After a "lame duck"
session, the 106th Congress adjourned, making slow but steady
progress on issues affecting people with disabilities. However,
starting in January 2001 a new Congress and a new President will
face a backlog of proposals on unaddressed issues.
The best news of the year was passage of the Children's Health
Act of 2000, which reauthorized and expanded federal funding for
children's health research. This law creates a Center for Birth
Defects and Developmental Disabilities at the Centers for Disease
Control (CDC) and authorizes "such sums as may be necessary" for its
operations. The next Congress will specify an actual budget for this
Center.
Another victory was inclusion in the Fiscal 2001
Labor-HHS-Education appropriations bill of an amendment providing
$50 million annually for states to develop "Real Choice" programs to
encourage people with disabilities to live in the community rather
than an institution. This legislation was based on a provision of
the proposed Medicaid Community Attendant Services and Supports Act
(MiCASSA).
The Ticket to Work and Work Incentives Improvement Act (TWWIIA)
to develop job-aid programs for people with disabilities will
receive $700 million in Fiscal 2001. However, SSA has yet to publish
the regulations clarifying the implementation of TWWIIA. Other good
news was increased funding for several programs that sometimes fund
services for people with disabilities. Head Start will grow by $1
billion (a 19% increase), expanding the number of participants from
880,000 to nearly 950,000. The Older Americans Act has a new
provision -- the $125 million annual National Family Caregiver
Support Program for activities such as respite care. Overall funding
for education programs was increased by 18%.
A variety of smaller programs also fared well in the
Labor-HHS-Education appropriations bill. Funding to reduce the
"Digital Divide" that disadvantages people who lack access to
computers was increased by $92 million. AmeriCorps received a $2.5
million funding increase to $83.074 million. The National Senior
Service Corps saw an overall increase of $5.729 million. Overall
funding for the Corporation for National Service grew from $731.6
million in fiscal year 2000 to $767.35 million in fiscal year 2001,
an increase of 4.9%. Ryan White AIDS program funding was increased
13%.
Although these increases and a 16% funding rise for the National
Institutes of Health were included in the Labor-HHS appropriations
bill, that bill fell short of hopes for other programs. It reduced
by 3% the amount of funding for the Title XX Social Services Block
Grant (SSBG) used by states to fund many community-based
organizations. However, the bill does allow states the ability to
transfer 10% of their Temporary Assistance to Needy Families (TANF)
funds to SSBG.
Perhaps the year's most disappointing development was Congress'
last-minute failure to pass the Family Opportunity Act (FOA), which
would have given states the option to allow middle-income families
to "buy in" to Medicaid when they have children with severe
disabilities. This would have helped thousands of families who face
bankruptcy each year because of high health costs not covered by
private insurance or the State Children's Health Insurance Program
(SCHIP). FOA was endorsed by more than 300 national
organizations.
Because FOA was sponsored by 79 of 100 Senators, its chances look
good in 2001. This is especially true because its chief Senate
sponsor, Chuck Grassley of Iowa, is expected to become chairman of
the committee with jurisdiction over the bill. This year, the
committee chairman declined to consider the bill despite its
widespread support.
Another bill affecting Medicaid that did pass was the so-called
provider "givebacks" bill to reverse a number of payment cuts made
by the Balanced Budget Act of 1997. Most provisions of the bill will
increase Medicare rates for providers, such as hospitals and
home-health agencies. However, the bill also includes changes making
it easier to conduct Medicaid eligibility determinations in places
such as schools. It adds $700 million to increase the period of
continued Medicaid eligibility for people who obtain jobs and leave
the welfare program. This bill clarifies that Medicare does cover
certain pharmaceuticals that are sometimes administered in
outpatient settings for conditions, such as multiple sclerosis.
In addition, the bill requires the Department of Health and Human
Services (HHS) to issue a final regulation that phased out so-called
Medicaid Upper Payment Limit (UPL) waivers. Under UPL waivers,
states engage in what some call "creative accounting" to maximize
the federal share of payments for Medicaid services, with the
resulting annual total of $3 billion in additional funds used for
purposes ranging from health care and social services to roads and
tax cuts. States with current waivers will be required to phase them
out over a two- to six-year period (depending on the waiver's
initial approval date).
The "givebacks" bill waives the 24-month Medicare eligibility
waiting period for people diagnosed with Amyotrophic Lateral
Sclerosis (ALS), also known as Lou Gehrig's disease. This is because
life expectancy after ALS diagnosis is often less than 2 years. The
bill also included FY2002 spending authorization for the Maternal
and Child Health Block Grant, also known as Title V, which was
raised by $145 million to total $850 million.
The reauthorized Developmental Disabilities Assistance and Bill
of Rights Act of 2000 includes the four components of the
Developmental Disabilities Act (DD Act): (1) the Developmental
Disabilities Council State Grant; (2) the Protection & Advocacy
System for People with Developmental Disabilities; (3) the
University Affiliated Programs; and (4) Projects of National
Significance. This bill also reauthorizes the Family Support Act as
part of the DD Act reauthorization. The Family Support Act was
originally included as Part I in the 1994 reauthorization of the
Individuals with Disabilities Education Act (IDEA). Its
reauthorization is now included as a separate title in this bill. In
addition, a separate title in the bill authorizes funding for
training programs for direct support personnel (see WW vol. 6, issue
12 for details).
Although both the Senate and House of Representatives passed
bills on managed-care patients rights in 1999 on bipartisan votes,
Congress was unable to iron out differences between the two bills.
Next year, a new effort may be possible because of Democratic gains
in the recent Congressional elections.
A key election issue was drug coverage for Medicare
beneficiaries. The in-coming Senate's 50-50 split and the House's
narrow Republican majority make it unclear whether an added Medicare
benefit or a state approach focusing on low-income beneficiaries
will be the preferred approach. Continued partisan divisions within
both the Senate and House in 2001 suggests that President Bush is
not likely to win a large tax-cut proposal. This could be good news
for people with disabilities in two respects. First, it would mean
more of the budget surplus might be available for health, education,
employment, and housing programs. Second, it could improve the
chances for targeted tax cuts, such as a credit for family
caregivers, waiver of payroll taxes for non-profit groups that hire
personal-care attendants (aides), and tax incentives to buy
long-term care insurance.
On other topics, this year's Congress also made little progress.
For instance, the need for full federal funding of the Individuals
with Disabilities Education Act (IDEA) was noted but not acted on.
However, IDEA funding was increased by $1.4 billion for a Fiscal
2001 total of $7.4 billion. And, the appropriations bill did provide
$2 billion for the Child Care and Development Block Grant in FY
2001, an increase of $817 million over the prior year.
Although lack of affordable housing is one of the biggest
problems for people with disabilities, no new funds were earmarked
specifically for housing vouchers for persons with disabilities.
However, $453 million was appropriated for 79,000 new housing
vouchers of all types. A welcome development for not-for-profit
service organizations was a new law limiting postal rate
increases.
Many bills that did not pass this year are likely to be
re-introduced in 2001. In addition, systematic improvement of the
Medicaid program may be considered. Payments under Medicaid - the
primary program helping people with severe disabilities live in
community settings - continue to decline, making it harder and
harder for community agencies to hire and retain qualified staff.
This is creating a crisis that threatens not only implementation of
the Supreme Court's Olmstead decree, but many services
already being provided in the community.
© 2001 UCP
