State Disability News Highlights 10.28.16

State Disability News Highlights for Period ending 10/28/2016

Lead Story:   Idaho

More than 4,000 Idahoans enrolled the state’s Medicaid program for adults with developmental disabilities will no longer have their funding determined by an unknown formula, thanks to a settlement between the ACLU of Idaho and the state’s department of health and welfare. On Tuesday, the ACLU of Idaho announced it, as well as co-counsel James Piotrowski, received initial approval for a settlement agreement with the Idaho Department of Health and Welfare after more than five years of litigation. Under the terms of the settlement, systematic changes will be made to that way the department provides adults who have developmental disabilities with Medicaid funding that allows them to live more independent lives.  “We are pleased to see a new era on the horizon for Idahoans with developmental disabilities, as well as their families and advocates,” said Leo Morales, executive director of the ACLU of Idaho. “Hopefully this settlement will bolster the voice of these Idahoans, while also permanently protecting their constitutional rights.” The lawsuit began in 2012, according to a press release from the ACLU of Idaho, when many adults in the Idaho Medicaid program for community-based service for developmental disabilities saw cuts to their service levels. The cuts, the release adds, were computed using a formula that the Department of Health and Welfare refused to disclose, claiming it was a “trade secret.” Idaho Federal District Court Chief Judge B. Lynn Winmill ordered the cuts be reversed, which restored approximately $30 million in Medicaid assistance annually. The Idaho Department of Health and Welfare appealed Winmill’s decision, but in 2015 the Ninth Circuit Court of Appeals upheld the order. ACLU of Idaho attorneys and Piotrowski, who represented all of the adults in the program in the class action suit, continued to take legal action by challenging the previously secret formula itself. Earlier this year, the release states, Winmill struck down the formula, as well as other aspects of the program. According to the release, Winmill determined the formula and aspects of the program were unconstitutional because they “arbitrarily deprive participants of their property rights and hence violate due process.” The court ordered the Idaho agency to make systematic changes to the program, and the release states that the settlement approved Monday addresses those changes. “We look forward to working closely with the adults who receive these services, along with their families and advocates,” said Tom Shanahan, spokesman for the Idaho Department of Health and Welfare. “This program has always been dedicated to helping adults with developmental disabilities live full and successful lives in their communities. We are committed to honoring participants’ choices and hearing their voices to help improve the program through the agreement.” Shanahan added the agency’s next step is to begin working on a resource allocation model that can be used to determine budgets for program participants. To accomplish this, the department will work directly with participants, their families and advocates and the Human Services Research Institute in Oregon. In the meantime, the department must also make immediate changes to protect the due process rights of participants through training and reimbursement for advocates to help participants appeal their assistance levels. “We have reached a critical juncture in this case, but the work is far from over,” said Richard Eppink, ACLU of Idaho legal director. “Now it is up to Idahoans with developmental disabilities, and those who love and advocate for them, to mobilize as the state works on these important changes. The Department of Health and Welfare must engage with you under this settlement, but it is so very important that you get involved so that your voice is heard.” The ACLU of Idaho has established a website,www.OurHealthandWelfare.org, for those impacted by the settlement to keep informed and involved. More information about the settlement, including a copy of the settlement agreement itself, is available on the ACLU of Idaho website at www.acluidaho.org. The court will hold a hearing to decide whether to grant final approval to the settlement on Jan. 12, 2017. http://cdapress.com/news/local_news/article_0a75fe02-7d44-5f6e-bb3c-e29ca5726087.html

Arkansas

Gov. Asa Hutchinson is once again exploring a plan to use managed care to reduce the cost of providing services to the developmentally disabled and mentally ill. But this time, instead of hiring traditional managed care companies, the state would make payments to organizations owned by hospitals and other health care providers to provide the Medicaid benefits.  Dennis Smith, a senior adviser on Medicaid to Department of Human Services Director Cindy Gillespie, told the Arkansas Health Reform Legislative Task Force on Monday that the plan would save the Medicaid program money by reducing emergency room use and hospitalizations. The new proposal would also generate millions of dollars in revenue for the state through a tax on insurance premiums collected on the managed care plans. Some task force members complained Monday that they weren’t briefed earlier on the new planning efforts, including a meeting in August between Gillespie and the board of the Partnership for a Healthy Arkansas that resulted in the hiring of a consultant that developed the proposal. Under the proposal, statewide organizations, known as provider-led coordinated care organizations, would contract with regional provider networks that would share information and create plans for recipients’ care. In an Oct. 14 letter to Gillespie, Hutchinson said the proposal could be a “viable option for providing improved care management to those in need of an intensive level of these services.” He asked Gillespie to present him with a plan and recommendations on the proposal by Nov. 30. “If this provider-led model can be designed to give the State the same advantages as a [traditional] managed care model, I would prefer to move forward with the provider-based model, since it appears to be more appropriate for Arkansas,” Hutchinson said in the letter. To read more – http://www.arkansasonline.com/news/2016/oct/25/managed-care-plan-shifting-task-force-t-1/?f=news-arkansas

