Training Presented By: Disability Rights California

Learning Objectives Gain general information on Assistive Technology and Medi-

Cal Learn basic advocacy skills regarding budget and policy What Topics We Will Cover What AT does Medi-Cal cover currently? Background on California budget and legislation What are proposed changes in state legislation and budget

affecting Medi-Cal and AT? What is the impact of federal Health Reform on AT funding? What advocacy opportunities are available for organizations

and consumers regarding AT?

What is an AT Device?Any item, piece of equipment, or product or systemWhether bought off the shelf, changed or custom built,

that is used to increase, maintain or improve functional capabilities of individuals with disabilities.

Things you use to assist you with your disability-related needs

What is a service?What you may need to choose, get, or use an AT deviceE.g. nursing, occupational therapy, physical therapy

See Disability Rights California’s AT manual for more information: http://www.disabilityrightsca.org/issues/assistive_pubs.htm

Medi-Cal pays for medically necessary treatment

• Services• Medicines• Durable medical equipment, and• Medical supplies.• Necessary to protect life, to prevent a

significant illness or disability, or to alleviate severe pain. California Welfare & Institutions Code §§ 14059.5, 14133.3

Medi-Cal puts assistive technology in a number of categories, e.g.

Medical suppliesDurable medical equipmentA prosthetic device

Medi-Cal will only pay for the least expensive item that meets your medical needs

TAR process

If Medi-Cal denies the TAR, you have a right to: an explanation in writing appeal within 90 daysfile for a fair hearing, fill out and mail the

reverse side of the Medi-Cal notice-of-action form. Or, you can send a letter to:

Chief Administrative Law JudgeState Hearings DivisionDepartment of Social Services744 P StreetSacramento, CA 95814

• If you ask for a fair hearing within 10 days of the date of Medi-Cal’s written notice, current benefits will continue until an Administrative Law Judge issues a hearing decision

Disability Rights California website: http://www.disabilityrightsca.org

Assistive Technology resources and publications: http://www.disabilityrightsca.org/issues/assistive_pubs.htm

Accessing Assistive Technology Manual, Chapter 10, Medi-Cal: http://www.disabilityrightsca.org/pubs/533001.htm (available in English, Spanish, and Chinese)

Preparing Letters of Medicaid Medical Justification letters: http://www.nls.org/av/winter06.htm

Topics covered Both budget and bills are importantWhy budgets are Important for people with

disabilities and advocatesHow California’s budget worksKey budget datesWho does whatBudget trailer billsThe advocate’s roleKey budget resources

Both budget and bills are important• Budgets provide authority to spend money

and can make changes for a single year. • Bills make statutory changes, create

programs, establish or modify eligibility, or raise or lower taxes and are permanent

Why budgets are important for people with disabilities?

Express our priorities and values as a society

Framework and funding, including Medi-Cal and AT

Great policy ideas usually require moneyIf a policy change requires money, then you

may need both bill and budget

How California’s budget worksConstitutional frameworkThe constitution can only be changed by a vote of the

peopleInitiative process reduces the discretion of the

legislature in how it allocates state funding. Governor must introduce a balanced state budget

within the first ten days of each calendar year. The Legislature shall pass a budget by June 15.

Any bill, including the budget, that appropriates money from the state General Fund must be approved by a 2/3rds vote (exception: appropriations for public schools).

• Any measure enacted for the purpose of increasing revenues requires 2/3rds vote. All local tax increases must now be approved by the voters.

• California has a line item veto that allows the Governor to eliminate or reduce any spending item in the budget. This gives the Governor the final word on almost every issue.

• In large part because of the requirement for a 2/3rds majority, over the last several years the Legislature and the Governor have not concluded the budget by the required time

Advocates often ask why taxes can’t be raised if there’s not enough money available. They can, but it requires a 2/3 vote of the Legislature, plus the Governor’s signature. This takes broad-based consensus. One Disability Rights California advocacy goal is to have the 2/3rds majority requirement of the Constitution changed through the initiative process.

Bills that take effect immediately (urgency bills) require a 2/3 vote. Other measures take effect on January 1.

State appropriations are subject to limit; excess goes to taxpayers and public education.

State must reimburse local governments for mandated programs and costs.

Legislature must authorize bonds by 2/3 vote

Key budget dates  The Budget process moves according to a schedule On or before January 10: Introduction of the Governor’s

Budget.Late February: Release of the Legislative Analyst’s

Review of the BudgetMarch - April: Budget Subcommittees hold hearings

and review the budget. Some issues may be decided at this time. Others will be “left open” for further consideration at the May Revise hearings.

Early May: Governor releases the May Revision to the Budget.

