AccessAbility

New Governor Andrew Cuomo’s budget proposal contains more questions than answers. Facing a $10 billion projected budget deficit, he has responded by calling for huge amounts to be cut and leaving the details to so-called “commissions” of “stakeholders”.

Cuomo said many interesting things as he rolled out his State of the State and budget messages. Among them, “I understand the importance of keeping jobs ... I also understand that that does not justify the burden on the taxpayer and the violation of civil rights of the young person who is in a program that they don’t need where they’re not being treated hundreds of miles from their home just to save state jobs. An incarceration program is not an employment program. If people need jobs, let’s get people jobs. Don’t put other people in prison to give some people jobs. Don’t put other people in juvenile justice facilities to give some people jobs. That’s not what this state is all about ...”

He didn’t say this specifically about people with disabilities, but a large percentage—perhaps the majority—of incarcerated children do have learning, emotional, developmental and/or psychiatric disabilities. If he understands that point, perhaps he can understand it when it comes to other people with disabilities being kept in institutions, people who can be served more effectively and less expensively in their own homes.

Cuomo also said he doesn’t want to just cut Medicaid; he wants to reform it, make it both less expensive and more helpful to people, including people with disabilities who use long-term care. He created a Medicaid Redesign Team (MRT) to come up with recommendations to do this.

Sadly, though, most of the proposals the MRT saw were the same tired old managed care ideas that the state Department of Health (DOH) has been promoting for over a decade and hasn’t been able to get past the legislature. Managed long-term care exists in New York City, and it doesn’t work very well. The state will not pay managed care providers enough to serve the people with the greatest needs, so they “cherry pick” the easier-to-serve people and the rest—the most expensive to serve—stay in non-managed programs. Putting hard-to-serve people into managed care will not cut costs. but it could bring in more federal dollars. That’s an old New York game though: maximizing federal Medicaid

matching dollars even if it insanely inflates the cost of doing business.

Other proposals attacked the availability of personal assistance services and ignore the moral and financial consequences: that cutting those services will force people with disabilities into more expensive institutional settings. Again, nothing new there; Cuomo’s father tried to do the same thing 15 years ago, as has every governor since.

Then there is the bait-and-switch of the Medicaid Redesign process: A promise to involve all “stakeholders ”—but only one consumer representative on a team stacked with union officials, hospital and homecare operators, state agency heads and politicians. Thousands of reform proposals collected from far and wide—but only a few selected by DOH to provide to MRT members with enough detail to make intelligent decisions, and some good ones not given to them at all. Public claims that DOH did not endorse or oppose any proposals—but hard-nosed behind-the-scenes arm-twisting and sweet-talking of MRT members by DOH officials to get certain ones accepted. Open meetings with lots of public testimony—at 2 minutes per person except for certain privileged public officials. An open process—with a workload that required, but didn’t get, full-time attention from MRT members, and instead consisted mostly of public meetings that didn’t allow substantive discussion, and was capped off by an early vote rushed through by DOH and key MRT members to approve recommendations which, it now appears, were never seriously in doubt.

And finally there was Cuomo’s close friend Jeffrey Sachs, a so-called health industry “consultant” who functions as a lobbyist in all but the most technical legal sense. Allegedly Sachs came up with the MRT idea, which is based on a similar process that took place in Wisconsin (and appears not to have produced actual significant Medicaid savings), and recommended people to be appointed to the team. The New York Times revealed that Sachs, an MRT member, has worked on behalf of several hospitals and health care providers in New York and contacted state officials to prevent them from cutting funding to or closing at least one of them shortly before Cuomo took office. Asked whether Sachs was in fact lobbying and, by implication, unfairly influencing the MRT process, Cuomo, who has heavily promoted a plan to tighten ethics rules for state Legislators, including requiring them, many of whom are lawyers or consultants, to disclose who their clients are, merely remarked that MRT members aren’t required to disclose their clients.

So among the many questions to be answered, one must certainly be: Is there really anything “new” here at all, or is this the same old wolf in a particularly nice-looking wool sweater?

This year is different—so said many pundits and politicians. So far, though, it appears that the differences are more in style than substance.

The process has moved rapidly and produced hundreds of pages of information, much of which we’ve read but haven’t had time to analyze fully. As we went to press, rookie Governor Andrew Cuomo was finalizing his 30-day amendments to his budget bills, and important unanswered questions remained. By the time you read this, much more will have happened. All we can do now is provide a snapshot of where we were at the beginning of March.

There’s an approximate $10 billion budget deficit projected for FY 11-12, with deficits mounting in the years after that. According to Cuomo, various formulas have been written into state law to determine rates of spending increases on things like Medicaid and school aid, and in past years the budgets that have been passed have only reduced these rates of increase. Others say that much of the deficit is “on paper”—that is, it’s estimated by assuming spending increase rates that have never been, and are not likely, to be enacted.

Cuomo initially proposed to address the deficit by cutting actual state spending by about $3.7 billion. Note that for many years in a row, allegedly “balanced” budgets have been enacted that actually increased state spending, despite significant projected deficits.

In addition to cuts, his initial proposal included about $450 million in “revenue enhancements”, such as expanding the state ’s lottery offerings. Cuomo claimed he will not raise taxes but he included an “assessment” on horse racing winnings and allegedly tightened some tax loopholes. There were also about $805 million in “one-shot” budget items—accounting tricks such as transferring funds between accounts, delaying payments into the next fiscal year, and selling off state assets. And there was some new spending, including various proposed “performance incentives” for schools and medical providers.

Cuomo claims that everyone must share the pain, but he does not include the wealthy in his definition of “everyone”. He wants to let an income tax surcharge currently in effect on people with incomes over $200,000 lapse. Various reports have claimed that keeping the surcharge in effect would knock $1 billion or more off the deficit.

So what were the initial proposed cuts?

• $2.85 billion from projected spending, or about $1 billion from last year’s spending, from Medicaid.
• $2.85 billion from projected spending, or about $1.5 billion from last year’s spending, for school aid.
• A 10% across the board cut to state agency operating budgets ($1.4 billion), to be achieved in part by various state agency mergers and consolidations, in part by closure of unneeded prisons and youth correction facilities, and in part by either negotiating cheaper contracts with unions representing state workers or by laying off up to 10,000 of them.
• $1.8 billion in cuts to other programs

There were, officially, no specifics on how the Medicaid, school aid, and some agency reorganization cuts would be achieved. Instead, various commissions of “stakeholders” met to come up with plans. At press time, plans for Medicaid and “mandate relief” had been presented to the Governor, and he had accepted the Medicaid recommendations.

Of most interest to people with disabilities is the package recommended by the Medicaid Redesign Team (MRT). Most of the MRT members are state agency officials, public and health industry union leaders, executives from hospitals and other medical service providers and their lobbyists, and members of the legislature. Only one member represents consumers of Medicaid-funded services: Medicaid Matters NY.

