Disability Policy News In Brief

President’s FY 2016 Budget Request for Disability Programs in the Departments of Health and Human Services, Education, and Labor,
February 9, 2015

On February 2, the President transmitted his FY 2016 Budget Request to Congress, the first step in the annual federal budget and appropriations process. AUCD is very pleased to be able to report that the President's budget provides increases to many important programs that assist people with disabilities to live, work , and fully participate in our society. To provide these increases, the President's budget generally raises revenues on high income earners to help pay for proposals that the Administration believes will help the middle class. Below is a summary of the President's budget for many of the programs within the Departments of Labor, Health and Human Services, and Education that assist people with disabilities and families. The next step in the budget and appropriations process is for the House and Senate to develop their own overall budget proposals, taking the President's budget into consideration. AUCD and other advocates will have to work hard to ensure that Members of the Budget and Appropriations Committees understand the value of many of these programs as they begin to develop individuals funding bills over the spring and summer.

Please see the full table comparing the President’s budget with the final appropriations for Fiscal Year 2015.

Health and Human Services 

Administration for Community Living

University Centers for Excellence in Developmental Disabilities (UCEDDs)
The President has requested a nearly $945,000 increase for the UCEDD line, for a total request of $38,619,000. This request would bring UCEDD funding higher than it had been in the past three years, but still below FY11 figures, before Budget Control Act caps and sequestration took effect. While this budget proposes to end new automatic sequester cuts, it does not yet restore funding to historical levels, let alone if budget lines had kept pace with inflation. The nearly $1 million increase would pay for a cost-of-living increase in UCEDD core grants (as required by the Developmental Disabilities Act), as well as continued operation of National Training Initiative grants and technical assistance activities to the UCEDD network. For more information, see page 177 of the Administration for Community Living Congressional Justification.

Developmental Disabilities Councils
The President has requested flat funding for DD Councils, at $71,692,000. The administration also requests a $643,000 through the Projects of National Significance funding line to assure continued operations of technical assistance to the DD Councils. DD Council funding remains lower than in FY11, before the Budget Control Act caps and sequester cuts took effect. Each DD Council is allotted funding based on a formula that takes into account the population, the extent of need for services of persons with developmental disabilities, and financial need. For more information see page 161 (DD Council) and 183 (PNS) of the Administration for Community Living Congressional Justification.

Developmental Disabilities Protection & Advocacy
The President also requests level funding for the Developmental Disabilities Protection & Advocacy (P&A) programs, a request of $38,734,000. As with the rest of the DD Network, this request remains lower than FY11 levels, before the Budget Control Act caps and sequester cuts took effect. For more information see page 169 of the Administration for Community Living Congressional Justification. 

Developmental Disabilities Projects of National Significance (PNS)
The President requests a total of $14,500,000 funding for PNS, a $5,643,000 increase in PNS funding. Of that figure, $643,000 is earmarked for technical assistance to the Developmental Disabilities Councils and $5 million is requested for a Youth Transitions Initiative. PNS funds discretionary programs which support and complement the work of the DD Network programs (UCEDDs, DD Councils, and P&As). The goal of the Youth Transitions Initiative is to bring together entities such as the state Developmental Disabilities agency, Department of Education, Vocational Rehabilitation, DD Council, UCEDD, and other agencies to address comprehensive needs of youth with intellectual and developmental disabilities as they transition from adolescence into young adult life. In this proposal, ACL would fund these entities to identify barriers to employment for youth, develop plans, and implement interagency programs that produce better outcomes for this population. The proposal also includes an evaluation of the initiative in 2016. For more information, see page 183 of the Administration for Community Living Congressional Justification and page 135 of the HHS Budget In Brief where it is highlighted.

