DISABILITY ISSUES PLATFORM
FOR CANDIDATES IN THE 2007 VIRGINIA GENERAL ASSEMBLY ELECTIONS
Disability advocacy organizations of the Commonwealth of Virginia share these same beliefs; we believe in freedom, choice, equal access and opportunity, dignity, and respect for all citizens of the Commonwealth who have disabilities.
The Commonwealth's policies and practices should reflect the right of citizens with disabilities to lead productive lives as they so choose. Currently, 18% of Virginians have a disability and their issues and concerns with policies related to disabilities need to be addressed forthright. As a candidate for the General Assembly, you can become a positive change for citizens with disabilities. You will be faced with many policy issues during the General Assembly session and this Platform gives you guidance on these policy choices to be a positive force for citizens with disabilities. We encourage you to utilize the Platform as guidance in developing disability positions for your campaign.
As you conduct your campaign we encourage you to engage all citizens by making your campaign accessible, by providing fully accessible locations, by providing sign language interpreters, by ensuring that websites are accessible, and when requested providing campaign materials in alternative formats, such as Braille and large print. We look forward to seeing you on the campaign trail and at the polls.
Services for Virginians with Disabilities
No Place Like Home
DD AND MR MEDICAID WAIVERS
Additional Medicaid wavier slots are needed to significantly reduce waiting lists. Medicaid Waiver services include personal care, respite care, day support, supported employment, skilled nursing, residential services, and other long term care services. Long waiting lists exist for both Developmental Disabilities (DD) and Mental Retardation (MR) Waiver services. Over 750 people are on the DD Waiver waiting list. Over 4,000 people are on the MR Waiver waiting list with 2,000 in the Aurgent@ category. The Olmstead Task Force recommended reducing waiting lists over a specified period to ensure Olmstead compliance.
Action: Fund 300 Medicaid Waiver slots for people with DD and 800 Medicaid Waiver slots for people with MR each year of the biennium.
EARLY INTERVENTION AND PRE-K SERVICES
Intensive, early intervention and pre-kindergarten services for children with developmental disabilities and other disabilities ensure their needs are addressed early in the "window of opportunity" to reduce the long-term intensity of their needs.
Action: Increase state funding for intensive, early intervention and pre-kindergarten services.
HOUSING TRUST FUND
There needs to be stable, on-going funding for the Housing Trust Fund and additional funds dedicated to increasing the availability of accessible, affordable housing that is in compliance with federal law, and that utilizes universal design principles.
Action: Fund the Housing Trust Fund.
MOBILITY OPTIONS
More than 1 in 5 adults age 65 and over do not drive. Additionally, a significant number of persons with disabilities do not drive as a result of their disabilities. Adequate funding for transportation would increase the independence and self-sufficiency of Virginians with disabilities and seniors. Support investment in public transportation systems (both inter- and intra-jurisdictional), including completion of the Dulles Corridor Rail Extension Project in Northern Virginia; and in rural parts of the state develop strategies better meeting the transportation needs of people who rely on public transportation. Increased funding for specialized transportation programs serving persons with disabilities and seniors; and funding to improve coordination among service providers statewide are needed.
Action: Request that the Department of Rail and Public Transportation conduct a study that would outline what is needed to expand public transportation in parts of Virginia that are currently underserved or not served.
MONEY FOLLOWS THE PERSON (MFP) PROJECT
1
A Money Follows the Person (MFP) Demonstration Project, was awarded to Virginia in May 2007 by the federal Centers for Medicare and Medicaid Services (CMS). MFP is intended to assist persons with disabilities and seniors who want to move out of nursing homes, Intermediate Care Facilities for Mental Retardation (ICF/MRs), and long-stay hospitals to live in their own homes in the community. It is expected that at least 1,041 individuals would transition from the institutional setting over the five years of the project. CMS will provide an enhanced federal Medicaid match for each individual in the MFP demonstration for the first year after their transition from institution to community-based services. Virginia will experience significant cost savings in the long-term by shifting emphasis from provision of services in more costly institutional settings to provision of community based services. The 2007 General Assembly Session considered funding the state match for MFP but a decision to approve it was postponed until the federal government actually awarded the grant.
Action: Fund state match to ensure successful implementation of MFP.
Action: Support a state funded housing supplement to facilitate an individual's move from an institution to a community setting.
PERSONAL MAINTENANCE ALLOWANCE
The Personal Maintenance Allowance (PMA) is designed to cover basic community living costs such as housing, food and basic needs.Virginia has not kept up with inflationary trends in this area. The PMA was raised 65% two years ago; the PMA is currently $1,028. However, the PMA needs to be raised to the federally allowed amount of 300% of the monthly SSI payment to reflect the current cost of living and inflationary rates. A 2005 Joint Legislative Audit and Review Commission (JLARC) report well described the problem with Virginia=s low PMA. The Joint Commission on Health Care and Virginia=s Olmstead Task Force have recommended that the PMA be increased to 300%. The current low PMA rate makes community living for people with disabilities marginal at best and impossible for some.