The MRT held public forums and meetings around the state over nearly two months. They received a series of presentations from state Department of Health (DOH) officials on Medicaid spending. The PowerPoint slides from these presentations heavily promoted various managed care proposals that DOH has been trying to get enacted for several years, including managed long-term care. They also collected thousands of proposals from organizations and private citizens. DOH provided various levels of detail on these proposals in at least three different sets of documents to the MRT. They did not include all of the proposals they received, though.

Many participants in the MRT process complained that not enough time was provided to fully analyze the proposals, discuss them as a group, or propose their own alternatives. A final two-day meeting was scheduled for the MRT to decide on the recommendations. However, a vote, apparently pre-arranged between DOH officials, representatives of the Governor, and key MRT members, was rushed through at the end of the first day. The sole consumer representative, and the representatives from the state Legislature, abstained under protest.

The approved package was delivered to the Governor, whose staff made additional changes and put them into a budget bill. The following information comes from a draft version of that bill that we received hours before the final version was due to be released. The final version may be somewhat different.

First, the Governor reported that actual new Medicaid enrollments (mostly due to the recession putting people out of work, who then lost their health insurance and qualified for Medicaid) were somewhat lower than projected. He therefore agreed to reduce the amount to be cut from Medicaid from $2.85 billion to $2.3 billion.

The MRT couldn’t find anywhere near that amount in the proposals they received. They therefore added the recommendation that Medicaid spending be cut by 2% “across the board”. This is fiction; the actual language contains several exceptions, with the result that some things won’t be cut much or at all, and others will be cut by much more.

Ominously, the specific proposals plus the 2% cut add up to about $1.65 billion. There are still $650 million in allegedly necessary cuts unaccounted for. The Governor’s bill gives the DOH Commissioner authority to come up with the rest without legislative approval. The Commissioner could impose utilization controls and cut payment rates to do this, without public review or significant advance notice. He would also be able to ask the federal government to approve any Medicaid State Plan or Waiver amendments necessary to make these cuts, and those changes could include terminating any Waiver or optional State Plan services. Over the longer term, the bill would create a 2-year Medicaid budget cycle, and would cap the rate of Medicaid spending increases at the medical component of the Consumer Price Index, as averaged over ten years—currently about 4%. The Commissioner could adjust the Medicaid program as often as monthly to keep spending under this so-called “global cap”, using any of the above measures.

Now we come to the specific proposals, but bear in mind that given the above, they are just guidelines for action. If the Legislature approves Cuomo’s bill, things could get a lot worse than this, and very quickly, in the months ahead.

Cap Personal Care Level I at 8 hours per week. Level I provides services to people with significant disabilities that don’t involve touching their bodies, such as cleaning and cooking. Although sometimes decried as luxurious “maid service”, without Level I services recipients would end up using more-expensive medicalized homecare services, or even more expensive nursing facilities, just as surely as they would if they couldn’t get help with bathing or toileting.

Eliminate the “prescriber prevails” rule from the Preferred Drug List. Medicaid recipients can follow an appeals process to get drugs not on this list if a doctor feels it’s necessary; currently, even if the approval is ultimately denied, the drugs must be provided. DOH wants to remove this provision because it believes that the people who create the list are always right; the medical profession, in general, believes that’s not necessarily true and people’s health will be jeopardized.

Reduce fee-for-service dental payments for adults. There already aren’t enough Medicaid dental providers because these fees are so low.

End “spousal refusal” for state-plan long-term care services. In NY, if a spouse (or dependent under age 21) needs long-term care and isn’t eligible for Medicaid because of the family’s income, then the other spouse or adult family member can refuse to provide support for the person in a purely technical financial sense, and the person who needs services can have their Medicaid eligibility determined only on the basis of their own income. DOH claims this is now illegal under federal law. DOH also says that people who need long-term care can get what they need from various Medicaid waivers, which have “the same income and resource protections as those allowed under the spousal impoverishment provisions for nursing home residents,” and that “waivers for disabled children disregard parental income and resources in determining the eligibility of the child.” However, the Long Term Home Health Care Program (LTHHCP) is the only waiver for adults that has the spousal impoverishment feature; the Traumatic Brain Injury and Nursing Home Transition and Diversion (NHTD) waivers do not. Eligibility for personal assistance services is significantly limited under all of these waivers; they either don’t provide a full range of services, do not serve all disabilities, or cap services at unrealistically low levels. Requiring married partners to be on waivers would force many of them, or their children, into institutional settings that would cost more than the state plan services they were getting.

Eliminate or limit denture coverage for adults.

Most people over the age of 21 who need Medicaid long-term care could eventually be forced into managed care programs to get it. The Governor’s bill imposes some fairly high hurdles to do this, and the projected savings aren’t very big, despite all the hoopla surrounding the concept. DOH knows that under the Affordable Care Act (also known as “Obamacare”), if they call managed care a “medical home” they can get a much larger federal Medicaid match for it for two years—90%. The “medical home” concept is fairly new. It’s a form of managed care that is supposed to expand beyond strictly medical services to address people’s needs for other things that affect their health, such as nutrition and stable housing. It has been claimed that this can work well, both saving money and enabling people with significant disabilities to stay in the community. However, it appears that after two years the federal match goes down to 50%, at which time DOH very likely would have to gut the program to stay under the global cap.

The Governor’s bill only definitively calls for moving some long-term care recipients in New York City into managed care beginning in 2012. Managed long-term care would be phased in upstate later. This is a good idea because right now there are no Medicaid long-term managed care providers serving upstate NY. DOH would have to come up with a rate structure that is attractive enough to get some providers to offer plans first—which may never happen, and if it does, the scheme probably won’t produce all of the projected savings.

Also, most of the items that “exempt” or “exclude” certain people from having to be in Medicaid managed acute care would remain in effect for managed long-term care until DOH is satisfied that plans are available to meet those people’s needs. Thus, for example, “SSI recipients”, “residents of an ICF/MR” and “individuals with characteristics and needs similar to residents of an ICF/MR” might eventually be moved into managed care. But don’t count on it. It won’t be well-received in the DD advocacy community. We at STIC don’t think people with developmental disabilities should get special treatment when it comes to availability or financing of services; they ought to face the same issues people with other disabilities face, and work together with them so that everyone benefits equally. Their strongest advocates won’t do that though, so it’s better than even money that managed care for people with developmental disabilities is dead on arrival, and much better than even money that people with physical disabilities will get shafted.

The MRT isn’t done either. It sets up some work groups to address ongoing issues. One good one would look at increasing supported housing options for people eligible for, or coming out of, nursing facilities.