Aging and Disability Resource Centers (ADRCs)
The President has proposed in this budget a $13.8 million increase for the ADRCs, after volatile funding and short-term authorizations have made their future uncertain, for total funding of $20 million. The Affordable Care Act provided $10 million in mandatory funding for the ADRCs for FY10 through FY14. ADRCs also received about $6 million each year in discretionary appropriated funds. In FY15 the authorization for mandatory funding expired, and ADRC funding was cut to the remaining $6.1 million in discretionary funds. The $13.8 million requested increase reflects the replacement of lost mandatory funding with discretionary, plus an additional $3.8 million. This budget proposes funding ADRCs solely through discretionary dollars. With this increase, ACL would fund approximately 35 new state grantees to finalize their development and operation of sustainable No Wrong Door systems. No Wrong Door systems coordinate between ACL, the Centers for Medicare and Medicaid Services, and Veterans Administration to provide person-centered and conflict-free long-term services and supports for all populations and all payers. For more information, see page 206 of the Administration for Community Living Congressional Justification. 

Family Support
This budget requests $15 million in new funding to develop and implement a national strategy to ensure the optimal deployment of public and private resources at the state and community level to support family caregivers. Rather than merely providing transitory social services, the goal is to decrease or even head off reliance on services such as Medicaid HCBS residential care, institutional care and nursing facility care. According to the budget narrative, this initiative will focus instead on approaches that can bolster the ability of families to provide high-quality care for family members while maintaining a quality of life for themselves by accessing multi-dimensional, flexible supports and leveraging and enhancing their local community resources. In FY16, ACL expects to award 5-7 grants to states in a range between $1-$5 million, with 75% of the funds to be spent on evidence-based and promising practices in family support, and 25% on innovative approaches, data collection, and evaluation.  See page 105 of the Administration for Community Living Congressional Justification for more.

Lifespan Respite Care
The Lifespan Respite Care program would receive a $2.64 million increase, for total funding of $5 million, under this proposal. This law authorizes funds for states to build or improve existing respite programs. This increase will allow for grants to two new states to build Lifespan Respite Programs. Learn more on page 127 of the Administration for Community Living Congressional Justification.

Family Caregiver Support Services
Authorized through the Older Americans Act, Family Caregiver Support Services provides grants to States and Territories to provide information, access assistance, counseling and training, respite care, and supplemental services to family and informal caregivers. The President has requested a $5 million increase, for total funding of $150.586 million. Learn more on page 96 of the Administration for Community Living Congressional Justification. 

Voting Access for Individuals with Disabilities
The President has requested level-funding for this program at $4.963 million. This funding provides formula grants for Protection & Advocacy programs to ensure full participation of people with disabilities in the electoral process, including registering to vote, casting a vote, and accessing polling places. For more information, see page 217 of the Administration for Community Living Congressional Justification.

National Institute on Disability, Independent Living, and Rehabilitation Research ("The Institute")
The Workforce Innovation and Opportunity Act of 2014 (WIOA) moved the Institute from the Department of Education to the Department of Health and Human Services and added "Independent Living" to its title. In this budget, the President has requested a $4 million increase for the Institute, for a total budget request of $108 million. This requested increase remains below the $112 million authorized by Congress in WIOA. The Institute sponsors comprehensive and coordinated programs of research and related activities to maximize the full inclusion, social integration, employment, and independent living of individuals with disabilities of all ages. Most funding is awarded through competitive grants, and most of the funds are awarded to universities or providers of rehabilitation or related services.

According to the budget narrative, ACL plans to publish a Notice of Proposed Rulemaking in Fy16 that would amend regulations governing the Institute's Disability and Rehabilitation Research Projects and Centers Program. The to-be-proposed regulations will "expand opportunities for field-initiated work within a clear framework that is designed to both encourage innovation and promote rigorous research, and by allowing for a regular schedule of competitions in pre-established priority areas" (page 193). Under the to-be-proposed framework, the Institute would support four types of projects: Exploration and Discovery, Intervention and Development, Intervention Efficacy, and Scale-up Evaluation. Learn more on page 189 of the Administration for Community Living Congressional Justification.

Independent Living
The Independent Living program, including Independent Living State Grants and Centers for Independent Living, were also moved by the WIOA to ACL from the Department of Education. This budget requests $22.8 million for State Grants and $83.3 million for Centers for Independent Living, a $5 million increase for the Centers. The increase is intended for Centers to implement the new fifth core service required by WIOA to facilitate the transition of individuals with significant disabilities into the community. More information is available on page 188 of the Administration for Community Living Congressional Justification.