California

California companies that provide in-home services for people with disabilities are getting higher payments from taxpayers to contend with a higher minimum wage and new labor laws, but they aren’t passing all of it on to their workers, California’s state auditor said Tuesday. Respite care workers provide basic needs for people with disabilities, giving family caregivers a break. The services are provided by private companies overseen by the Department of Developmental Services.  But unlike other programs overseen by the department, the respite-services program has no cap on how much companies can charge for administrative expenses and profit, State Auditor Elaine Howell wrote in a report issued Tuesday. Payments to vendors who provide in-home respite services increased 19 percent on average over a nearly two-year period, while payments to workers increased by an average of 13 percent. “Because the increases in vendors’ hourly rates are largely due to statutory changes in minimum wage and labor laws, we expected that the hourly wages paid to respite workers would increase at a similar rate,” auditors wrote. Between June 2014 and March 2016, vendor pay for the more expensive full-service option rose from $17.76 to $21.21 on average, while workers’ hourly wages increased from $9.89 to $11.14. A department official told auditors that a $1 increase in pay actually costs about $1.25 due to higher taxes, Social Security payments and other costs. But auditors say the department has not conducted a study to determine whether vendors are retaining an appropriate amount of money for profit and administrative costs. It used to require vendors to submit information about their costs but no-longer does so. Administrative costs varied significantly for a handful of providers that auditors reviewed, ranging from less than 15 percent to nearly 30 percent of revenue. In-home respite services accounts for about 5 percent of the $4.6 billion California spent last year for private vendors to provide direct service to people with developmental disabilities. Just over 51,000 workers employed by 303 vendors care for 61,000 Californians, according to the audit. Auditors recommended that the Legislature order a review of payments by late next year and require the department to resume collecting cost information from vendors. They also recommended background checks for workers.  To read more – http://sacramento.cbslocal.com/2016/10/25/audit-california-department-of-developmental-services/

Colorado

The closing days of the push to make Colorado the nation’s first state with universal health care are showing why supporters face such steep odds. Most voters have already received ballots in the mail and endured a long campaign to explain the measure, but huge questions remained at a meeting this week in suburban Denver to examine the proposal: How much is this really going to cost? Who would decide what my health care would look like? And what if it all ends in failure? The measure would set up a $25 billion-a-year health care system funded by payroll taxes, replacing the system of paying private health insurers for care and opting out of the federal health care law. Supporters are hoping to overcome those big questions with a simple recurring message — everyone hates the health care system now, so why not try a big change? They turned in signatures to get the measure on the ballot more than a year ago, and they have since been visiting community centers and church basements to talk up their plan. It calls for a new 10 percent payroll tax to replace insurance premiums and health care subsidized by an employer. But they have been heavily outspent by health insurers and other opponents, who have dropped more than $3 million to oppose the idea. With Election Day looming, the plan is still being explained, as it was at a Rotary Club meeting Monday, where a crowd of mostly retirees heard the details over pork chops and dinner rolls. “Everybody in the United States should have access to affordable health care when they need it, without having to file bankruptcy,” said Ralph Ogden, an attorney who helped write the measure. The room wasn’t sold. “The government does not have a strong track record of efficiency when running things like this,” said Dick Pierce of Arvada, an 84-year-old retired sales executive who is worried he would have to spend some of his life savings subsidizing health care for younger folks. Universal coverage proposals have failed time and again in the United States. Left-leaning Vermont recently pursued such a system, only to abandon it as too expensive. To read more – http://www.nytimes.com/aponline/2016/10/25/us/ap-co-election-2016-universal-health-care.html