Another group will consider “reforms” to Medicaid waivers. This is less warm and fuzzy, because among the proposals floated was one to impose an individual cap on service costs for each recipient in the NHTD waiver, whether for this waiver alone or in a new waiver that consolidates the NHTD waiver with the LTHHCP waiver. These measures would reduce the amount of Medicaid spending that these waivers save.

Among the proposals provided to DOH were several from the NY Association on Independent Living (NYAIL) and the Center on Disability Rights (CDR) that show how money can be saved by diverting or releasing people from nursing facilities and increasing use of the lowest-cost form of homecare, the Consumer Directed Personal Assistance Program. These proposals were discussed at the public hearings but were never provided to the MRT by DOH. DOH officials claimed they “didn’t understand them”. You can read them for yourself and see if you understand them here.

Cuomo wants to eliminate funding for all “optional” services provided under the DOH “General Public Health Work” program. We think this means ending direct support for county-operated programs that provide any of several direct medical services that are available through the state’s Medicaid program, as well as some other services that improve the “healthiness” of communities as a whole. The latter includes things like Medical Examiners and Radioactive Equipment Licensing. The former includes Home Health Services, Long Term Care, and Early Intervention Service Coordination, among others. These county programs might still exist but would either have to be entirely locally funded or, if they are Medicaid-reimbursable, would have to rely on the same Medicaid billing system that other providers use.

The Elderly Prescription Insurance Coverage (EPIC) program would be further cut back. The program generally serves people who are eligible for Medicare, which has the “Part D” prescription drug program. EPIC would no longer subsidize Medicare Part D premiums, and would only cover prescriptions at all for people who are in the “donut hole” (the range of total annual prescription costs between Part D’s minimum and catastrophic ranges, wherein Part D recipients must pay the total cost). The new federal health care law currently offers a discount program for people in the “donut hole” and will eventually phase it out entirely.

Unlike last year, OPWDD is actually projected to experience a budget cut. And unlike any other OPWDD budget in recent history, at least some funds will be transferred from segregated to integrated services. Here are some highlights:

Development of new group “homes” (at least those owned and operated by OPWDD) would be “delayed”, while “ investing to add 2,300 lower-cost residential and/or non-residential opportunities to support individuals and their families.”

Funds for sheltered workshops and “day training” programs will be cut “to encourage placements into other, more effective community-based integrated day and employment programs.”

The Governor’s budget address also referred to redirecting funds from state-operated “mental hygiene” programs to “ community based” services—which may mean to not-for-profit providers, though the choice of language is somewhat confusing. “ Mental hygiene” refers to programs provided by OPWDD, OMH, and OASAS.

A couple of other items are more problematic. Funding for transportation for residents of most OPWDD group “homes” would be cut. These facilities already don’t provide enough transportation to enable individual residents to go to places that they choose at the times they choose. And OPWDD plans to tighten the screws on service providers with “more aggressive reviews of providers’ overall surplus/loss analysis, as well as further constraints on administrative and non-personal service costs.” Most state agencies already refuse to pay providers for the full cost of services. There are limits to the extent to which providers can come up with funds from other sources to cover these gaps. When those limits are reached, providers will not be able to afford to continue to provide the services at all.

OMH will freeze development of all new community residential supports other than the individualized supported housing “slots” it is required to create for residents of adult “homes” under the DAI v Paterson court order. They will also reduce rates paid to some existing supported housing providers, and “convert residential pipeline units to lower-cost alternatives” (this presumably means units in the advanced planning stage but for which no bricks and mortar have been laid).

As mentioned above, some state-operated programs may be de-funded in favor of lower-cost not-for-profit providers.

Governors always want to try to get private medical insurance to pay for Early Intervention services; a new wrinkle this year appears to be that Cuomo wants to enact legislation to require insurance companies to cover these services, rather than merely make providers try to collect from them.

Although some prominent state legislators initially complained about the MRT process, and about Cuomo’s effort to take away their ability to fine-tune Medicaid policy, after the surprise early vote on the recommendations they were strangely silent. Meanwhile, Cuomo has said he will “get his budget” one way or another, because if the Legislature doesn’t approve his bills by April first, he will, like Paterson before him, enact his cuts by means of funding continuation measures that legislators will face great pressure to approve. At press time, it was anybody’s guess what the final outcome would be.

The state Board of Regents has an ongoing project to provide “mandate relief” to school districts. Ideas are proposed and voted on by the Regents; some are approved and others rejected.

The Board of Regents is the governing body of the State Education Department (SED). Unlike other state service agencies, SED is not answerable to the governor. The Regents are elected by the state legislature and they appoint the Commissioner of Education. So while Governor Cuomo has called for a comprehensive process to carry out “mandate relief” on both a statewide and local level, he cannot compel the Regents to do anything. The Regents have been working on this on their own for a few years, though in view of the recession, expected cuts to state education funding, and budget problems at school districts, this year’s list of proposed changes is quite a bit longer than previous ones, and they appear to be working in cooperation with Cuomo’s “Mandate Relief Redesign Team ”.

Several proposals would affect special education. We don’t think all of them are necessarily bad, but here are the ones that could be detrimental to students with disabilities:

• Eliminate the requirement that an individual evaluation include specific assessments to be conducted as part of the initial evaluation: physical examination, individual psychological evaluation, social history, observation, other appropriate evaluations and functional behavioral assessment when behavior impedes learning.
  
  All of these are essential to understand the needs of students with disabilities. In particular, school districts in New York State have a terrible track record of addressing behavioral issues that arise from disabilities; they are resistant to viewing them as related to disability and accepting responsibility for remediating them through educational means. This is why there are so many instances of injury to these students inflicted by school staff and why we need the state to establish and enforce strict limits on use of physical restraint and seclusion. We certainly can’t afford to eliminate the requirement for functional behavioral assessments.
  
  
• Eliminate the requirement that the Committee on Special Education (or Preschool Special Education) must provide a copy of the state ’s handbook for parents of students with disabilities or a locally approved handbook when a student is referred for special education.
  Parents are often given incomplete, biased, or wrong information by local school officials. It’s bad enough that a local district can write its own handbook; it’s completely unacceptable not to provide standardized written information to parents.
  
  
• Reduce the two year statute of limitations on commencement of an impartial hearing to the federal standard of one year.
  
  People usually try to resolve disputes informally if they can. Sometimes it takes more than a year to exhaust informal efforts. On the other hand, it could be argued that letting a dispute run longer than a year without demanding formal resolution is being too lenient with school officials; this provision could very well result in more formal complaints and hearings, not fewer.
  
  
• Eliminate the requirement that the parent selects the preschool evaluator from list of approved evaluators.
  
  
• If the requirement of parental choice of evaluator is repealed, eliminate the requirement that the Board of Education must provide parent with list of approved evaluators in the geographic area.
  
  School districts have a huge incentive to use evaluators who will produce recommendations that they prefer—typically for fewer or lower-quality services because this saves money. It is unacceptable to allow districts to interject their biases into the evaluation process.
  