Assistive Technology
Assistive Technology is the final program moved by the WIOA from the Department of Education to ACL within the Department of Health and Human Services.  The budget proposes a $2 million decrease for Assistive Technology programs, requesting $31 million in total, reflecting statutory changes in assistive technology programs. According to the congressional justification, in FY 2005, Congress amended the Assistive Technology Act to eliminate a separate federal alternative financing program and establish a State AT grant program that requires the state conduct financing activities, including alternative financing loan programs. However, in the past two years Congress has continued to appropriate $2 million for alternative financing. The $31 million budget request includes $25.7 million the AT State grant program, $4.3 million for Protection and Advocacy for Assistive Technology, and $996,000 for National Activities, which funds state training and technical assistance, the AT Act informational website, and data collection. More information is available on page 223 of the Administration for Community Living Congressional Justification.

Health Resources and Services Administration

Autism and Other Developmental Disabilities - including Leadership Education in Neurodevelopmental and Related Disabilities (LEND)

The President has requested level funding at $47,099,000 for the Autism and other Developmental Disabilities funding line, which includes the LEND program. FY16 funding will support the existing 43 LEND training programs, 10 developmental-behavioral pediatrics training programs, 10 state systems grants, 5 autism intervention research networks, 2 resource centers, and 14 research grants.  These activities are coordinated with the Interagency Autism Coordinating Committee and the CDC's Learn the Signs Act Early campaign. For more information, see page 223 of the Health Resources and Services Administration's Congressional Justification.

Universal Newborn Hearing Screening
The President has requested level-funding for the James T. Walsh Universal Newborn Hearing Screening program, at $17, 818,000. MCHB awards competitive grants to states and territories, and funds one national technical assistance center, to assist states to develop newborn hearing screening and early intervention programs. MCHB also funds 11 LEND programs to expand and augment their pediatric audiology training efforts. For more information see page 240 of the Health Resources and Services Administration Congressional Justification.

Family-to-Family Health Information Centers
The Protecting Access to Medicare Act of 2014 extended authorization for the program and provided $2.5 million for a portion of FY14 and $2.5 million for a portion of FY15, bringing the total funding for FY14 to $5 million. Funding for the Centers is usually attached to legislation related to Medicare physician payments. Congress must revisit this legislation by March 31, 2015, and may authorize additional fund for FY15 and/or FY16. As Congress seeks a permanent solution to the Medicare physician payment formula (the Sustainable Growth Rate or SGR), AUCD and the disability community will advocate for a permanent authorization for appropriations for the Centers, as well as adequate funding.  For more information see page 265 of the Health Resources and Services Administration Congressional Justification.

Maternal, Infant, and Early Childhood Home Visiting Program
The Protecting Access to Medicare Act of 2014 also provided appropriations for the home visiting program for FY15. For FY16, the President is requesting a $100 million increase. The increased funding will allow up to 10 additional competitive State awards and up to 11 additional Tribal awards, which together would provide an estimated 130,000 additional home visits and serve an estimated 35,000 additional families (compared to FY15). Like the Family-to-Family Health Information Centers, authorization for continued appropriations is dependent on Congressional action by March 31. For more information see page 269 of the Health Resources and Services Administration Congressional Justification. 

Centers for Disease Control and Prevention

National Center on Birth Defects and Developmental Disabilities (NCBDDD)
The President has requested level-funding for the NCBDDD at $131,781,000. This includes $67,966,000 from the Affordable Care Act Prevention and Public Health Trust Fund, which is not the intended purpose of the Fund. Of this amount, the budget would allocate: $64.2 million for Child Health and Development, which includes $52.4 million for Health and Development for People with Disabilities, and $15.1 million for Public Health Approach to Blood Disorders. For more information, see page 208 of the CDC Congressional Justification. 

