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The Bend in the Road

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The Bend in the Road

by: 
Diane McComb, Liaison to State Association Executives

State Associations across the country are gearing up for the new legislative session beginning in January. There is a myriad of daunting issues facing providers supporting people with disabilities and their families.

States are collectively in slightly better economic shape going into 2017; however, a number still register negative revenue collection. Twenty states are reporting budget surpluses, however, nationally growth is just under 3%.  Evidence points to continued slow growth for 2017. All of this points to tight budgets for FY 2018.

Minimum wage efforts are wreaking havoc for providers where states failed to recognize the impact to agencies primarily funded through Medicaid. As ANCOR’s Save our Services (SOS) campaign so adeptly points out – we can’t raise our rates just because the rules change. We need state governments and Medicaid to recognize the impact of these changes and provide the funding necessary to meet the obligations. This is particularly trying in jurisdictions where local municipalities have invoked a minimum wage increase (Seattle, New York City, Baltimore, and others) with no recognition by state or municipal government to assist budgetarily.

Last year’s legislative efforts will continue in 2017.  We can expect to see legislation introduced looking at sheltered workshops, 14c sub-minimum wage, rate setting, Medicaid expansion, managed care, and ABLE Act implementation. The implementation of the HCBS Community rule will likely see continued efforts by states to further community inclusion. At the same time the new administration’s leadership at DOJ may signal a slowdown in Olmstead enforcement.

We must also be mindful of the impact the new administration may have on State budgets. As changes to Medicaid are contemplated, there is a high likelihood of states having to assume a greater degree of liability to maintain existing structures of healthcare and waiver implementation. Should block grants move forward, business as we know it, will be dramatically different state by state.

To be sure, some states set standards far exceeding the Community Rule and Olmstead expectations. Those states will likely continue on that path regardless of funding. Yet for other states, funding and ideology issues may slow progress. Advocates will have to be vigilant.

State associations will do well to educate state lawmakers regarding the limitations of Medicaid funding – the fact that agencies can’t increase rates, the impact of Medicaid on the state and local economies, the number of jobs resulting from Medicaid funding. We must be prepared to meet whatever proposals come out of Washington with aggressive advocacy. Governors and their staff, legislators and state officials must all understand the potential ramifications of changes to Medicaid funding formulae. We want them advocating on our behalf in Washington to assure changes to Medicaid won’t have an adverse impact to people with disabilities.

Forty years ago, we compared the wages paid to DSPs with those of the fast food industry. Despite incredible efforts, we still find the comparison valid. Yet if we look back over the decades, we must recognize the amazing progress made in terms of more individualized supports and inclusion in communities by people with disabilities.

State associations and providers of supports and services to people with disabilities and their families, indeed, people with disabilities have demonstrated remarkable resilience over time. We are up to this challenge moving forward. The bend in the road in not the end of the road, unless we fail to make the turn.  

Diane McComb is ANCOR’s Liaison with State Associations around the country and may be reached at dmccomb@ancor.org.