  
• Eliminate the requirements that Boards of Education have plans and policies for appropriate declassification of students with disabilities—regular consideration for declassifying students when appropriate and the provision of educational and support services upon declassification.
  
  This one seems perverse; eliminating this requirement would be likely to cost school districts more money.

The issue was on the agenda for a Regents meeting in early February; while there was no significant discussion of the special education items, none were removed from the list. It appears that this will be coordinated with the recommendations to be produced by Cuomo’s Mandate Relief team on March 1.

Binghamton ADAPT members discussed the ongoing concern that the NYS Most Integrated Setting Coordinating Council (MISCC) has, after nine years, still not come up with a real working plan to implement the US Supreme Court’s Olmstead decision in NY. The group decided to prepare and present a proclamation at the MISCC meeting on January 26 during the public comment period. Many of our members have spoken before the MISCC in the past.

Members also decided to make paper chains just long enough to fit between outstretched hands. Many people in our group who could not go to Albany helped make these chains. The links held short statements about ending segregation, about freedom, etc. This activity made everyone feel a part of the action. We borrowed a crusader costume and set of balance scales. A proclamation was written and was revised several times, in cooperation with the work of other independent living advocates in the state. The plan was to read the proclamation as our Crusader for Independence and Justice stood before the MISCC holding the scales of justice. The rest of the team would silently hold their chains above their heads and break the chains at the end of the proclamation.

A group of seventeen people and one guide dog traveled to Albany for the MISCC meeting. One person in the group found a van we could borrow to hold the majority of the group. Another person in the group volunteered to drive the van. One person who went came as a personal care attendant for another person in the group. This attendant was so excited about what we did that she now wants to join our local ADAPT group. The person who had offered to wear the costume and hold the scales of justice was a woman who fought for years to get out of an institution and she now lives in her own home. Five of the people who went with us are survivors of institutional living.

As the time for the public speaking session approached, our member who was going to wear the costume and hold the scales became very ill and had to leave the meeting room. Three people from our group assisted her.

One of our institutional survivors, Sharon Ross, in true ADAPT spirit, stepped up to take her place. After several years of institutionalization, Sharon moved into her own home and has remained independent for over twenty years. We quickly changed the last paragraph of the proclamation to substitute her name. Since Sharon has very shaky hands, she decided to not hold the scales of justice. Instead, she held her paper chains above her head and held her head bowed as the proclamation was read. Sharon told us, “She couldn’t do it—she was too sick. I was willing to step up for her because she is my friend and that’s what friends do. And I wanted to show the committee how we felt. Sometimes people don’t hear what we are saying. The chains were a good symbol— because institutions hold us back from living in our own homes. ”

The other members of the group also held their chains during the reading and all broke the chains at the close of the proclamation. One of our group, a new member taking his first trip to Albany, came to the podium next. He told his story of being hospitalized for eight months before he could receive mental health services in the community. It was something he felt empowered to do after we arrived. Our speakers were acknowledged with applause. We left shortly afterwards in order to get our ill member home.

As a result of this action, National ADAPT has accepted us as a local chapter. We will call ourselves Southern Tier ADAPT and we meet on the third Wednesdays of the month, at STIC, from 4 pm - 5:30 pm. All are welcome. If you have questions, call Susie Link, Bob Deemie, Darlene Dickinson, or Sue Ruff at (607) 724-2111 (voice/TTY).

In 1999 the Supreme Court ruled in the Olmstead decision that unnecessary segregation of individuals with disabilities in institutions constitutes discrimination based on disability. In 2002, state agency leaders were charged with developing a plan that would implement the Olmstead decision. We looked forward with hope and anticipation to working together to create a meaningful, comprehensive, real and timely plan for achieving the Most Integrated Settings for New Yorkers with disabilities. The MISCC has had nine years to convert institutional or segregated placements to integrated, community based services.

Some of us have come to MISCC meetings year in and year out. We, the people with disabilities, fought for its establishment. Some of us have brought people with us who told their stories of segregation, abuse, loss of civil rights and lack of freedom. We are the same people who fought for decades for the passage of the ADA and NYS Human Rights Laws. And our mothers and fathers, brothers and sisters, children and friends continue to languish in institutions.

In his State of the State address, Governor Cuomo made references that we have not heard a governor ever make and which give us hope for justice in the next four years. He said with passion, “For those of us who are old enough to remember Willowbrook, it brings back very bad memories.” and “an incarceration program is not an employment program. ” While he spoke specifically about juvenile justice facilities, his words touched us deeply, because we see unnecessary institutionalization every day, we know people who want to get out, and yet unnecessary, archaic policies continue to keep our people “ chained”. Sadly, although Willowbrook may have closed, the practices and beliefs that allowed Willowbrook have not completely vanished.

Therefore, let us introduce our crusader for independence and justice, Sharon Ross. Sharon is a survivor of an institution. She has fought tirelessly for her independence and now lives in her own home. She has faced and overcome the barriers that were put in her way and she wants to help others to do the same. Sharon extends her hand to the Governor and all of you who are members of the MISCC, in hope and expectation that together with the Governor’s passion, the MISCC’s actions and a new administration behind us, we can break the chains and free our people.

With lightning speed this winter, Albany politicians put together and passed a bill to allow villages to use old-fashioned mechanical lever voting machines for certain elections. It was signed into law by Governor Cuomo on the last day of February.

These machines are inaccessible to people with disabilities, and their sole use has been outlawed under the federal Help America Vote Act and other federal laws. These laws require that at least one accessible voting machine must be available in each precinct for each election.

We have been told this temporary law, which expires on December 31, 2012, was passed largely because Nassau County and some upstate communities have failed to comply with legal requirements to obtain accessible machines. Apparently an election was due to be held in Nassau County in late winter and, as Assemblywoman Donna Lupardo told a STIC staffer, “We can’t just disenfranchise all those voters.” Asked why it was okay to disenfranchise voters with disabilities, Lupardo had no answer.

This bill is blatantly illegal and if any village holds an election without providing at least one accessible voting machine in each district, it will be sued.

This case, which the US Supreme Court has agreed to hear, addresses the issue of whether states can be sued for violating federal Medicaid law if they cut Medicaid funding to the point where it reduces the availability of services. The case actually is a combination of three California cases.

Medicaid is funded jointly by the federal government and states. The percentage that states must contribute varies from state to state.

Federal Medicaid law requires that so-called “state plan” Medicaid services must be uniformly available statewide, and must be as readily available as the same services are to people who have private medical insurance.

