance is not required as long as the housing remains available for at least 40 years for occupancy by very low income persons with disabilities. Five-year project rental assistance funds (PRAC) come along with a capital advance and are used to cover the difference between the tenants’ contributions toward rent and the cost to operate the project.

These funds will support 1,436 units distributed on a regional basis. Each HUD office will receive capital advance funds for a minimum of 10 units with any left over amount allocated through a "fair-share" plan. Nonprofit organizations are the only entities eligible to apply for this funding. Applications are due to HUD by May 27, 1999.

Fair Housing Initiatives Program

The Fair Housing Initiatives Program is designed to increase compliance with the Fair Housing Act and with substantially equivalent state and local fair housing laws. There is approximately $15 million available to be allocated in the following manner:

Private Enforcement Initiative: $9.3 million to support private fair housing enforcement organizations in their investigations of alleged fair housing violations. Two to three year single projects are funded at $300,000 and partnership projects are funded at $600,000.

Education and Outreach Initiative: $4.5 million to assist private and public non-profits to operate projects that inform the public about their rights and obligations under the Fair Housing Act. Most of these funds are allocated for 18 month programs through the Regional/Local/Community-Based Program. Some funds are targeted towards improving options for minorities and others specifically targeted to improving options for people with disabilities.

Fair Housing Organizations Initiative: $1.2 million targeted to new fair housing enforcement organizations in underserved areas (limited to those who have previously been funded under this initiative).

The application deadline is April 27, 1999.

Other programs of interest to The Arc listed in the Feb. 26 SuperNOFA and their deadlines follow:

• Community Development Technical Assistance - May 26, 1999

• Lead Hazard Control – May 26, 1999

• Homeless Assistance – June 2, 1999

HUD published three additional important NOFAs in the March 18 Federal Register. One regarding the availability of $48.5 million for new tenant-based rental subsidies for people with disabilities through the "Mainstream" Housing Opportunities for Persons with Disabilities Program (a set-aside in the Section 811 program). A very important modification this year, sought by The Arc and other advocates, is that this funding is available to non-profit disability organizations as well as to Public Housing Agencies (PHAs). Congress directed HUD to make this modification in the FY 1999 HUD appropriations bill and is providing 1,600 five-year rent subsidies to both non-profit disability organizations and PHAs qualified to administer the program. Nonprofit disability organizations and PHAs may each apply for up to 75 vouchers. Applications that meet a basic threshold screening will be put into a lottery for funding.

This announcement by HUD is critically important for people with mental retardation and other disabilities because it is the first time that non-profit disability organizations have been eligible to apply for Section 8 tenant based rent subsidies. This program is new and it is important for non-profits to be able to compete successfully. Therefore, funds have been provided by the Melville Charitable Trust and the Joseph P. Kennedy Foundation so that the Technical Assistance Collaborative can provide guidance to interested chapters of The Arc. Please contact Christina Chang at TAC (617) 742-5657 for more information about technical assistance. Information is also available on the CCD Housing Task Force Opening Doors Web page at http://www.c-c-d.org/doors.html; the HUD web page at http://www/hud.gov/fundsavl.html; or the TAC web page at http://www.tacinc.org/.

During the past three years, HUD made these funds available only to PHAs through the Section 8 Mainstream Program for People with Disabilities. Unfortunately, only 11 percent of PHAs were willing to apply. When a PHA refused to apply, disability advocates had no other way to obtain these rent subsidies for people with disabilities in their communities who desperately needed them. In addition, 29 percent of those PHAs that did not apply believed that there was no need for this rental assistance for people with disabilities! The Arc and other advocates know that there is a need and are hopeful that making this rental assistance available to non-profits will get the assistance to the people who need it.

According to the NOFA, in order to be eligible to apply, a nonprofit organization must have the experience with or the capacity to:

• administer rental housing programs or manage rental housing (e.g. private rental housing, HUD or state-related housing programs);

• carry out Section 8 related activities such as: making determinations as to rent reasonableness; performing housing quality standards (HQS) inspections and enforcement; conducting annual reexamination of participant families; and meeting other Section 8 requirements;

• meet all program responsibilities including, when requested: assisting program participants to gain access to supportive service within the community; providing housing search assistance; and identifying funding sources and providing technical assistance to owners for making reasonable accommodations or making units accessible to persons with disabilities.