• Mid-May: Budget Subcommittees hold May Revise hearings to review the budget. Subcommittees pass their portion of the Budget which then goes to the full Budget Committee

• Late May: Each house passes a budget.• Late May: Two house conference committee meets to

resolve differences. Tactically, as advocates, sometimes we want to make sure there is a difference in the budgets passed by each house so that the item goes to conference; other times we need to make an early compromise so that the item is the same in both the senate and the assembly

June 15: Constitutional deadline for the Legislature to pass the budget.

June - “Big Five” meets to resolve major policy differences.

July 1: New fiscal year begins.August – September: Departments such as DDS are

crafting their budget estimates and proposals for new areas of funding.

September – January 10: Control Agencies review departmental budget proposals and Department of Finance reviews the agencies.

The Governor’s office reviews them all to come out with his/her Budget on January 10.

Who Does What?The Governor: Note pre-eminent role of the Governor in the

process. Reviews, approves, or rejects Budget Change Proposals from

state agencies and departments. Proposes a spending plan and policy initiatives for the year. Introduces his/her version of the budget in bill form in each

house of the Legislature. Signs or vetoes the final budget bill approved by the

Legislature. Can veto all or part of individual spending proposals (line

items) in the budget approved by the Legislature. Cannot increase funding above the level proposed in the

budget.

The Legislature:Reviews, increases, or decreases individual spending

proposals contained in the Governor’s budget.Can add new programs to the budget as proposed by

the Governor.Can require state agencies to conduct studies or

prepare reports to the Legislature (Supplemental Report Language).

Can specify restrictions over the use of funds allocated in the budget (Budget Control Language).

Must approve passage of the budget by a 2/3 vote of each house.

Can override the Governor’s veto by a 2/3 vote.

Budget trailer billsA budget trailer bill makes statutory policy changes

needed to implement the budget. It does not move through legislative policy committees, so in effect, it is a backdoor way of changing policy. It moves as part of the budget package.

Sometimes the language of the TB changes is not made public but negotiated as part of the Big Five process. It can be important to have backdoor access.

In the 1990s, the TB became the major way of making policy changes. Since then, it has fallen in and out of favor.

  Meeting with Legislative Members and/or their Staff1

Self-advocates and other advocates play a key role in the development of responsive public policy

 The advocate’s role is considered more important since the advent of term limits. Term limits make it more difficult for legislators to develop expertise in multiple areas of law

 Scheduling meetings with Senators or Assembly Members

Meeting the Member vs. StaffSpend time preparing for the meetingDevelop a short written fact sheet or position letter 1Adapted from materials provided by the National Disability Rights Network (NDRN)

• Stay “on message”• Don’t feel you have to respond to every

question, if you don’t know the answer• Clearly identify what you want the Member to

do• Be time efficient

• Be respectful -- not too casual• When referring to a Senator, always call them

either "Senator Smith", or "The Senator"• Wrap up the meeting effectively • After the Meeting: fulfill your promises

DO

Make an appointment.   Be on time for the visit. Be positive and friendly.

DON’TArrive unexpectedly and be

upset if the member can’t see you personally

  Be late for the visit.

Be confrontational.(Do not ever threaten or

berate the Member or aide.)

DO

State the reason for your visit.

Be concise and specific.

Introduce yourself and briefly identify what/whom you represent.

Briefly describe the issue(s).

Limit the number of issues to be discussed

State your position and recommendation on the issue(s).

DON’T

Try to discuss several different issues.

DOPersonalize the issue(s).Tell how the action will affect

people with disabilities. Provide reliable data/facts to support your position.

 Provide the names of people whocan be resources for the Memberand give him/her additionalinformation.

Leave a written summary of yourposition.

DON’T

Talk only in terms of

numbers and statistics.

Give incorrect information

or try to answer questions

that you do not know.

DO

Write a thank you letter.

Thank the Member/aide for the visit Summarize the visit.

Identify follow-up steps

Ask for the Member’s commitment.

DON’T

Forget to write a thank-youletter

Ignore the Member for therest of the year.

• Many resources are available on the Internet• Governor’s Office

• Governor’s Budget Summary: Released on January 10th. Summarizes key policy proposals. Presents the economic and fiscal context of the budget

• The Governor’s Budget: Released on January 10th. Contains line item detail of all state spending

• Department of Finance: Access to Governor’s Budget documents. http://www.dof.ca.gov/budget/

• Legislative Analyst’s Office (nonpartisan)• Reports and issue analyses.

http://www.lao.ca.gov/ • Perspectives and Issues: Released in

February. Presents overview of revenues and expenditures, analyzing key policy initiatives

• Legislative Analyst’s Analysis of the Budget Bill: Released in February. Don’t leave home without it. Detailed analysis of state spending. http://www.lao.ca.gov/laoapp/main.aspx?type=2&PubTypeID=2

SenateIncludes free bill tracking service and ability to

monitor Senate hearings and floor sessions via the internet. http://www.sen.ca.gov

The Red Book: Budget overview prepared by the Senate Budget and Fiscal Review Committee