National Institutes of Health

Eunice Kennedy Shriver National Institute on Child Health and Human Development
The President has requested $1.3 billion ($1,318,061,000 total), an increase of $31,490,000 for this institute which provides core funding for the Intellectual and Developmental Disabilities Centers (IDDRC). This includes $122 million for extramural research in Intellectual and Developmental Disabilities, a $2.9 million increase over FY15 appropriations. According to the congressional justification, the request also includes NICHD participation in broad NIH scientific efforts, including the just-announced Precision Medicine Initiative ($4.5 million for NICHD of the $250 million initiative) and Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative ($2.25 million for NICHD of the $70 million initiative). The budget does not request funding for the National Children's Study, which was discontinued in FY15 appropriations. For more information see the NICHD Congressional Justification.

Centers for Medicare and Medicaid Services

The President proposes a number of legislative proposals for Medicare and Medicaid. These programs are mandatorily funded; the President does not request funding and Congress does not appropriate funding every year. However, the President's budget includes legislative proposals to improve the programs.  Below are the descriptions of some of these proposals that would improve access to home and community-based services:

1.       Pilot Comprehensive Long-Term Care State Plan Option: This eight-year pilot program would make comprehensive long-term services and supports available through the Medicaid state plan, rather than through waivers, in participating states. At the end of eight years, the Secretary of Health and Human Services would have the discretion to make the pilots permanent. The estimated cost of the proposal is $4.1 billion over 10 years.

2.       Expand Eligibility for the 1915(i) Home and Community-Based Services (HCBS) State Plan Option: The Budget proposes to update eligibility requirements to increase states' flexibility in expanding access to HCBS under 1915(i) state plan option. Under current law, certain non-categorically eligible individuals who meet the needs-based criteria can only qualify for home and community-based services through the 1915(i) state plan option if they are also eligible for home and community-based services through a waiver program. This proposal would remove that requirement. The estimated cost of the proposal is $1.3 billion over 10 years.

3.       Allow Full Medicaid Benefits for Individuals in a Home and Community-Based Services State Plan Option: This proposal would provide states with the option to offer full Medicaid eligibility to individuals who access HCBS through the 1915(i) state plan option. Under current law, when a state elects to not apply the community income and resource rules for the medically needy, these individuals can only receive 1915(i) HCBS and no other Medicaid services. The estimated cost of this proposal is $38 million over 10 years.

4.       Require Coverage of EPSDT for Children in Inpatient Psychiatric Treatment Facilities

5.       Provide Home and Community-Based Waiver Services to Children Eligible for Psychiatric Residential Treatment Facilities: This proposal provides access to home and community-based waiver services for children and youth in Medicaid who are currently institutionalized and/or meet the institutional level of care. Currently, children and youth who meet this institutional level of care do not have the choice to receive home and community-based waiver services and can only receive care in an institutional setting. This proposal builds upon findings from the five-year Community Alternatives to Psychiatric Residential Treatment Facilities Demonstration that showed improved overall outcomes in mental health and social support for participants with average cost savings of $36,500-$40,000 per year per participant. The estimated cost of this proposal is $1.6 billion over 10 years.

6.       Expand Eligibility Under the Community First Choice Option (CFCO): This proposal would allow states to make CFCO available to anyone who would be eligible under the state plan if they were in a nursing facility.

7.       Create Pilot to Expand Program for All-Inclusive Care for the Elderly (PACD) Eligibility: This proposal would pilot and expansion in PACE eligibility, currently limited to individuals age 55 and older, to include those between age 21 and 55. PACE provides comprehensive long-term services and supports to Medicaid and Medicare beneficiaries through an interdisciplinary team of health professionals who provide coordinated care to beneficiaries in the community, including medical and social services designed to maintain community living and divert nursing facility admission. This pilot would test whether PACE can effectively serve a younger population without increasing costs. The estimated cost of the pilot is $0 over 10 years.

AUCD is still analyzing these policy proposals.  If you would like more details, see page 155 of the CMS Congressional Justification.

Children's Health Insurance Program
The President also proposes extending funding for the Children's Health Insurance Program (CHIP) through FY 2019. Under current law, the authorization for CHIP expires on September 30, 2015. CHIP provides health coverage for children from families with incomes higher than Medicaid eligibility levels. CHIP coverage includes comprehensive coverage for children with disabilities, often more robust than private insurance. This proposal is paid for through an increase in tobacco taxes. The estimated budget impact is a savings of $7.3 billion over 10 years. 