It appears that subsidies for the Mainstream Program — because they are defined as Section 8 subsidies — may not be restricted to particular disability sub-populations. Thus, interested applicants must be able to serve people with different types of disabilities.

The deadline for application has been extended to June 30 (it was originally set for May 7).

Other Section 8 Tenant-based Rental Assistance

The March 8 Federal Register also announced the availability of an additional $40 million in Section 8 tenant-based rental assistance for people with disabilities. Only Public Housing Authorities (PHAs) may apply for these funds. If there is a responsive PHA in a community, advocates should consider continuing to work with their PHA instead of applying directly for the funds available to non-profits. There are several reasons for this (1) PHAs have access to a great many more funds and the responsive ones should be rewarded, and (2) funds for non-profits are limited and should be targeted to those most in need – those with a non-responsive PHA.

The funds are allocated in two ways:

1. $20 million to fund approximately 4,200 Section 8 vouchers for non-elderly people with disabilities in an effort to compensate for units that are lost in public housing due to "elderly only" designation plans;
2. $20 million to fund approximately 4,200 Section 8 vouchers for non-elderly people with disabilities in an effort to compensate for units that are lost in assisted housing due to "elderly only" housing.

The application deadline is June 30.

Partisan Politics Continue to Flavor Managed Care Debate on Capitol Hill

Children and adults with mental retardation and their families need access to affordable high quality health and health-related services and supports. They need this access in the private health insurance market and in Medicaid and Medicare. Many children and adults with mental retardation need greater than average access to specialists or to health-related services, such as therapies, in order to live healthy, independent and productive lives in the community. Managed care -- if designed solely to cut costs – often can be dangerous for people with high health care needs. Despite this serious concern, many people with disabilities have been swept up in the move to managed care. For example, according to the Bureau of Labor Statistics, 74 percent of working people had regular fee-for-service health coverage and only 27 percent were in managed care in 1989. By 1997, the numbers were reversed. Only 27 percent of working people still had fee-for-service health coverage and 73 percent were in managed care.

There must be strong consumer protections built into managed care if it is to meet the needs of children and adults with mental retardation and other disabilities. Of major importance are: strong non-discrimination protections; a definition of "medical necessity" that reflects the importance of maintaining, not only improving, function; access to specialists; strong quality standards and internal and external appeals; the availability of an "ombudsman" to help guide people through the system; and strong, enforceable remedies if harm is done.

Efforts last year to pass managed care consumer protection legislation faced strong opposition from the insurance industry and, unfortunately, became a very partisan issue – eventually dying during the final days of the 105^th Congress. However, this year again, managed care legislation is close to the top of both the Republican and Democratic legislative agendas for the 106^th Congress. This is reflected in the current flurry of activity as numerous bills are introduced and as Congressional committee action begins. So far, there are numerous proposals on the table. The major ones are the Democratic leadership bill, the Patients’ Bill of Right (S.6/H.R.358); the Senate Republican leadership bill, the Patients’ Bill of Rights Plus (S.300/326); and the House Republican leadership bill, the Patient Protection Act (H.R.448) – the same bill that passed the House last year. In addition, a bipartisan "centrist" bill, the Promoting Responsible Managed Care Act of 1999 (S.374), has been introduced in the Senate and a similar bill has been introduced in the House, the Managed Care Reform Act of 1999 (H.R. 719). Other health care leaders in the House and Senate – on both sides of the aisle – are discussing or soon will be introducing bills.

Senate Action

Current major Senate Republican players are Sen. Jeffords (R-Vt.), Chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee; Sen. Frist (R-Tenn.), Chairman of the HELP Public Health Subcommittee; Sens. Lott (R-Miss.) and Nickles (R-Okla.), the Senate Majority Leader and Assistant Majority Leader; and Sen. Chafee (R-R.I.) who introduced the "centrist" bill in the Senate. Current major Democratic players remain Sen. Kennedy (D-Mass.), Ranking Member on the HELP Committee, and Sen. Daschle (D-S.D.), Minority Leader. Waiting in the wings and working on their own bill are Sens. Roth (R-Del.) and Moynihan (D-N.Y.), Chairman and Ranking Member of the Finance Committee.