Budget Subcommittee #3 Health and Human Services Agenda http://www.senate.ca.gov/htbin/testbin/agenda?INET_FTP:[SEN.COMMITTEE.SUB.BFR_3_HEALTH]schedule.htm

Assembly Provides the same services as the Senate web site.

http://www.assembly.ca.gov Budget Subcommittee #1 Health and Human Services Agenda:

http://www.asm.ca.gov/acs/subcommitteeframe.asp?subcommittee=1

California Budget Project: Issue analysis, email update service. Including California Budget Project Budget Overview: Released in late January. Presents an overview of key proposals, social and economic trends. http://www.cbp.org

Legislative Counsel: Provides free bill tracking service and allows you to search California Codes. http://www.leginfo.ca.gov

California State home page: Gateway to agency information and data. www.ca.gov

Welfare and Institutions Code section 14131.10: Medi-Cal no longer pays for the following benefits and services for most adults. There are some exceptions. Dental servicesSpeech therapy servicesPodiatric servicesAudiology servicesChiropractic services

Acupuncture servicesOptometric and optician services

ophthalmology [doctor services for the eyes] will continue to be covered

Violates federal law and will be rescinded; see below

See http://www.disabilityrightsca.org/pubs/F01001.pdf for more information about these cuts

• Governor proposed to cut $118 million by eliminating state-funded Medi-Cal for lawfully present immigrants who do not qualify for federally-funded Medi-Cal.

• Maximum benefits caps onhearing aids ($1,510)durable medical equipment ($1,604)incontinence supplies ($1,659)urological supplies ($6.435)wound care supplies ($391)

• Capping doctor visits to ten per year

• Mandatorily enrolling seniors and people with disabilities into managed care plans

 • Restoring optometry benefit for adults as required by

federal law • See http://atnetworkblog.blogspot.com for analysis

and response to these proposals

Conference committees are currently working on the details of the budget.

A group of members from each house chosen by the leadership to reconcile the decisions of the budget subcommittees in each house.

There are still many things in this budget that will need to be worked out.

The Assembly conferees are Blumenfield, Fuentes, Skinner, Conway, Nielsen.

The Senate conferees are Ducheny (Chair), Leno, Lowenthal, Dutton, Huff.

Even though the subcommittees have rejected many of the governor’s cuts, they could be resurrected.

• The Legislature still has to come up with multiple solutions for the budget shortfall.

• You can find out who your legislators are and their contact information by going to the following link using your zip code: http://www.leginfo.ca.gov/yourleg.html )

• 1408. (09-0057) Would change legislative vote requirement to pass a budget from two-thirds to a simple majority. Retains two-thirds vote requirement for taxes. Initiative constitutional amendment. Available at http://www.sos.ca.gov/elections/ballot-measures/initiative-referendum-status.htm

AB 754 (Chesbro) will be repurposed to include the language of AB 214 (Chesbro), a DME bill that Disability Rights California proposed last year but failed in the Assembly Appropriations Committee.

This bill would require health service plans which cover hospital, medical or surgical expense to also offer coverage for medically necessary Durable Medical Equipment (DME) and services.

See http://www.disabilityrightsca.org/legislature/Legislation/2008-2009/2009sponsored.htm

• More people will be eligible for Medi-Cal• More people will have access to affordable health

insurance• Insurers will not be able to turn people down due to pre-

existing conditions• Eliminates use of lifetime limits and reduces annual

limits• Community First Choice Option, allows States to offer

home and community based services to disabled individuals through Medicaid rather than institutional care. But some services, like some AT and DME, are excluded

• 2.3 percent excise tax on the sale of a medical device by a manufacturer or importer

• Standard set of comprehensive benefits including medical, mental health, prescription drug, and rehabilitative services. People will be able to pick among four levels of coverage – bronze, silver, gold, and platinum. Standard benefit levels will make it easy to compare benefits and costs

 

The Class Act will create a new national insurance program to help adults who have or develop functional impairments to remain independent, employed, and stay a part of their community. Financed through voluntary payroll deductions will help remove barriers to independence and choice• Housing modification,• Assistive technologies,• Personal assistance services,• Transportation,• that can be overwhelmingly costly, by providing a cash

benefit to those individuals who are unable to perform 2 or more functional activities of daily living.

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• Sacramento Regional Office• 100 Howe Avenue, Suite 235-N• Sacramento, CA 95825• Phone: (916) 488-9950• Website: www.disabilityrightsca.org

AT Network Staff• Kim Cantrell (Director of Programs) kim@cfilc.org• Allan Friedman (Technologies Manager)

allan@cfilc.org• LaCandice McCray (Outreach & Training Advocate)

lacandice@cfilc.org• Mazuri Colley (Information & Assistance Advocate)

mazuri@cfilc.orgCFILC phone: 916-325-1690AT Network I&R Line: 800-390-2699