States violate these requirements all the time by setting rates for Medicaid reimbursement that are so low that few providers agree to accept them. New York is notorious for doing it for dental services, for example. But as states have struggled with budget deficits in recent years, they have been cutting rates more frequently and deeply than ever. Some of these states have been sued for violating Medicaid law. Courts have generally ruled in favor of the plaintiffs on the issue of whether the federal equal availability rule is allowable. So in recent years some states have adopted a different tack: they have argued that plaintiffs lack legal standing to sue them.

This is a pretty technical case. The Supremes were asked to rule on both points but they only agreed to consider the issue of standing. This suggests that there is not a majority on the Court that would invalidate the equal availability rule if given the opportunity. Instead, if the Court rules for the plaintiffs, the case will go back to the lower courts to consider the actual rate issue; if the Court rules for the states, new plaintiffs who do have standing to sue will have to come forward, such as Medicaid recipients, and that is likely to happen.

For the last 15 years or so, Medicaid service providers have been able to bring suits like this on grounds of the US Constitution’s “ Supremacy Clause”, which says that federal law takes precedence over state law. There is a distinction between cases that argue federal supremacy under the Constitution’s “Spending Clause”, in which federal funds are provided to states on the condition that they follow certain requirements, and the “Non Spending Clause”, in which funds are not involved.

Various Circuit Courts of Appeal have ruled on these cases under one or the other of those clauses, but the Supreme Court has not.

Some Supreme Court Justices (Chief Justice Roberts, among others) have sort of “wondered aloud” as to whether private citizens or organizations have standing to sue under the Spending Clause, because of a decades-old case in which a minority opinion suggested that agreements with states to operate programs under funding restrictions are analogous to “contracts” between the feds and the states. In traditional law, providers would be a third party and have no standing to sue for violation of the contract. However, more recently courts have found that third parties do have standing to sue in relation to various contracts. This history makes it unlikely that there will be a majority on the court to disallow these suits.

So while there has been some attention to this issue in the disability and health care fields, no one should assume that the Supreme Court is going to say it’s legal for states to get away with reducing Medicaid rates to pointlessly low levels, or that nobody can sue states for doing so.

Twenty-two states have filed briefs in support of California. The federal Justice Department has filed a brief supporting the plaintiffs. We should have a decision by July.

The New York Association on Independent Living (NYAIL) is dedicated to removing barriers to the full community integration of people with disabilities of all ages. NYAIL represents Independent Living Centers and the people with disabilities they serve. Independent Living Centers (ILCs) are controlled and primarily staffed by people with disabilities, and provide a variety of community-based services, such as peer counseling, independent living skills training, advocacy, and assistance with obtaining housing, education, employment, and other necessary services that empower people with disabilities to live independent, fully integrated lives in their communities. We propose the following priorities to address barriers to community living and ensure the civil rights of people with disabilities are protected.

• Make discrimination by landlords based on a tenant’s source of income illegal under State Human Rights Law. A.1121 (Bing) and S.83 (Squadron)
  
  Landlords often reject tenants with rental subsidies, such as Section 8 and subsidies tied to the Nursing Facility Transition and Diversion and Traumatic Brain Injury Medicaid Waivers. Many people with disabilities rely on those subsidies and other assistance programs to live independently in the community. Discrimination based on source of income is illegal in New York City. The legislature should make source of income discrimination illegal throughout New York State.
  
  
• Incorporate inclusive design features in new residential housing that receives financial assistance for construction from federal, state, county or local governments. Not yet introduced.
  
  Most existing housing stock was not built to meet the needs of people with disabilities, including disabilities acquired as one ages. Housing built using inclusive design features would meet the needs of all people, throughout the lifespan, and allow homes to be visitable to friends and family members with disabilities. Renovation of new homes is much more expensive than including accessibility features at the start, when the home is constructed.

• Incorporate Title II of ADA into NYS Human Rights Law. A.71 (Paulin) and S.2407 (Marcellino)
  
  The Americans with Disabilities Act (ADA) of 1990 and Section 504 of the Rehabilitation Act of 1973 each provide comprehensive protection for the civil rights of people with disabilities under federal law. Under the 1999 US Supreme Court Olmstead decision, people with disabilities are entitled to receive the services and supports they need to live in the community and avoid unwanted placement in nursing facilities and other institutions. Title II of the ADA provides protections against discrimination on the basis of disability in services provided by public entities, including State and local governments. The bill to incorporate Title II into State law was passed by the State legislature during the 2009 and 2010 sessions, but vetoed by Governor Paterson. This bill would clarify the scope of protections against discrimination by public entities, including in the provision of services, programs and activities. Public entities would be required to make reasonable accommodations and individuals with disabilities would gain critical access to the administrative enforcement mechanisms through the State Division of Human Rights. To date, more than 30 other states have incorporated Title II into State law, and none have reported any increased costs as a result.

• Amend State Social Services Law Section 384-b to eliminate subdivisions (4)(c) and (6)(a-e), which permit termination of parental rights on the basis of “mental illness or mental retardation”. S. 2835 (Huntley) and A.6668 (Rivera) of 2010
  
  Parents with psychiatric and intellectual disabilities are vulnerable to the loss of custody and termination of their parental rights because of a long-standing bias in State law. Since 1976, State Social Services Law has included as grounds for the termination of parental rights, the inability “by reason of mental illness or mental retardation, to provide proper and adequate care...” of a child. The use of these disability-related grounds for termination promotes the discriminatory belief that parents with such disabilities are unable to care for their children and creates a presumption that these parents are unfit. The safety of children is adequately protected, however, by other provisions of SSL 384-b allowing termination based on a parent’s behavior rather than their disability.

• Include the history of people with disabilities as required curriculum in all elementary and secondary schools. A.10852 (Schroeder) and S.7930 (Stachowski) of 2010
  
  In order to fully integrate people with disabilities into the community, the attitudes of our society as they relate to people with disabilities need to change. Education on civil rights of people with disabilities is the foundation for ensuring these rights are protected and attitudes changed. This bill would adopt a statewide curriculum to promote greater awareness and understanding of people with disabilities and has no fiscal implications.
  
  

• Cap fares for paratransit at levels no higher than the base fares for transportation of non-disabled adults utilizing the public transit system. S. 1225 (Duane) and A. 737 (Kellner)
  
  
• Provide a tax credit for the purchase of accessible vehicles by transportation companies. A.966 (Kellner)
  
  Title II of the ADA prohibits discrimination against people with disabilities in the provision of transportation services. The limited availability of accessible transportation services is a major barrier faced by individuals with disabilities throughout the state, often leading to unemployment, the inability to access medical care, lack of access to polling sites, and isolation from friends, family, and full community participation. Many people with disabilities rely heavily on the provision of paratransit services; however public transit budget woes have led to an increase in cost for such services. The paratransit bill would cap paratransit fares, under the premise that authorization of transit fares for people with disabilities at a level higher than those for non-disabled citizens is discriminatory. In addition, the increased availability of accessible transportation options will result in considerable savings to the state Medicaid program as the cost of paying for ambulettes to transport wheelchair users to medical appointments will decrease significantly.

