On June 15, the House Labor-HHS-Ed subcommittee met to mark up the FY 2019 Labor-HHS-Ed appropriations bill, which includes funding for LENDs and UCEDDs. The markup is archived here. See the House Labor-HHS-Ed full bill text here and also see summary of the bill. The Senate markup is still expected at the end of this month.
In total, the House draft bill includes $177.1 billion in discretionary funding (what does Discretionary mean?), essentially the same as the Fiscal Year (FY) 2018 level. The bill targets investments in medical research, public health, biodefense, education, and important activities that help promote "job readiness". The legislation also includes several provisions to "rein in unnecessary regulations" and to "protect the sanctity of life". Some highlights from the bill are list below:
Department of Health and Human Services (HHS): $89.2 billion - an increase of $1 billion above FY18 and $2.4 billion above the President's request
National Institutes of Health (NIH): $38.3 billion - an increase of $1.25 billion above FY18 and $4.1 billion above the President's request
Centers for Disease Control and Prevention (CDC): $7.6 billion - $663 million below FY18 and $2 billion above the President's request
Health Resources and Services Administration (HRSA), which funds LEND: $6.5 billion - $196 million below FY18 and $3 billion below the President's request. And $655 million for the Maternal and Child Health Block Grant, an increase of $3 million over FY18. Zeroed out family planning and reduced rural health by over $9 million.
Substance Abuse and Mental Health Administration (SAMHSA): $5.6 billion - $448 million above FY18 and $2.1 billion above the President's request
Centers for Medicare and Medicaid Services (CMS): $3.5 billion for CMS administrative expenses - $168 million below FY18 and $42 million below the President's request
Administration for Community Living (ACL): $2.2 billion - $10 million above FY18 and $363 million above the President's request
Department of Education: $71 billion - $43 million above FY18. Of which, $12.3 billion for IDEA special education grants to states, an increase of $50 million over FY18. Also, increases funding for charter schools by $50 million, to a total of $450 million.
Career, Technical and Adult Education: $1.9 billion - an increase of $115 million over FY18
Impact Aid: $1.4 billion - an increase of $52 million above FY18
Department of Labor (DoL): $12.1 billion - $88.8 million below FY18
Employment Training Administration (ETA): $9.8 billion - a decrease of $216 million below FY18
Social Security Administration (SSA): $12.4 billion to administer SSA activities - $332 million below FY18, and $164 million above the President's request
Affordable Care Act (ACA) aka ObamaCare: The legislation contains several provisions to stop the implementation of ACA - including prohibiting the use of any new discretionary funding to implement ACA
Action Step: Send a short note to your member of congress, let them know what the funding for LENDs, UCEDD and IDDRCs means in real terms in your community. Use the FY2019 appropriation ask to guide your comments: Autism CARES/LEND Act Funding and UCEDD Funding
Remember to Register and Vote!
June 19 is the DC primary races for mayor, council, representatives, and more. The dates for other state primaries are listed here.
Action Step: Visit vote.gov to register
Health Care
Non-emergency Medical Transportation (NEMT)
The Trump administration's fiscal year 2019 budget request signaled that the Centers for Medicaid and Medicare Services (CMS) intends to use regulatory authority to allow states to drop the Medicaid NEMT benefit; a benefit that has been part of Medicaid since the program's inception in 1966, which many low-income Americans rely on in order to get to and from medical appointments. Multiple peer-reviewed articles indicated that transportation was the most are common barrier to accessing healthcare for low-income and chronically ill patients - roughly 25 percent of patients missed an appointment due to transportation problems. The potential new Trump administration rules under which NEMT becomes optional would allow states to drop the benefit for the persons with disabilities, older adults, and children entitled to the early and periodic screening, diagnostic, and treatment.
Action item: Educate you state Medicaid agency and your congressional delegation on the importance of NEMT. Share why you or your family member uses NEMT. Explain what would happen if you did not have access to NEMT.
Opioids
On June 12, the Senate Finance Committee approved (27-0) its draft legislation to address the opioid crisis entitled Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018. The bipartisan Senate Finance package combines 22 bills recently introduced by committee members. It includes provisions that would expand telehealth access for addiction treatment, remove lifetime limits under Medicaid for medication-assisted treatment for substance use disorder, and support treatment through family-focused residential programs. It would also require that health care professionals use electronic prescribing for Medicare-covered drugs for certain controlled substances. According to a preliminary committee estimate, the bill would cost $162 million over 10 years. Section-by-section summary of Senate bill. On the same day, the House Energy & Commerce Committee passed 25 of its own opioid-related bills. Congressional Budget Office cost estimates for each bill can be found here.
