In their presentations to the Joint Finance and Appropriation Committee (JFAC) this week, House H&W Chairman Janice McGeachin and Senate H&W Chariman Patti Anne Lodge both recommended that the FY13 budget include funds to restore services from last year's HB260 cuts. Specifically, Chairman McGeachin recommended restoring the cuts to people with a dual diagnosis and restoring preventative dental for all adults on the Enhanced Plan. Chairman Lodge also recommended restoring the dual diagnosis coverage, however, her recommendations for restoring preventative dental included only those adults who are on the Developmental Disabilities (DD) Waiver or the Aged and Disabled (A&D) Waiver.   Rep. McGeachin spoke about her recommendations in an interview this week on Idaho Reports (click here to link to Idaho Reports).

On Friday, JFAC voted to set the FY13 budget based on the Joint Economic Outlook Committee's forecast. This is $33 million below the Governor's budget recommendations. As JFAC begins setting budgets next week, the legislature will also be considering possible tax cut legislation. Rep. Mike Moyle introduced a $35 million tax cut bill that lowers the income tax for Idahoans in the top tax bracket. 

The Advocacy and Provider representatives are close to finalizing bills to restore cuts from HB260. There is a possibility that the changes will be incorporated into one bill, however, we are still working with the bill sponsors. As referenced by the two H&W Committee Chairs above, restoring duplicative services for the 600 children and adults with a dual diagnosis has strong support by the legislature. We have worked with the Dept of H&W on changing the language in the statute to clarify the differences in mental health and developmental services to address the concerns with duplication. The fiscal impact is $900,000 in state general fund dollars.  

The second program that has strong legislative support is restoring preventative dental coverage. There is a split in how much can be restored based on the fiscal impact. To restore preventative dental coverage for all adults on the Enhanced Plan, it would cost the state $1.9 million in state general fund dollars. To restore preventative dental only for adults on the DD and A&D waivers, the cost would be approximately $650,000. The Advocacy and Provider representatives are encouraging legislators to restore the coverage for all adults on the Enhanced Plan, thereby, not disallowing this service to adults with a mental illness and others who have medical and developmental needs but are not on a waiver.

We are anticipating the bill(s) to be introduced in House State Affairs Committee for a print hearing next week and then the bill(s) will move to the House Health and Welfare Committee.  

Here is a brief update on four pieces of legislation and language we have been working on and why it will or will not be included in proposed legislation:

HB260 Follow Up Bill (fiscal impact $900,000 state general fund)

Will be included:

• Change the sections in the law that require a person with a developmental disability and a mental illness to choose between PSR and developmental therapy even if they need both.
• Eliminate the language that says that budgets for services for adults with developmental disabilities will be moved into a "tiered approach as currently used for children's developmental therapy."

Will NOT be included:

• Strike the language in law that limits Psychosocial Rehabilitation Services (PSR) to 5 hours a week for children and 4 hours a week for adults. Although this didn't increase hours of service since this cap is still in rule, the Dept. of Health and Welfare did not support making this change because they are expecting to make significant changes in the law next year as it relates to the new managed care contract for mental health services. 
• Change the language that says that budget modifications will be allowed only when health and safety issues are identified and allows for budget modifications to promote employment or the cost effectiveness of the individual's plan. The Dept. cannot support any statute changes that relate to current law suits. The KW v. Armstrong suit relates specifically to how the Dept. is interpreting the limitation to budget modifications. Hopefully the federal court's decision will resolve the individual budget cutting/appeal process resulting in a change in the statue. And adults whose budgets have been significantly cut since July will have their budgets and services restored.

Dental Bill (fiscal impact is $1.94 million state dollars) - note: these changes may be added to the HB260 Follow up bill

Will be included:

• Remove the language that limited adults to only medically necessary oral surgery and maintenance of pain. It permits preventative and restorative dental care for adults.   The uncertainty is whether there is enough support to include restoring all dental to those on the Enhanced Plan or only those on the DD and A&D waivers.

Blended Rate Bill (fiscal impact of $1.1 million state dollars).

Will NOT be included:

• This bill would have eliminated the language that requires the Dept. of Health and Welfare to develop a blended rate to cover both individual and group developmental therapy services. The Dept. and Rep. McGeachin have indicated that they have heard from a couple of Developmental Disabilities Agencies that they do not support removing this language from law and are in support of the blended rate. They are open to reviewing this in the future when there is more consensus in the provider community.