The New York Association on Independent Living (NYAIL) and the Center for Disability Rights (CDR) offer the following action plan for both immediate and long term savings in New York’s Medicaid program. The Independent Living Center (ILC) network has served as the voice of the disability rights movement in New York since its inception more than two decades ago. ILCs help the state advance policies of community integration and move people with disabilities from institutions and other segregated settings to the community, as required by the Americans with Disabilities Act and the Supreme Court’s Olmstead decision, 527 US 581 (1999).

New York State must provide consumer choice through a range of community-based service options and support these alternatives to institutional placements. The state must shift away from a traditional model of care that is over-reliant on medical professionals and treats people with disabilities as patients, toward a consumer directed model that empowers people to take control of their services. Finally, the state must take advantage of federal incentives in the Affordable Care Act that provide additional Medicaid funding to implement these shifts. With the support of the new Administration, and clear direction to its county partners and providers, the following proposals will actually move people into appropriate and less costly settings.


If the State transitioned only 10% of the Medicaid-eligible individuals who have expressed a desire to return to community-based living, according to CMS figures, to the NYS Nursing Home Transition and Diversion (NHTD) Medicaid waiver, even factoring in a 1% disenrollment rate, New York State would save $6.3 million in the first year and $127.15 million in the non-federal share over five years.


Too often, people are placed in a nursing facility immediately following a hospital stay and struggle to leave this costly setting later to return to the community. By implementing an expedited enrollment process in the NHTD waiver and diverting just 10% of the Medicaid-funded nursing facility admissions, New York State would save $6.2 million in the non-federal share during the first year and $125.25 million in the non-federal share over five years.


The Community First Choice Option (CFC) allows states to create a community-based state plan service for people who are at an institutional level of care. Even with the offset of providing services to a new population of people with DD/ID, by implementing CFC, the state stands to save $4.5 million during the first year and over $332 million in non-federal share savings over five years. (This figure increases to $391.39 million as some of the other recommendations in this paper are implemented.)


New York State is eligible to participate in the State Balancing Incentive Payments Program to receive an additional two percentage points of the federal medical assistance percentage (FMAP). Factoring in a reduced growth rate in total long term care spending—to account for needed budgetary reductions—NYS can expect to achieve a savings of $12 million in total long term care spending over three years by rebalancing the system toward community-based options.


Not all home and community-based services are alike or equally cost-effective. A person may receive long term services and supports in the community from a medical model agency or through a consumer directed program, where consumers—as opposed to an agency—manage services and are empowered to hire, direct, and dismiss their attendants in accordance with their plan of care. This results in lower costs to the state through reduced reimbursements, because consumers take on the administrative roles (i.e. scheduling) that an agency nurse or case manager is typically responsible for. In addition, aides can perform skilled tasks that under an agency model are performed by expensive medical personnel.

The Consumer Directed Personal Assistance Program (CDPAP) is the most cost-effective model for assistance in the home. Because certified home health agency (CHHA) services are not authorized through the Local Departments of Social Services (LDSS), the Department of Health (DOH) can identify usage for each county, including consumers who are the long term, high cost users of CHHA services. By shifting consumers from CHHAs to CDPAP, the state would reduce Medicaid spending by $4.5 million during the first year of implementation and $89.9 million in non-federal share savings over five years.


While the savings from transitioning people from traditional Personal Care to CDPAP are not as significant as from CHHAs, the process necessary to realize these savings requires no additional staff or infrastructure and dovetails into existing work done by the LDSSs. To assure local implementation of this initiative, DOH should set aggressive targets for each county. The state would reduce Medicaid spending by about $1.9 million in the first year and $38.85 million in non-federal share spending over five years.


To increase the savings generated by using CDPAP, the state should implement policies which would promote its use, such as changing the state regulations on who can receive payment for service to be inline with federal regulations. By amending the state regulations to expand the definition of personal attendant, we estimate that 1% of the nursing facility population over 65 years could transition into the community and the state would save $11.48 million in the non-federal share in the first year and produce $186.1 million in savings over five years.


While there are options for obtaining assistive technologies (AT) under certain waivers and through vocational rehabilitation services, DOH has generally overlooked AT as a potential method of cost savings. We recommend that DOH instruct LDSSs to assess consumers who receive a high number of service hours as to whether AT could reduce the hours of service necessary. Assuming that the state provides AT to only 12 people a month from across the state, reducing their need for personal care, and factoring in a 1% disenrollment projection, the state would reduce Medicaid spending by $1.74 million in the non-federal share in the first year and produce $38.3 million in savings over five years.

Below you will find 2 additional agencies that were inadvertently left off our last newsletter’s list of housing agencies in our area that may assist you in your affordable and accessible housing needs.

167 Clinton Street
Binghamton NY 13905
(607)772-2850
www.firstwardaction.org

The First Ward Action Council is a community-based developer and provider of housing and housing services in Broome County. Currently, the organization is managing several storefronts and more than 120 apartments, including fully accessible units, for families of all sizes. Senior housing complexes include the Schoolhouse Apartments at St. Cyril’s in Binghamton; the Vestal Pines Apartments on Route 26 in Vestal and the Choconut Creek Apartments in Choconut Township, PA.

The Action Council also operates a home-repair service for senior citizens in Broome County. Exterior stairs are rebuilt, wheelchair ramps installed, and leaky faucets fixed with eligible seniors being responsible for only the cost of materials.

935 East Avenue, Suite 300
Rochester, NY 14607
Phone: (585) 461-4263
Fax: (585) 461-5177
Email: sheen@rochester.rr.com
www.sheenhousing.org

Sheen Housing is a not-for-profit housing agency that addresses the housing needs of very low- to moderate-income families, seniors, and people with disabilities throughout our service area. A few of the programs that Sheen Housing may assist with are Emergency Home Repair, Access to Home Program, Home Ownership programs, and Housing Development.

Sheen Housing is a Rural Housing Preservation Company offering housing opportunities in 13 counties in New York State: Allegany, Cayuga, Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, and Yates Counties.

Can you afford to turn away about one-fifth of your current and potential customer base?
Consider this...

• How many people in the US have a disability? (A: 51.2 million)
• What percent of your customers are likely to have a disability? (A: about 20%)
• No business/organization can afford to turn away about 20% of its potential customers. Yet, if businesses are not accessible and welcoming to customers with disabilities, that may be what they are doing.

Many businesses draw their customers from older populations. Also, our population is aging, meaning that the customer base is increasingly becoming older.

Consider this...

• Baby boomers make up 35% of the population
• They have 77% of the financial assets
• They have 57% of the discretionary income (AARP, 2002)

This number is likely to increase in the next decade.