Work Requirements
On June 15, the Trump administration and advocacy groups met in federal court in Washington DC over whether the HHS secretary has the legal authority to allow Kentucky to establish a work requirement (via 1115 waivers) and other new conditions on people receiving Medicaid coverage. US District Judge James Boasberg, an Obama administration nominee, heard oral arguments in the case, which was filed in January by the National Health Law Program (NHeLP), the Kentucky Equal Justice Center, and the Southern Poverty Law Center (see NHeLPs Steward v. Azar case review). The groups, representing 16 beneficiaries, are suing to block Kentucky's unprecedented Medicaid waiver requiring beneficiaries to work or participate in "community engagement" activities such as job training, school, or volunteering. The federal government never previously permitted states to impose work requirements as a condition of Medicaid eligibility. 40 health policy scholars wrote in an amicus brief supporting the lawsuit filed on behalf of several Kentucky Medicaid enrollees. See previous edition of In Brief for more information on AUCDs concerns regarding Medicaid work requirements and the potential consequences it could have people with disabilities and its negative affect on health equity for all low-income Americans.
Civil Rights
DREAMers
This week, the House is expected to vote on bills related to immigration and Deferred Action for Childhood Arrivals (DACA. Note that all DACA recipients are technically also DREAMers, however not all DREAMers are DACA recipients):
One of the proposals is not expected to have enough support to pass called the Securing America's Future Act introduced by Representative Goodlatte (R-VA); see bill text and summary.
The other is a "compromise" bill called Border Security and immigration Act, aimed at "offering a solution for recipients of the expiring DACA program" as well as increasing border security by 50 percent and includes $25 billion to build a border wall. There are also "safeguards" that ensure that if any money for the wall is rescinded in the future, the "DREAMers' pathway would be shut off". The bill also claims to prevent children from being separated from their parents at the US-Mexico Border; however, analysis of the bill indicates that this proposal does not outlaw family separation and removes the requirement that children be kept in the "least restrictive" conditions possible,and not be detained any longer than necessary. The Trump administration calls those protections "loopholes", and blames them for "forcing" the administration to separate families.
Senator Dianne Feinstein also recently introduced a bill called Keep Families Together Act (S 3036), which quickly gained several cosponsors. This bill was developed in consultation with child welfare experts to "ensure the federal government is acting in the best interest of children" by protecting the welfare of children and ensuring children be separated from their parents only in the event they are being trafficked or abused by their parents.
It is yet to be seen if this "compromise" bill would have the votes to pass the House among Republicans, as Democrats are not expected to support it. If it were to pass the House, the Senate has made no indication it would take up the bill, rendering the votes largely a political exercise. There is also rumor that the "compromise" bill and Feinstein's bill may be combined.
Action Item: You can share your input with your Representatives (find them using this tool). It may be helpful to share details about the roles DREAMers/DACA recipients play in your life and your community. If you have examples of DREAMERs/DACA recipients working in jobs that impact disability, share that as well.Share your thoughts on the safety and care of children who likely include children who have disabilities and about how immigration policy is impacting workforce that touches lives of people with disabilities.
On June 11, the US Supreme Court ruled in Husted v. A. Philip Randolph Institute by a 5-4 decision to uphold the practices used by Ohio to remove voters from the state's voter rolls. This voter suppression practice cancels the registration of voters who chose not to vote and who then fail to respond to a notice. AUCD is concerned that this ruling will further marginalize millions of voters including those with disabilities, low-income Americans, veterans who are already underrepresented because of existing barriers to voting, such as inaccessible polling places, equipment, and transportation. This decision can also increase the likelihood that other states will enact similar voter suppression tactics and undermine the fundamental right to vote. Read Justice Sotomayor statement here, where she states "low voter turnout rates, language-access problems, mail delivery issues, inflexible work schedules, and transportation issues, among other obstacles, make it more difficult for many minority, low-income, disabled, homeless, and veteran voters to cast a ballot or return a notice, rendering them particularly vulnerable to unwarranted removal under the Supplemental Process."
Action items: Educate your State and local election boards on the barriers to voting for people with disabilities and other marginalized groups. Share ideas on how to make voting more accessible for all people. Explain that the right to vote should never be a "use it or lose it" proposition.
Senator Lamar Alexander said the Senate HELP Committee will mark up a bill on June 26 or 27 reauthorizing the Carl D. Perkins Career and Technical Education (CTE) Act - H.R. 2353 (115) , under which the federal government spends about $1 billion each year on CTE programs. The law hasn't seen an update since 2006. The hearing can be viewed here. Information on CTE can be found here.
Action Item: Contact your Senators to educate them about the ways Perkins can effectively serve people with disabilities by using this pre-crafted email, which you can personalize.
Tuesdays with Liz: Disability Policy for All
This week, Liz sits down with Kate Mevis, who works for Senator Bob Casey as the Staff Director for the U.S. Senate Special Committee Aging. They discuss Liz's contributions on Capitol Hill during her time as a fellow and Congressional initiatives on inclusive employment. Learn more:
A network of interdisciplinary centers advancing policy and practice for and with individuals with developmental and other disabilities, their families, and communities.