The Senate HELP Committee marked-up (made changes to) and approved the Republican leadership managed care reform bill (S.300/326) on a party line vote March 18 after rejecting a series of Democratic amendments designed to broaden either the protections or the coverage of the bill. In fact, the Committee rejected every Democratic amendment except one by Sen. Wellstone (D-Minn.) that would allow patients to pay for their own behavioral health care after their coverage runs out – not a big victory for consumers. Committee Republicans did make some changes to the bill because of Democratic advocacy, including some limited improvements in relation to access to specialists and prescription drugs. However, a strong "access to specialists" amendment put forward by Sen. Harkin (D-Iowa) was defeated and a much more limited provision, supported by Sens. DeWine (R-Ohio) and Frist, was passed. Currently, the most contentious issues remain "medical necessity" and plan liability. Sen. Kennedy, with the support of The Arc and other advocates, believes that it is critical that there be some type of definition of medical necessity in the law to keep health plans from using their own arbitrary definitions to refuse coverage for needed services and supports.

House Actions

The Republican health care leaders in the House include the new Speaker of the House, Rep. Hastert (R-Ill.), Rep. Bliley (R-Va.) and Bilarakis (R-Fla.), who are the respective Chairman of the House Commerce Committee and Chairman of the Commerce Committee Health and Environment Subcommittee; Rep. Ganske (R-Iowa), who introduced the bipartisan "centrist" bill in the House and Rep. Norwood (R-Ga.), who has introduced a managed care bill and an affordability bill. Reps. Ganske and Norwood are a physician and a dentist, respectively, and members of the Commerce Committee. Both have already spoken out against the Republican bill that was approved by the Senate HELP Committee. The House Democratic leaders are Rep. Dingell (D-Mich.), Ranking Member of the Commerce Committee; Rep. Brown (D-Ohio), Chairman of the Health and Environment Subcommittee and Rep. Pallone (D-N.J.), a member of the Commerce Committee.

The House Commerce Committee held a hearing on consumer protections on March 24. The hearing was focused on protections that enjoy some bipartisan support, such as coverage of emergency services, access to specialists, and the availability of more information from health plans. However, Reps. Dingell and Pallone raised the issues of medical necessity and plan liability in the hearing. Most Committee Democrats and Reps. Norwood and Ganske pushed for the strongest protections possible during the hearing. At the same time, most Committee Republicans say they want to avoid over-regulation and cost increases.

A hearing was held March 25 in the House Education and Workforce Subcommittee on Employer-Employee Relations on association health plans (AHPs) and Multiple Employer Welfare Arrangements (MEWAs). The Arc and other health care advocates are concerned that these approaches would split the insurance market with healthy people using MEWAs and AHPs and less healthy people being left to pay higher premiums. One of the major supporters of MEWAs and AHPs was former chairman of the Employer-Employee Relations Subcommitee, Harris Fawell (R-Ill.), who has retired. Fortunately, the new chairman, Rep. Boehner (R-Ohio) has indicated that he is skeptical about these plans and understands the concerns of opponents.

There are a number of major reasons why something could happen this year. For one thing, both parties feel the pressure to produce health care reforms for the electorate and both Senate Majority Leader Lott and Speaker of the House Hastert have promised action. For another thing, Speaker Hastert has a longstanding interest in health care reform issues. Even with all the stars in alignment, however, strong managed care consumer reforms continue to face major opposition from the managed care industry and some business interests.

Rematch: HUD Secretary Cuomo Faces Rep. Frelinghuysen
in Appropriations Hearing

HUD Secretary Issues Memo Regarding Consolidated Plan

CCD Testifies on IDEA Funding

Paul Marchand, Director of The Arc’s Governmental Affairs Office and Co-Chair of the Consortium for Citizens with Disabilities Education Task Force, testified on the administration’s FY2000 budget request for programs authorized under the Individuals with Disabilities Education Act. The hearing was held on Feb. 11 by the Senate Committee on Health, Education, Labor and Pensions, chaired by Sen. James Jeffords (R-Vt.).