Statistics clearly show a continuing upward trend. There will be more people with disabilities in the years to come, and people with disabilities will represent an increasingly greater portion of your customer base
Consider this...

• In 2006, the population of people over age 65 was 37.3 million—this represents a 10% increase since 1996
• The number of Americans who will reach 65 over the next 2 decades will increase by 39% during this decade (US Administration on Aging, 2007)

Consider this...
According to a major study conducted by Travel Industry of America, 21 million Americans with disabilities traveled in the years 2004 and 2005 alone, nearly double from one decade ago. According to a study conducted by the Harris Interactive Poll and the Open Doors Institute, the number of leisure trips and hotel stays made by people with disabilities was up 50% just between 2002 and 2005 (Hospitalitynet.org, 2005).

If you are not welcoming and accessible to customers with disabilities, you are not welcoming to their families/ companions either.

People with disabilities are not using your business/agency by themselves.

• 20 million families have a member with a disability
• About 30% of your potential customers will be using your business WITH someone who has a disability
• You will not only lose the business of people with disabilities; you will also lose the business of anyone with them (Qi Wang, 2005; Harris Interactive, 2005)

Are you disability-friendly? Word is getting around!

Consider this...

• People with disabilities are more likely to use the internet to identify disability-friendly businesses/agencies
• Many new websites or blogs are devoted to describing customer experiences for people with disabilities at specific businesses/agencies

As an added point, keep in mind the “Customer Dissatisfaction Study” recently reported by the Wharton School of Business. This study found that a negative customer experience (for any customer) is far more damaging to customer retention than was previously thought. “Word of mouth” negative customer experiences are about five times more damaging to businesses than the experience itself. This trend is intensified for customers with disabilities, who are more likely to research businesses/services for disability-friendliness and accessibility than other customers.


Customers with disabilities are more likely than other customers to be loyal to those businesses where they had a good experience.


People with disabilities have significant spending power.

Most people are operating with the implied assumption that people with disabilities have no disposable income. This is far from the truth. There are a number of factors that contribute to the fact that people with disabilities actually have a great deal of disposable income. But the most prominent is the fact that as we age we are more likely to acquire a disability. And, as a rule of thumb, the older we are, the more disposable income we have.

Travel and People with Disabilities

• Have $220 billion in discretionary spending power
• 21 million traveled for business or pleasure
• The number of leisure trips and hotel stays has increased by 50% since 2002
• 71% eat in restaurants at least once per week (AARP, 2002)

Making your agency/business welcoming and accessible to people with disabilities makes it better for everyone else too!
Consider this...

Changes you make for accessibility also make your business more accessible to everyone:
- Parents with strollers
- Shoppers with heavy bags
- Exhausted customers
- The customer who just broke her ankle
- AND everyone in the future who will have a disability


Whether or not you are considering the market advantages of welcoming customers with disabilities, YOUR COMPETITORS ARE!


Being accessible is probably not as costly or complicated as you may think.

The key to providing excellent customer service to people with disabilities is simply having the right attitude—simply having the willingness to treat ALL customers with dignity and respect. Many accessibility changes cost little or nothing: moving tables/chairs to provide a wider throughway, lowering product/materials displays so that someone using a wheelchair can reach them, or providing menus in Braille.


Tax Credits and Deductions

To assist businesses with complying with the ADA, Section 44 of the IRS Code allows a tax credit for small businesses and Section 190 of the IRS Code allows a tax deduction for all businesses.

The tax credit is available to businesses that have total revenues of $1 million or less in the previous tax year or 30 or fewer full-time employees. This credit can cover 50% of the eligible access expenditures in a year up to $10,250 (maximum credit of $5000). The tax credit can be used to offset the cost of undertaking barrier removal and alterations to improve accessibility; providing accessible formats such as Braille, large print and audio tape; making available a sign language interpreter or a reader for customers or employees, and for purchasing certain adaptive equipment.

The tax deduction is available to all businesses with a maximum deduction of $15,000 per year. The tax deduction can be claimed for expenses incurred in barrier removal and alterations.

To learn more about the tax credit and tax deduction provisions contact your tax consultant and/or contact the DOJ ADA Information Line.

New York’s Adirondack Park is a six-million acre wonderland for those who love the outdoors. The largest wilderness area east of the Mississippi River, it attracts hikers and bikers, as well as folks who fish, bird, golf and gallop. But if you’re blind or deaf or use a wheelchair, you may have a tough time getting in on the fun. That’s what prompted Joel N. Schadt to create hiking trails that cater to all levels of ability.

“I’ve worked with people who are developmentally disabled all my life,” says Schadt, a 21 year-old student at Paul Smith’s College in Franklin County, NY. “It’s what I want to do with the rest of my life.”

Schadt was inspired by his brother, Matt, 25, who has cerebral palsy and cognitive disabilities that his family attributes to a bad batch of vaccine during Matt’s infancy.

“Matt’s always in the back of my mind,” Schadt said. “I want to be able to hire my brother and everybody else like him who is stuck working at a fast food place. If Matt doesn’t work, he doesn’t get Medicaid, so it’s a vicious circle.”

When Schadt was charged with completing a 400-hour externship as a condition of his May 2011 graduation, he homed in on a project that would provide three hiking trails that Matt, and anybody else, could use.

Schadt had a tough road to plow: dead trees, falling fences and swampy pathways made the 15-year-old south Franklin County trail system resistant to overhaul. So Schadt, a Recreation and Adventure Travel Ecotourism student, enlisted help from the staff and participants at the adjacent North Star day treatment program, whom he had intended to use the trails in the first place. Clients of North Star—who may be deaf, non ambulatory, mentally ill, have low or no sight, or face behavioral challenges—were all recruited as volunteers on the project.

Schadt began by talking to the North Star team members about what kinds of things they wanted and needed in a trail. With this information he created Red, Green and Blue accessibility levels. Of the three categories, Blue is most accessible, allowing navigation by wheelchair.

Along the Green path, Schadt derooted and destumped trees to make the way smooth. He put wood chips down to absorb soppy moisture. The Green trail spoke to the needs of those who have challenges lifting their feet, or who experience difficulties with hand-eye coordination and balance. Red—the most challenging of all—left roots and stumps intact and dipped up and down hills, giving hikers what Schadt called “a taste of a typical Adirondack trail.”

Though Schadt completed three trails over a span of five or six acres, the cost of his project was minimal, thanks to donations that included 18 tons of crushed stone, a gas-powered tamper to set the stone into place, lumber for fences and benches, and two trailers full of wood chips. Schadt recycled or reused everything he could. Some tools that were broken during the project were even used to make railings.

“For anything I couldn’t do or didn’t know how to do,” Schadt said, “I got people to help.” A friend of Schadt’s, well-versed in ecology, taught him that hard woods (such as cedar, maple, and birch) are best for construction of benches and fencing because they would last longer—or because, as Schadt put it, “we’d get more bang for the buck.” Soft woods were used to line the side of the trails and to make posts for the signs. A horticulturist also donated his services to teach the project’s participants about forest cycles.