Medicaid and the Administration for Children and Families
The President has proposed a five-year Medicaid-ACF partnership demonstration to reduce the over-prescription of psychotropic medications for children and youth in foster care. States would receive performance-based Medicaid incentive payments to improve care coordination and delivery for children and youth in foster care through increased access to evidence-based psychosocial interventions with the goal of reducing the over-prescription of psychotropic medications and improving outcomes for these young people. The estimated cost of this proposal is $552 million over 1 years.

Education

Special Education (IDEA)
Part B Grants to States
The President has requested $11.7 billion in grants to states for special education, a $175 million increase over FY15 and an average per-pupil expenditure of $1,768. The program makes formula grants to states to pay the additional costs of providing special education and related services to children with disabilities ages 3 through 21. The request also includes $17 million for technical assistance to states. For more information, see page 31 of the Department of Education Budget Summary and Background.

Part B Preschool Grants

The Budget contains $403.2 million for preschool grants, a $50 million increase over FY15 and an estimated per-pupil expenditure of $541 for approximately 745,000 children with disabilities ages 3 through 5 to supplement funds provided under the Grants to States Program. For more information, see page 31 of the Department of Education Budget Summary and Background.

Part C Grants for Infants and Families
The President has requested $503.6 million, a $65 million increase, for grants to states to implement statewide systems of early intervention services for infants and toddlers with disabilities. According to the justification, this request would provide early intervention services to approximately 340,000 infants and toddlers with disabilities and their families. The request also includes $15 million for Pay for Success projects, which supports expanded early screening, early intervention, and other services for infants and toddlers with disabilities and at-risk infants and toddlers who would otherwise not qualify for services under Part C of the IDEA in their State. For more information, see page 32 of the Department of Education Budget Summary and Background.

Part D State Personnel Development
The President has requested level-funding, $41.6 million, for grants to states to enhance their systems for personnel preparation and professional development in the areas of early intervention, education, and transition services for children with disabilities. For more information, see page 32 of the Department of Education Budget Summary and Background.

Part D Technical Assistance and Dissemination
The President has requested a $54.3 million, a $10 million increase, for competitive grants for technical assistance and dissemination of materials based on knowledge gained through research and practice. The request, which is in addition to the separate $17 million set-aside under the Grants to States program to help States meet data collection requirements, would support continuation costs for projects initiated in previous years. According to the budget summary, the requested increase will support Results Driven Accountability Implementation grants to build capacity to implement State Systemic Implementation Plans. For more information, see page 32 of the Department of Education Budget Summary and Background.

Part D Personnel Preparation
The President requests level funding, $83.7 million, to prepare personnel to teach children with disabilities.  The Department is required to support (1) training for leadership personnel and personnel who work with children with low-incidence disabilities, (2) at least one activity in the broadly defined area of personnel development, and (3) enhanced support for beginning special educators. For more information, see page 33 of the Department of Education Budget Summary and Background.

Part D Parent Information Centers
The President requests level funding, $27.4 million, to support centers that provide parents with the training and information they need to work with professionals to meet the early intervention and special education needs of their children with disabilities. The request would support new competitive grants and continuation awards for about 103 centers as well as awards to provide technical assistance to the centers. For more information, see page 33 of the Department of Education Budget Summary and Background.

Education Technology, Media, and Materials
The President requests level funding, $28 million, for this program (formerly known as the Technology and Media Services program) that makes competitive awards for research, development, and other activities that promote the use of technology, including universal design features, in providing special education and early intervention services. For more information, see page 33 of the Department of Education Budget Summary and Background.

Special Olympics Education Programs
The President requests level funding at $7.58 million, previously provided under the Technical Assistance and Dissemination program, to support this program. The request includes fund to support Project UNIFY, a school-based education program designed to develop teamwork skills and increase awareness and social acceptance of students with intellectual disabilities. For more information, see page 34 of the Department of Education Budget Summary and Background.