Action: Raise the Medicaid PMA to 300% of the monthly SSI payment.
PREVENTION OF INSTITUTIONALIZATION
People with disabilities are sometimes placed in nursing homes and other institutions because of the lack of information and supports that could have prevented their institutionalization. Once someone is institutionalized they often lose their housing and informal supports that can be very difficult to reestablish when they choose to leave the institution. It is vital that timely, correct, and thorough information and supports be provided so that people can avoid unnecessary institutionalization.
Action: Increase funding for information and referral services, support services and outreach to persons who are at risk of institutionalization.
SERVICES FOR PERSONS WITH BRAIN INJURY
JLARC was directed by the 2007 General Assembly to report on the effectiveness of and access to brain injury services in Virginia. Brain injuries result in a variety of physical, cognitive, and emotional problems. Recent increases in state funding and potential implementation of a Medicaid Waiver program prompted calls for a review.
Action: Support implementation of the recommendations in the JLARC report due in the fall of 2007 that enhance access to community based services for people with brain injury services.
STREAMLINE BENEFIT ELIGIBILITY PROCESS
Virginia is one of only eleven remaining states that requires people to complete two separate eligibility processes – one for SSI and one for Medicaid. The administrative costs for this duplicate process could be saved.
Action: Amend the eligibility process so that people who are eligible for SSI become eligible for Medicaid, without having to go through a second eligibility process.
Education
Students with disabilities receive supportive services in schools, and school personnel also adapt curricula and accountability measures. These services offer the key to establishing maximum independence for people with disabilities, thereby increasing contributions to society and reducing the need for (and intensity of) services for adults with disabilities.
IMPROVING SCHOOL-TO-WORK TRANSITIONS FOR STUDENTS WITH DISABILITIES
Students with disabilities are entitled to educational services that will enable them to maximize their independence. A critical element of future independence is the transition planning provided by schools. Transition services should be coordinated, multi-agency approaches to assist students with independent living and employment skills. The long-term outcomes for adults with disabilities all too often include unemployment, poverty, and restricted living environments due to lack of independent living skills.
Action: Request a legislative study of the transition process from school-to-work for students with disabilities, including examination of the implementation of the required transition planning elements.
MAINTAIN VIRGINIA'S CURRENT PROTECTIONS FOR STUDENTS WITH DISABILITIES
Virginia is currently updating the Regulations Governing Special Education Programs for Children with Disabilities in Virginia. Although this issue is currently in the regulatory drafting and public comment process, legislative action may be needed.
1
Action: Maintain Virginia's current protections for students with disabilities and regulatory requirements for their education.
Employment for Virginians with Disabilities
Work should be valued as a priority in Virginia. Work is an everyday expectation of what individuals in our society do and how they are perceived. A critical component of community integration is an individual’s choice to work and the opportunity to work. For those who choose to work, the dignity, responsibility, self-competence, and economic independence resulting from the opportunity to have gainful employment or a meaningful career is one of the most effective ways of reducing dependence on public benefits, enhancing self-reliance, changing attitudes, and promoting full community integration of Virginians with disabilities.
Unfortunately, almost three out of four (75%) of Virginians with disabilities are unemployed or underemployed while Virginia enjoys a statewide unemployment rate of approximately 3.2%. Virginians with disabilities want to live and work in their communities B they want to earn wages, to pay taxes and to purchase consumable goods and services in their communities B just like all Virginians.
COMPETITIVE EMPLOYMENT AS A CHOICE FOR PEOPLE USING DD AND MR WAIVERS
The Medicaid rate for Individual Supported Employment (SE) limits access to employment and contributes to the already high unemployment rate of Virginians with disabilities. Very few of the people who are receiving MR Waiver services are competitively employed with SE services.
Action: Adjust the Medicaid Supported Employment Rate for Individual Supported Employment to parallel the SE rates assigned to each employment services organization (ESO) by the Department of Rehabilitative Services (DRS). No cost is assumed since financial offsets will be realized when existing Waiver recipients move to competitive employment from other more expensive day services.
CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES
Personal Assistance Services (PAS) are provided through the Department of Rehabilitative Services to individuals with disabilities such as spinal cord injuries, brain injuries, cerebral palsy, or muscular dystrophy, who require assistance from another person to perform non-medical activities of daily living. These services are typically provided to people who are employed and who do not qualify for Medicaid.
Action: Fund DRS PAS to serve an additional 50 people who are waiting for these services.