A stickler for details, Schadt made every effort to build sensory components into each of the trails. Interpretive signs along the routes allow hikers to identify animals, herbs and plants as they move forward. Visitors to the trails can break into teams, competing to determine which group can pick out the most specimens. The trails also provide ideal posts for watching or listening to birds.

Just outside the North Star center, Schadt and his volunteer crew built a twelve-foot-by-twelve-foot deck on which the staff can socialize. If tackling a challenging behavior issue, staff can take a client on a walk, allowing him or her to cool down and regain a level head. Picnic tables are available for lunch al fresco, and grounds are ideal for dog-walking. Schadt notes that during winter months, the area is wide and flat enough for snowshoeing or cross-country skiing.

“This was the best job I’ve ever had,” Schadt said. “I’m already looking into disability-related organizations I can work with when I graduate this May. I want to take people out on adventures, and expand their opportunities and experiences.”

The Joel N. Schadt Interpretative Trail took Joel N. Schadt about three months to complete. As summer ended, Schadt’s volunteers and donors joined North Star employees and community members at large for a celebratory ribbon-cutting in the woods, where everyone snacked on Kool-Aid and cookies as Schadt spoke a few words about his passion for the project.

Afterwards, Schadt’s guests checked the sign that greeted them at the entrance, selected a trail, and enjoyed some of the best the Adirondacks have to offer.

New York State gives counties and municipalities the option of reducing property taxes up to 50% if the property is owned by a low-income person with a disability. (Editor’s note: We don’t know what counties in south-central New York offer this option; you’ll need to contact county government to find out.)

The property must be the owner’s primary residence. This means you must live in the house, condominium, or cooperative apartment more than six months a year.

The applicant must have a disability, defined as a physical or mental impairment not due to current use of alcohol or illegal drugs. If a husband/wife, siblings, or registered domestic partners own the property, only one owner needs to have a disability to qualify for reduction. All owners must qualify as disabled for other types of co-ownership.

Taxpayers applying for the Disabled Homeowner’s Exemption (DHE) or the Senior Citizens Homeowners’ Exemption (SCHE) are only entitled to one of the exemptions.


If you qualify for DHE or SCHE the table below will help you estimate how much you can save.

If the Owners’ Income Is	Can Reduce the Assessed Between (DHE/SCHE) Value By:
$36,500 and $37,399	5%
$35,600 and $36,499	10%
$34,700 and $35,599	15%
$33,800 and $34,699	20%
$32,900 and $33,799	25%
$32,000 and $32,899	30%
$31,000 and $31,999	35%
$30,000 and $30,999	40%
$29,000 and $29,999	45%
$0 and $28,999	50%

NYPS is a pharmacy discount card that can lower the cost of your prescriptions by as much as 60 percent on generics and 30 percent on brand name drugs. Just show your card at a participating pharmacy to receive your discount right at the counter. NYPS is sponsored by New York State and supported by pharmacies and pharmaceutical manufacturers who are generously providing these discounts to you.


New York State residents are eligible if they are not already receiving Medicaid and are:

• Either age 50 up to 65, or persons with a disability who have been determined disabled by the Social Security Administration; AND
• Have annual household income less than $35,000 (single) or $50,000 (married).

• Use the online application or the online application in Spanish (en Espanol) to apply right on the Web site: https://nyprescriptionsaver.fhsc.com/
• Use the Portable Document Format printable application or the printable application in Spanish (en Espanol) , fill it out and mail it in to us.
• Call us and we’ll help you complete an application: (800) 788-6917 (voice) or (800)-290-9138 (TTY)

• You will receive a discount card within two weeks after your application is approved.
• Use the card at any of our participating pharmacies.
• You will be eligible for discounted prices on most prescription drugs.

In March 2010, Congress passed the health care reform law, the Patient Protection and Affordable Care Act. The law created a temporary program until January 2014 that makes coverage available for individuals who have a pre-existing medical condition, have not had insurance for six months, and who are legal US residents.

This new program is called the Pre-Existing Condition Insurance Plan (PCIP) and will be available throughout the country. In New York State, the PCIP plan is the NY Bridge Plan, administered by GHI, an EmblemHealth company.

PCIP plans will operate until the year 2014. At that time other provisions of health care reform will go into effect and state health benefit exchanges will be available for individuals to purchase coverage.

• No Deductibles
• Preventive Care
• $20 Office Visit Copay
• $500 Inpatient Per Occurrence Copay
• $100 Emergency Room Copay
• Pharmacy Benefits
• Vision Care

The NY Bridge Plan provides “a bridge” of health insurance from October 1, 2010 until January 1, 2014 for New Yorkers with pre-existing medical conditions.

www.ghi.com/nybridgeplan/index.html

Broome County is one of the 12 New York State counties with families at highest risk for residential fires chosen to participate in a smoke alarm installation program. Firefighters from Triangle Volunteer Fire Company will conduct home visits to residents in selected communities to install free smoke alarms and provide fire safety education.

Funding for this initiative is through a Fire Prevention and Safety Grant provided to the New York State Department of Health and the New York State Office of Fire Prevention and Control by the Federal Emergency Management Agency (FEMA).

“The goal of FEMA’s Fire Prevention and Safety initiative is to prevent both fires and fire related deaths and injuries,” said Glenn Pahlman, Chief of Triangle Volunteer Fire Company. “Smoke Alarms are the most effective early warning device for fires. About 70% of residential fire deaths result from fires in homes with no smoke alarms or no working smoke alarms. Just having a working smoke alarm cuts the chances of dying in a reported fire in half,” he said.

This program will reach out to residents, including senior citizens, children and those living in neighborhoods who are vulnerable to fire deaths and injuries. Installing smoke alarms in their homes and providing fire safety education to household members will greatly reduce this risk. Residents who wish to schedule a home visit can call Jessie Hinton at (607) 624-8965.

“Residential fires disproportionately affect our most vulnerable citizens, including children aged 14 and under and adults aged 65 and older. Fire prevention is still the best medicine. The ‘best’ fire is the one that never starts and the person least likely to be injured or killed in a fire is the one who is never exposed to fire danger in the first place,” said Jessie Hinton, firefighter with Triangle Volunteer Fire Company.

Community intervention is critical to improve the recognition of the importance of fire safety. This program will provide the opportunity for local fire departments to work together with the county health departments and other community organizations to address critical fire prevention and safety issues.

To learn more about fire safety, visit the New York State Office of Fire Prevention and Control’s web site at www.dhses.ny.gov/ofpc/, the Federal Government’s resource site for residential fire safety and prevention information at www.firesafety.gov or the National Fire Protection Association at www.nfpa.org.