In discussing IDEA funding, the testimony provided an overall review of President Clinton’s budget request from a disability perspective, as well as an historical review of unmet promise from the federal government to states and schools in the two decades of IDEA’s funding history. The committee was also reminded that all students with disabilities had a constitutional guarantee to a free, appropriate public education, regardless of the availability of federal funding.

CCD decries the administration’s one tenth of one percent increase for the IDEA State Grant program. CCD recommends at least a $500 million increase for Part B. Current Part B funding represents only 12% of the 40% excess cost reimbursement promised by Congress almost twenty-five years ago. CCD is also seeking significant increases in the IDEA Preschool and Early Intervention programs. Calling these programs the "Headstart" for young children with disabilities, CCD seeks funding increase parity between Headstart and IDEA’s early childhood programs.

Priced Out in 1998: The Housing Crisis for People with Disabilities is the latest publication from the CCD Housing Task Force and the Technical Assistance Collaborative. Priced Out was just released in late March and a copy will be sent to each state chapter of The Arc within the next few weeks. It is also available on-line at http://www.c-c-d.org/priced_out_in_1998.htm.

Priced Out was published so that people with disabilities, their families, and advocates can accurately document the housing crisis facing people with disabilities to local, state, and federal policy makers. This information will help advocates clearly show the level of need in their states and communities and help them play a more active role in the development of state and community Consolidated Plans.

Using state and community specific data, Priced Out documents the nature and severity of the housing crisis that people with disabilities face across the nation, especially the over 4 million people with disabilities who receive Supplemental Security Income (SSI). The message in Priced Out is a simple one. In 1998, there was not one county or metropolitan area in the United States when a person receiving SSI benefits could actually follow federal guidelines for affordability and pay only 30 percent of their monthly income for rent. Instead, as a national average, a person with a disability must spend 69 percent of his or her SSI monthly income to rent a modest one-bedroom apartment price at the HUD Fair Market Rent. This is a very important finding because HUD considers any very low income household paying more than 50 percent of their income for rent to have a "worst case" housing need.

Not only are people with disabilities who live on SSI among the poorest of the poor, but they also face the continuing loss of housing in the community as public and assisted housing becomes "elderly-only". A copy of Priced Out is being provided to each Member of the House and Senate so that they and their staffs can be aware of the problems faced in their home states and districts.

Family Support Program Funds Available. The Administration on Developmental Disabilities requested applications for financial assistance under the Family Support Program for FY 1999. The announcement was published in the March 17 Federal Register. States can receive up to $200,000 to fund new or improve existing family support programs. This is the first year that the federal Family Support Program has been funded.

The closing date for applications is May 17. Contact Pat Laird at the Administration on Children and Families (ACF) for application materials at (202) 690-7447; email: add@acf.dhhs.gov or print the application from the ADD web site: http://www.acf.dhhs.gov/programs/add/pns99-fs.htm.

NCD Progress Report Published. The National Council on Disability (NCD) submitted its annual progress report to President Clinton as required under the Rehabilitation Act of 1973. National Disability Policy: A Progress Report reviews federal policy activities in 1998 noting where progress has occurred and making further recommendations.

Overall, NCD reports that the rate of progress for national disability policy is much slower than the disability community had hoped for following the passage of the Americans with Disabilities Act in 1990. The report points out that, in addition to the slow progress being made in many areas of disability policy, a backlash against children and adults with disabilities continues to motivate attempts to weaken important civil rights laws like the ADA and the Individuals with Disabilities Education Act (IDEA).

Opening Doors is published on a quarterly basis as a joint effort by the Technical Assistance Collaborative, Inc. and the Consortium for Citizens with Disabilities (CCD) Housing Task Force. The Opening Doors project also produces special reports and funding alerts. Each state chapter of The Arc receives Opening Doors by mail; however it is also available on the internet at the following address:

http://www.c-c-d.org/doors.html