Institute for Education Sciences

Research in Special Education
The President has requested level funding of $54 million special education research designed to expand the knowledge and understanding of infants, toddlers, and children with disabilities and how best to support their development through improved teaching and special education and related services. For more information, see page 64 of the Department of Education Budget Summary and Background.

Special Education Studies and Evaluations
The President has requested a $13.0 million - a $2.2 million increase - for this program that supports studies to assess the implementation of the Individuals with Disabilities Education Act (IDEA) and effectiveness of state and local efforts to provide special education and early intervention to children with disabilities. For more information, see page 64 of the Department of Education Budget Summary and Background.

Rehabilitation Services

Vocational Rehabilitation State Grants
The President has requested $3.4 billion for formula grants to State VR agencies to help individuals with disabilities gain employment. This amount is consistent with the inflation adjustment specified in the authorization statute, $56.7 million over the mandatory funding amount allocated in FY15, and $300.2 million over the FY15 post-sequester level, which required a 7.3% reduction in mandatory programs. Of the amount requested for VR State grants ,

$41.2 million would be set aside to support grants under the American Indian Vocational Rehabilitation Services program. For more information, see page 34 of the Department of Education Budget Summary and Background.

Supported Employment State Grants
The President has requested a $3 million increase for funding of $30.5 million. This formula grant program provides supplemental funds to State VR agencies for supported employment services for individuals with the most significant disabilities. The requested increase would help states implement changes made under the Workforce Innovation and Opportunity Act (WIOA) increasing emphasis on supported employment and opportunities for youth with the most significant disabilities. For more information, see page 35 of the Department of Education Budget Summary and Background.

Higher Education

Model Transition Programs for Students with Intellectual Disabilities (TPSID)
AUCD is very pleased to report that the President has requested level funding, $11.8 million, for TPSID programs that support students with intellectual disabilities in higher education. Last year, the President proposed to eliminate separate funding for the program. The request also includes the $2 million increase the program just received in the FY 2015 final appropriations bill for the National Coordinating Center. For more information, see page 58 of the Department of Education Budget Summary and Background.

Department of Labor

Office of Disability Employment Policy (ODEP)

The President has proposed a $297,000 decrease in funding for ODEP, a request of $38.2 million. The Budget includes $9,000,000 for the Disability Employment Initiative, which is jointly funded by Employment and Training Administration (ETA) for a total of $18,809,000 to build the capacity of American Job Centers to serve people with disabilities. For more information, see page 60 of the Department of Labor Budget in Brief.

Training and Employment Services

Workforce Innovation Fund
The Department is not requesting funding in FY 2016 but will continue to provide oversight and technical assistance to grantees that received awards in previous years. In addition, the Department will use FY 2014 funds to make awards for the final round of WIF grants later in FY 2015. Under the Workforce Innovation Fund (WIF), the Department made competitive awards to eligible States, local areas, and tribal communities to support "transformative workforce development strategies to help the national workforce system deliver services that are cost- effective, demand-driven and impactful." For more information, see page 14 of the Department of Labor Budget in Brief.

Budget/Appropriations

On Friday, January 10, Chairman of the House Appropriations Committee Hal Rodgers (R-OK) introduced three-day continuing resolution, intended to buy more time for the appropriations leaders from the House and Senate to finish an omnibus package to fund federal government programs for the remainder of the 2014 fiscal year that began on Oct. 1. The leaders of the House and Senate Appropriations Committee have been working on an appropriations package in line with the Ryan-Murray budget agreement (see January 6 In Brief), but need more time before the January 15 deadline to iron out details of the omnibus spending package. Senator Mikulski's (D-MD) office has said that they are still working on the Labor-HHS-Education bill, which has the most relevance to the AUCD network. The amount of money (302(b)) allocated for the L-HHS-ED bill have also not been made public. AUCD will provide an analysis of the omnibus bill once it is made public.

From the AUCD legislative staff: 7 Reasons Why You Are Absolutely Required to Educate Policymakers. 

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For definitions of terms used in In Brief, please see AUCD's Glossary of Legislative Terms. 

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