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Training Presented By: Disability Rights California.

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Presentation on theme: "Training Presented By: Disability Rights California."— Presentation transcript:

1 Training Presented By: Disability Rights California

2 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?

3 What is an AT Device? Any item, piece of equipment, or product or system Whether 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 device E.g. nursing, occupational therapy, physical therapy See Disability Rights Californias AT manual for more information:

4 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

5 Medi-Cal puts assistive technology in a number of categories, e.g. Medical supplies Durable medical equipment A prosthetic device Medi-Cal will only pay for the least expensive item that meets your medical needs TAR process

6 If Medi-Cal denies the TAR, you have a right to: an explanation in writing appeal within 90 days file 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 Judge State Hearings Division Department of Social Services 744 P Street Sacramento, CA 95814

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

8 Disability Rights California website: Assistive Technology resources and publications: ubs.htm ubs.htm Accessing Assistive Technology Manual, Chapter 10, Medi-Cal: (available in English, Spanish, and Chinese) Preparing Letters of Medicaid Medical Justification letters:

9 Topics covered Both budget and bills are important Why budgets are Important for people with disabilities and advocates How Californias budget works Key budget dates Who does what Budget trailer bills The advocates role Key budget resources

10 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

11 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 money If a policy change requires money, then you may need both bill and budget

12 How Californias budget works Constitutional framework The constitution can only be changed by a vote of the people Initiative 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).

13 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

14 Advocates often ask why taxes cant be raised if theres not enough money available. They can, but it requires a 2/3 vote of the Legislature, plus the Governors 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

15 Key budget dates The Budget process moves according to a schedule On or before January 10: Introduction of the Governors Budget. Late February: Release of the Legislative Analysts Review of the Budget March - 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.

16 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

17 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 Governors office reviews them all to come out with his/her Budget on January 10.

18 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.

19 The Legislature: Reviews, increases, or decreases individual spending proposals contained in the Governors 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 Governors veto by a 2/3 vote.

20 Budget trailer bills A 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.

21 Meeting with Legislative Members and/or their Staff 1 Self-advocates and other advocates play a key role in the development of responsive public policy The advocates 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. Staff Spend time preparing for the meeting Develop a short written fact sheet or position letter 1 Adapted from materials provided by the National Disability Rights Network (NDRN )

22 Stay on message Dont feel you have to respond to every question, if you dont 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

23 DO Make an appointment. Be on time for the visit. Be positive and friendly. DONT Arrive unexpectedly and be upset if the member cant see you personally Be late for the visit. Be confrontational. (Do not ever threaten or berate the Member or aide.)

24 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). DONT Try to discuss several different issues.

25 DO Personalize 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 who can be resources for the Member and give him/her additional information. Leave a written summary of your position. DONT Talk only in terms of numbers and statistics. Give incorrect information or try to answer questions that you do not know.

26 DO Write a thank you letter. Thank the Member/aide for the visit Summarize the visit. Identify follow-up steps Ask for the Members commitment. DONT Forget to write a thank-you letter Ignore the Member for the rest of the year.

27 Many resources are available on the Internet Governors Office Governors Budget Summary: Released on January 10th. Summarizes key policy proposals. Presents the economic and fiscal context of the budget The Governors Budget: Released on January 10th. Contains line item detail of all state spending Department of Finance: Access to Governors Budget documents.

28 Legislative Analysts Office (nonpartisan) Reports and issue analyses. Perspectives and Issues: Released in February. Presents overview of revenues and expenditures, analyzing key policy initiatives Legislative Analysts Analysis of the Budget Bill: Released in February. Dont leave home without it. Detailed analysis of state spending. &PubTypeID=2 &PubTypeID=2

29 Senate Includes free bill tracking service and ability to monitor Senate hearings and floor sessions via the internet. The Red Book: Budget overview prepared by the Senate Budget and Fiscal Review Committee Budget Subcommittee #3 Health and Human Services Agenda _FTP:[SEN.COMMITTEE.SUB.BFR_3_HEALTH]sch edule.htm _FTP:[SEN.COMMITTEE.SUB.BFR_3_HEALTH]sch edule.htm

30 Assembly Provides the same services as the Senate web site. Budget Subcommittee #1 Health and Human Services Agenda: =1 =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. California State home page: Gateway to agency information and data.

31 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 services Speech therapy services Podiatric services Audiology services Chiropractic services

32 Acupuncture services Optometric and optician services ophthalmology [doctor services for the eyes] will continue to be covered Violates federal law and will be rescinded; see below See for more information about these cuts

33 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 on hearing aids ($1,510) durable medical equipment ($1,604) incontinence supplies ($1,659) urological supplies ($6.435) wound care supplies ($391)

34 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 for analysis and response to these proposals

35 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 governors cuts, they could be resurrected.

36 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: )

37 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 measures/initiative-referendum-status.htm measures/initiative-referendum-status.htm

38 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 008-2009/2009sponsored.htm 008-2009/2009sponsored.htm

39 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

40 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

41 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.

42 We appreciate the time you took to participate in this training. Please take a few moments to complete an ANOYMOUS survey, and your feedback will help us improve future training opportunities. Evaluation link:

43 Sacramento Regional Office 100 Howe Avenue, Suite 235-N Sacramento, CA 95825 Phone: (916) 488-9950 Website:

44 AT Network Staff Kim Cantrell (Director of Programs) Allan Friedman (Technologies Manager) LaCandice McCray (Outreach & Training Advocate) Mazuri Colley (Information & Assistance Advocate) CFILC phone: 916-325-1690 AT Network I&R Line: 800-390-2699

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