Collateral Contact Bill (fiscal impact of $1.23 million state dollars).

Will NOT be included:

• This bill would have struck the language that does not allow providers to be paid for collateral contact. The Dept. has stated that they do not support restoring these funds since they believe the requirement for collateral contact by providers is already included in rule and providers are paid for it in their direct service rates.

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Important Next Steps

Legislators will begin weighing in on a wide range of requests for additional funding and possible tax cuts.   Although we do not have bill numbers yet for the HB260 changes, it is important that members of the House and Senate Health and Welfare committees understand your support of the proposed changes, especially the importance of restoring dental coverage for all those on the Enhanced Plan.

Please write and thank the House and Senate H & W Chairs and committee members for their support of writing legislation that:

1. Restores services to people with a dual diagnosis, and
2. Restores preventative dental for ALL adults on the Enhanced Plan (this includes adults with mental illness and adults with developmental disabilities who are not on the A&D or DD waivers), and
3. Please share your personal story of why restoring preventative dental coverage is critical to you, your family member or those you know who have been impacted by this cut. They need to know the importance of restoring these services to all adults in the Enhanced Plan.

Write, call or e-mail the following legislators:  

House Health & Welfare Committee Members     

Idaho State Legislature
State Capitol Building
P.O. Box 83720
Boise, Idaho  83720-0038 (House)
(208) 332-1000 or toll free: (800) 626-0471      
  

Senate Health & Welfare Committee Members        

Idaho State Legislature
State Capitol Building
P.O. Box 83720

Boise, ID 83720-0081 (Senate)
(208) 332-1000 or toll free: (800) 626-0471       

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Court Case - KW v. Armstrong - H&W Individual Budget Cuts Challenged

The only updates that I have are:

• On Feb 10, the court entered a second Temporary Restraining Order (TRO) in the KW v. Armstrong case requiring the Dept. of Health and Welfare to release all of its budget tool information, including the actual spreadsheets and formulas to Idaho Legal Aid. 
• It has been reported that the Dept. of Health and Welfare has not agreed to voluntarily extend the relief to others in the DD program. 
• James Piotrowski filed a class complaint on Feb. 8th and is planning to seek a class-wide Temporary Restraining Order any day now.
• The Dept. of Health and Welfare has indicated that they cannot support changes in the HB260 legislation that relate to current lawsuits.  

For a Background and Synopsis of the KW v. Armstrong lawsuit seeKatherine's Updates - Week 4. 

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THIS WEEK 

JFAC Budgeting Schedule (Feb 21st - Mar 9th) - key budgets:

Wednesday, February 22nd

8:00 - 11:00    Division of Vocational Rehabilitation -  

FY12 Supplemental Request

                        Division of Medicaid - Supplemental Requests

Monday, February 27th

8:00 - 11:00    Division of Vocational Rehabilitation   

 Division of Medicaid - Supplemental Requests Continued

                        Commission for the Blind and Visually Impaired

Wednesday, March 7th

8:00 - 11:00    Dept of H&W (non Medicaid divisions)

Friday, March 9th

8:00 - 11:00    Dept of H&W (non Medicaid divisions continued)

Division of Medicaid - Budget

NOTE: The Idaho Division of Vocational Rehabilitation (IDVR) is requesting a supplemental of $367,000 to fund Community Supported Employment (CSE) Services in their FY12 Decision Units. These additional CSE dollars will provide job coaching for adults with developmental disabilities across Idaho who are currently on waiting lists for employment services. This request will be decided at the Feb. 22nd JFAC meeting.  

In addition, IDVR is requesting an increase in their state match for Vocational Rehabilitation funds of $576,900 to secure the full federal dollars available to Idaho of $2.1 million dollars. This 20/80 match funds the upfront costs of assisting adults with disabilities to seek and obtain competitive employment in the community. JFAC will decide on this request during IDVR's Feb. 27th budget hearing.  

Please contact members of the Joint Finance and Appropriation Committees and express your support for these two funding requests:

Idaho State Legislature
State Capitol Building
P.O. Box 83720

Boise, Idaho
       83720-0038 (House)
       83720-0081 (Senate)
(208) 332-1000 or toll free: (800) 626-0471

The HB260 Funding Requests will be part of the March 9th Medicaid Budget Setting meeting.

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