A gathering of New Mexicans with disabilities, from all across the State during the 2012 Legislative Session.   Monday, January 23  will feature presentations and workshops from 9am to approximately 4pm at the Courtyard by Marriott on Cerrillos Rd regarding key issues facing New Mexicans with disabilities.  A continental breakfast and lunch are provided.  Registration is required.  On Tuesday, January 24  there will be a rally in the Capitol Rotunda with speakers and awards from 11am – 1:30pm.  Information tables from 9am – 3pm in both wings of the Capital Building and visits with legislators.

Download the Registration Form Here

Presented by Disability Rights New Mexico and The Disability Coalition, the Forum will offer a preview and discussion of disability-related issues to be addressed in this year’s legislative session.  If you and/or your organization/agency are planning to be involved in any way in this year’s legislative session – making calls, sending letters, meeting with your legislators, attending committee meetings, etc. – or even if you’re just interested in what’s going on with disability issues in New Mexico, we hope you’ll plan to attend.  Details and registration information will be coming out soon.

Download the PDF Here

Download the PDF Here

Download the PDF Here

Download the PowerPoint Presentation .PPT File Here

Calls on Administration to Promote and Expand Home and Community Supports for New Mexicans with Disabilities

ALBUQUERQUE, NM — Governor Susana Martinez’s Medicaid Modernization is an opportunity to promote and expand opportunities for thousands of New Mexican children and adults with disabilities to receive community health and long-term supports in their communities. The Administration’s proposed Medicaid Modernization  will affect tens of thousands of people with disabilities, including people with mental health needs, developmental disabilities, chronic conditions, and people with other disabilities who rely upon supports for their daily physical needs to keep them out of nursing homes.

The Disability Coalition is the largest statewide advocacy coalition representing people with disabilities in New Mexico. The Press Conference immediately precedes the final day of the Southwest Conference on Disability, an event that will attract over 900 people with disabilities, families, advocates and professionals from 28 states and three countries, in addition to the United States. The Coalition is holding a Press Conference on October 7 at 8:30 am to bring attention to the needs of New Mexicans with disabilities and issue recommendations for the redesign. The Press Conference will be held at the Albuquerque Convention Center, Main Ballroom, Upper Level, West Side. 

‘The Governor’s key principle of home and community supports rather than institutions is fundamental to the redesign of the state’s Medicaid program and one that The Disability Coalition is fully behind,’ asserts Coalition Chair Jim Jackson. Mr. Jackson is also the Executive Director of Disability Rights New Mexico, a nonprofit legal advocacy organization working on behalf of the rights of persons with disabilities.

“The Coalition urges the Administration to work with representatives of the disability community on a meaningful and ongoing basis as plans for Medicaid redesign are developed and implemented,’ states Mr. Jackson.  The Disability Coalition’s recommendations are proposed to protect the health and safety of persons with disabilities, as well as to strengthen the services and supports that promote their independence and inclusion in the community. Among the recommendations provided by the Coalition are those relating to case management, getting people out of nursing homes with the supports needed to live in their home and community, and the Personal Care Option program, which provides assistance in the home to seniors and younger people with disabilities who need the level of care provided in a nursing home.

“The PCO allows individuals who need nursing facility level of care to stay in their own homes instead of going into a nursing home.  That’s cheaper for the state and much better for the individual,” said Ellen Pinnes, a health policy consultant who works with the Coalition.

The Press Conference on Friday will also feature people with disabilities who rely upon the Medicaid PCO program to remain in their community.

The Legislative Disability Subcommittee, chaired by Representative Antonio Lujan of Las Cruces, will be meeting immediately following the press conference.  The Subcommittee’s agenda will include briefings on some of these critical Medicaid programs, such as the Personal Care Option.

WHAT: PRESS CONFERENCE
WHO:  THE DISABILITY COALITION
WHEN: FRIDAY, OCTOBER 7^TH
TIME:    8:30 A.M.
WHERE: ABQ CONVENTION CENTER, MAIN BALLROOM, UPPER LEVEL, WEST SIDE

Medicaid Redesign – Recommendations

Download the PDF here

General recommendations:

1) Be sure the re-designed system has incentives that favor community placement over facility-based care.

2) Promote consumer direction in all long-term service programs, to improve consumer quality of life and reduce state expenditures.

3) Work with representatives of the disability community on a meaningful and ongoing basis as plans for Medicaid redesign are developed and implemented.

Developmental Disabilities waiver:

4) The DD waiver should not be included in a global §1115 waiver.  The Department of Health has engaged in a lengthy process of working with stakeholders to redesign this waiver, and the new waiver just went into effect on July 1.  DOH is in the process of refining the new provisions and is continuing to involve stakeholders in that ongoing process.  That process should be respected rather than disrupted.

Long-term services and supports (LTSS):

5) Reduce the “silos” that limit access to various LTSS programs:  once someone is eligible for Medicaid and meets nursing home level-of-care criteria, allow them to receive the services they need in the appropriate setting without losing eligibility.