DEPARTMENT OF REHABILITATIVE SERVICES (DRS) “ORDER OF SELECTION”
DRS is currently under an “Order of Selection” that limits vocational funding for Virginians with disabilities that want to work. Currently, only one category of four is open serving Virginians with the most severe disabilities - creating a current waiting list of 300+.
Action: Appropriate sufficient funding to DRS to eliminate the Aorder of selection@ and waiting list of Virginians with disabilities that want to be gainfully employed.
ELIMINATE DISINCENTIVES TO WORK
Employment improves the quality of life. Virginians with disabilities should not have to pay a Medicaid Waiver patient pay from their earned income. The current patient pay requirements are a disincentive to gainful employment.
1
Action: Adjust the Medicaid Waiver patient pay requirements to encourage Virginians with disabilities to work. Increase the current disregard from 200% to 300% (for 8-20 hours worked per week) and from 300% to 400% (20+ hours worked per week) of countable income using SSI rules.
Under Virginia’s initial Medicaid Buy-In legislation, only individuals eligible for Virginia’s Medicaid are eligible to participate. This prevents individuals who have earned and unearned income above 80% of the federal poverty level (FPL = $) to participate. Virginia’s first step is contradictory to the overall purpose for which the Medicaid Buy-In program was authorized by Congress. The federal goal is to allow individuals to “buy-in” to Medicaid who are otherwise ineligible because of earned income.
Action: Amend the current Medicaid Buy-In to fulfill its original federal intent. A viable Medicaid Buy-In program will ensure continuation of needed health care coverage providing an opportunity and incentive to seek gainful employment.
Persons with physical disabilities may need personal care to prepare for and to remain employed. Currently anyone who needs personal care services cannot participate in the Virginia Buy-In program.
Action: Amend Virginia Medicaid home and community based Waivers so that people can participate in the Waiver and the Buy-In simultaneously.
LONG TERM SUPPORTED EMPLOYMENT SUPPORT SERVICES (LTESS)
LTESS funds provide long term employment supports that help Virginians with disabilities maintain employment. Only 2,694 Virginians with disabilities currently receive LTESS services.
Action: Appropriate additional funding each year to keep pace with the number of Virginians with disabilities who need long-term employment support services to maintain employment.
PRIVATE SECTOR EMPLOYMENT OF VIRGINIANS WITH DISABILITIES
Virginians with disabilities that work become empowered and decrease their reliance on social services supported with tax dollars. Initially created by Kentucky and Louisiana, this initiative supports capital investment in private not-for-profit organizations that create competitive jobs for Virginians with disabilities. Action: Provide capital investment tax-credit program or job creation grant for non-profit community-based organizations that spend at least 75% of their revenues on directly employing or training Virginians with disabilities and other barriers to employment.
Quality Direct Care Workforce
A quality direct care workforce is essential for Virginians with disabilities to live independently. Individuals who provide personal assistance and health services to people with disabilities must earn a living wage, have health insurance, and have access to training and career advancement opportunities. In order to build a stable, professional workforce that Virginians with disabilities can count on, workforce development in the field of direct services must be a top priority for the General Assembly.
BENEFITS AND WAGES FOR THE WORKFORCE
Virginians with disabilities face great difficulty recruiting and retaining direct care workers. In order to build a stable, professional workforce that allows Virginians with disabilities to live independently at home, the direct care workers who deliver services and supports need a living wage with access to affordable and quality health insurance. Low wages and the lack of health insurance result in high turnover rates, making it difficult for Virginians with disabilities to recruit and retain quality workers.
Action: Provide access to affordable, quality health insurance for all of Virginia’s direct care workforce and their families.
Action: Increase the Medicaid reimbursement rates for home and community-based personal care assistants and other Waiver service staff, especially consumer-directed staff, in order to stabilize the direct care workforce by providing better wages and benefits.
DRS PERSONAL ASSISTANCE SERVICES
Virginians with disabilities who receive supports and services under the DRS PAS program to live and work independently deserve a quality personal care workforce which receives a living wage.
1
Action: Provide funds to DRS to raise the reimbursement rates for personal care assistants to be equal to the Medicaid reimbursement rates.
STUDY OF WORKFORCE ISSUES
Ensuring a stable, quality direct care workforce is a public policy priority, especially as Baby Boomers begin to retire and the demand for direct care workers increases exponentially. Virginia must begin to prepare now in order to meet this workforce shortage crisis.
Action: Request a JLARC study on the direct care workforce, focusing on recruitment and retention of the direct care professionals, including providers of consumer-directed services, who provide quality supports and services to Virginians with disabilities and older Virginians.
The following organizations support these actions. For more information about the items described in this Platform, please contact these organizations.