Example:  a person with income at 175% FPL who goes into a nursing home or a D&E waiver slot but who needs only attendant services to live successfully in the community could exit the facility or waiver slot and receive PCO services instead, thereby freeing up a waiver slot for someone who needs the broader array of services offered in the waiver.

If the state is paying managed care organizations (MCOs) to manage care for individuals needing long-term services and supports (LTSS), they should provide the flexibility for the MCOs to do so.  In a system where the MCO is paid a capitated rate, the state should not limit access to services based on fear of cost.

6) Implement Community First Choice and use it to replace PCO, serving more people with the same amount of money and reducing the disparity in income eligibility levels among programs.

Until CFC is implemented, preserve the integrity of the PCO program and maintain a sufficient level of services to meet the needs of program participants. 

7) Avoid placing excessive reliance on natural supports to substitute for paid services; rely on them only when they are readily available from a willing source.

People with disabilities (whatever their age) want to be able to live independent lives in their communities, not to be dependent on family members who have their own lives to lead.

Families (and friends) are already providing most of the long-term care in this country, as well as paying for a significant percentage of paid supports.  They incur financial,

emotional and physical burdens to do so.  The state should be working to find ways to relieve this burden and position New Mexico to address a growing population of seniors and people with disabilities.

Forcing family members to provide care regardless of their ability or willingness to do so leads to abuse and neglect.

8) Withdraw the current policy that makes D&E waiver slots available only to persons leaving nursing facilities, which has created a perverse incentive to go into a nursing home in order to get a slot in the community and which allows those individuals to leapfrog over everyone on the waiting list.

Use Money Follows the Person (MFP) for as many community transitions as possible (creating new waiver slots rather than using existing ones) and allocate vacancies in the waiver to people on the waiting list.

9) Implement MFP as intended.  Full and effective implementation of MFP in New Mexico will require:

A robust program for identifying nursing home residents who want community placement,

Adequate transition assistance, including the use of trained relocation specialists,

Accessible, affordable housing and an expanded personal care workforce,

Strong consumer input into design, implementation, and program evaluation, and

Including transitions from ICF/MRs. 

10) Adopt a plan for expeditiously moving people off the D&E waiver waiting list as required by Olmstead.  Recommend to DOH that they do the same for the DD waiver. 

11) Return the Mi Via self-directed waiver to a less medical and more person-centered model by: providing more flexibility in selecting supports to meet individual needs, and  restoring consumer decision-making authority. 

12) Ensure that each Medicaid recipient with a significant disability or chronic health care condition has access to case management/care coordination services.

13) Adopt a streamlined process for annual level-of-care redeterminations for people with permanent disabilities whose condition is not likely to improve.  (Federal law requires annual re-assessment but the state should explore use of a simplified process for this population.)

14)  If any of the current 1915(c) waivers are included in a global 1115 waiver, ensure that the ability to receive federal matching funds to serve more people through additional appropriations is not jeopardized.

Health care: 

15) Promote use of health homes for persons with chronic disease and/or other chronic health conditions.

16) Provide case management/care coordination for those who would benefit from that support.

17) In offering incentives for healthy lifestyles and appropriate use of health care services, be aware of the limits on the ability of people with disabilities to assume “personal responsibility” for their health and care, and don’t inadvertently penalize people with disabilities in any incentive program.  People aren’t always responsible for their health status or in a position to change it.

18) Co-pays are particularly problematic for people with disabilities who have to use services on a regular and frequent basis.  If used:

a) there should be none for services used on a frequent basis by people with disabilities or chronic health needs.

b) they should be imposed in a carefully tailored manner that provides incentives for good use of services and disincentives for inappropriate use, and does not penalize those whose health status requires frequent use of services or who don’t have readily available alternatives.

c) they should not be tied to the cost of care.  Some of the items and services used by people with disabilities are quite expensive but they are in no way frivolous expenditures.

19) Work with physicians and other providers to educate them and ensure that they have the knowledge, equipment and general ability to provide quality care to people with disabilities.

20) Make sure that any pay for performance measures do not penalize providers for caring for high-needs patients, or create incentives to avoid this population.

Download the PDF Here

Download the PDF Here

Like many others Cory has faced a lot of adversity in his life; having 13 surgeries before he was a senior in High School for example.  He has, however, also experienced much joy.

As a child he participated in sports and other activities like Wheelchair Track, Karate, and Skiing.  In 1999 he moved to Las Cruces, New Mexico to attend New Mexico State University where 4 years later he graduated with a bachelor’s degree in social work.  Since then he has had the privilege of working in independent living, the university system and the correctional system with each experience giving him the chance to improve how he works. He has even had the opportunity to travel internationally; in 2004 Cory went to Tokyo, Japan on a 16 day Cultural Exchange on Disability.

Now Cory is the sole proprietor of his own business, “Joyful Expression,” a Motivational Speaking venture. He hopes that through his talks he can engage listener’s minds to begin to look at the adversity they face in everyday life as not a hindrance to their goals but as something that will propel them closer to achievement.  He also hopes to engage those with disabilities to look at their disabilities not as a challenge or obstacle that needs to be overcome but as an opportunity for them to be the best versions of themselves that they can be.

Cory invites you to join him as we Roll Through Adversity and into The New Paradigm of Disability!

If you or your organization are interested in having Cory speak to your group he can be contacted through email at valenciaco2003@yahoo.com

Elmer L. Cerano, Executive Director

There is a nationwide debate as to whether or not employers should be allowed to continue to pay a deviated (reduced) wage to people who produce at a rate below the average.

Let me explain. Back in the 1930s, in an effort to allow military veterans with disabilities to find work, the government encouraged employers to pay a minimum wage that was reduced to match the levels of productivity of the worker. In other words, if the employee produced at 70 percent of the rate of the employee without a disability, they would earn 70 percent of the minimum wage.

Sounds like a relatively decent plan to allow people to work to their levels of capacity while not placing an unrealistic financial burden on the employer.

Over the years, this well-intentioned plan took some unfortunate turns.

Some unscrupulous employers doctored time studies and exploited the work and talents of people with disabilities. In other situations employees with disabilities purposely held back on their work hours, productivity and earnings in fear of losing government benefits such as Medicaid, Social Security and others.

So now comes the debate. In part, to reduce the risk of exploitation, should the deviated wage provision be eliminated, and should all employers be required to pay all of their employees at least the minimum wage, irrespective of the level of productivity?

Proponents say that the deviated wage has been and is still being abused and people with disabilities are paid less than the legal minimum wage. Everyone who has a job should be paid at least the legally required minimum wage irrespective of their levels of productivity. People with disabilities are singled out and, overall, they are paid less than people without disabilities.

Opponents of the elimination of the deviated wage provision agree that exploitation and unfair labor practices must stop; however, eliminating the employer’s ability to pay at a rate equal to the level of productivity will force employers to simply not hire people with disabilities.

The solution is, (or perhaps the solutions are) complex. A too simplistic remedy may simply discourage employers from hiring or retaining people who, due to their disability, have lower rates of productivity than their coworkers without disabilities.

The obvious best option is to assist people with disabilities, through creative job carving and the application of modern technologies, to find work where their productivity can be maximized and their earnings commensurate with this increased level of productivity. Level the playing field by increasing the productivity of the employee with a disability.

To do this, however, we need to change the job expectations for students with disabilities and we need to move beyond food, filth, and flowers when we think of good paying job opportunities for people with disabilities.

While we creatively increase productivity, we must also keep an eye on what kind of job opportunities the future will hold for everyone, not just for people with disabilities. If we fail to recognize the rapidly changing nature of work, twenty years will pass and, once again, people with disabilities will be left out of the labor force

It is currently projected that by 2016, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) will cost the American taxpayer over a trillion dollars each year. It appears that the only way to derail this tsunami will be to enable people with disabilities to work, earn a decent wage, and retain their assets.

We need to think beyond our traditional framework if we are to adequately address the issues around employment for people with disabilities. Perhaps there is another approach that might work – one that creates new incentives for the private employer to hire more people with disabilities in a fully integrated community work environment while, at the same time, assuring at least a minimum wage.

Here is an idea that is currently being studied by the Nish Institute on Economic Empowerment for People with Limited Productivity.

First: LEGITIMATELY calculate the true productivity of the employee on a job that has been appropriately carved to match their abilities.

Second: Allow the employer to pay at least minimum wage – adjusted for the employee’s actual productivity (yes, allow for a verifiable deviated wage).

Third: – and this is the cool part –

Allow the employee to file an Earned Income Tax Credit to make up the difference between what the employee actually earned and what should have been earned if the employee were producing at the rate of non-disabled employees.

This way:

• The employer is not forced to pay full wages for reduced productivity.
• The Federal Treasury, not the employer, makes up the difference between earned wages and the minimum wage.
• Earned Income Tax Credits are already available – but perhaps not to the degree necessary to make this work.
• The Federal Treasury reduces its cost for government benefits by allowing the person with a disability to earn money and offset their dependency on government benefits.
• The person with a disability is not at risk of losing their job due to low productivity and high cost to the private employer.
• People with disabilities are allowed to earn money and retain assets that can be used to pay for items and supports that otherwise would be paid for through government programs.

A lot more number crunching needs to be done and variables need to be seriously calculated before these ideas can become a reality. In the meantime, the debate rages on.

There is another debate also raging on the issues surrounding the continued use of segregated worksites for people with disabilities. Why do we still have them and what challenges does the future hold?

I will attempt to shed some light on this controversial topic in the next issue of Exchange.