Iowa

Gov. Terry Branstad said Monday he will explore a statewide increase in the minimum wage, replacing minimum wage hikes being approved on a county-by-county basis throughout Iowa. The Republican governor didn’t offer a specific figure for a uniform increase in Iowa’s minimum wage, but he suggested he would consult with experts for help in determining an appropriate figure. The state and federal minimum wage has been set at $7.25 an hour since 2008, and there is no indication Congress will act soon to raise it. “I think it would be wise for us to carefully review the workforce and what the needs are out there and look at what neighboring states have done and what is competitive,” the governor told reporters at his weekly news briefing.  However, Branstad also appeared to leave the door open for keeping the minimum wage at $7.25 an hour and having the Legislature simply approve a measure to block individual counties from raising the pay for low-income workers. Branstad said he plans to meet with Iowa House and Senate leaders after the Nov. 8 elections to discuss the minimum wage issue and to determine whether there is bipartisan support to pass a bill in the Iowa Legislature’s 2017 session, which convenes in January. “We know that this is a controversial and difficult issue, but hopefully it is one that we can address,” the governor said. He noted that he had signed a minimum wage increase in the past, and he suggested a statewide minimum wage law is a better approach than county minimum wage increases, which he believes could face court challenges. He also said problems can arise when a city is located on the border of two counties. To read more – http://www.desmoinesregister.com/story/news/2016/10/24/branstad-backs-statewide-minimum-wage-hike/92673274/

Kansas

Federal officials Monday opened their regional office in Kansas City to take feedback on several changes to disability support policies in Kansas — including one they’ve instructed state officials to put on hold. The Centers for Medicare and Medicaid Services told leaders of the Kansas Department of Health and Environment and Kansas Department for Aging and Disability Services earlier this month they cannot implement a change to the “capable person” policy — one of two changes to home and community-based disability support services made in May to help balance the state budget. Federal officials also have instructed the state to provide more information about the elimination of a waiting list for Kansans with physical disabilities who requested such services. KDADS announced in August that the list was eliminated, but CMS officials say they have questions about whether Kansans were dropped from the list improperly. Angela de Rocha, a spokeswoman for state agencies including the Kansas Department for Aging and Disability Services, said the agency will abide by CMS requirements for the capable person policy after it receives more federal guidance. “The agency has requested a technical assistance call with CMS to discuss the process,” de Rocha said. De Rocha said the agency has also provided CMS “extensive documentation” about the waiting list for services for Kansans with physical disabilities. The inclusion of home and community-based services in KanCare was one of the most controversial aspects of the state’s 2013 switch to managed care Medicaid administered by three private insurance companies. Legislators and Gov. Sam Brownback agreed to “carve out” the disability support services for one year to conduct voluntary pilot programs, but since 2014 those services have been included in KanCare. Brownback has said including the support services in the same plan as medical services for Kansans with disabilities allows for better coordination of their care and leads to improved health and lower Medicaid costs, which in turn means more services can to be provided to Kansans on waiting lists. To read more – http://www.khi.org/news/article/federal-officials-question-states-disability-support-policies

Kansas

Judy Talbot says a “medication washout” could help improve the condition of her daughter, who has autism and post-traumatic stress disorder. Talbot’s daughter is receiving nursing care at the Kansas Neurological Institute but has been unable to get the kind of specialized attention needed to adjust her medication regimen. But both ultimately have the same goal: to do a “medication washout” to determine whether the prescription drugs their autistic kids take are helping to control their recent dangerous psychotic episodes or actually causing them. Zbeeb, from Wichita, wants his 15-year-old son to be weaned off his medications at a place like Parsons State Hospital and Training Center. “We felt this was an appropriate place for my son to be in a 100 percent structured setting,” Zbeeb says. Talbot got her 32-year-old daughter into a state facility, the Kansas Neurological Institute, in August after her daughter spent a week strapped to a bed in a hospital emergency room. She thought KNI might be able to do a medication washout. Instead her daughter has received mainly nursing care, not the kind of specialized attention needed to adjust her medication regimen. “She’s been there all this time and hasn’t seen a psychiatrist,” Talbot says. Talbot and Zbeeb’s children both fall into a care gap for Kansans with a combination of developmental disability and mental health issues. Providers on both sides say they’re ill-equipped to care for people with that combination of ailments, especially given cuts to Medicaid, which is one of the main sources of health insurance for people with developmental disabilities and mental illness. Advocates for Kansans with developmental disabilities say they’re often excluded from mental health treatment facilities based on assumptions that they won’t be able to participate in counseling. Eric Atwood, a psychiatrist at the Family Service and Guidance Center in Topeka, says a process known as a medication washout can help some people who use antipsychotics. “The question is, is it appropriate to clear the slate and see how one functions without any medication,” he says. Zbeeb and Talbot both say the default treatment has been to medicate their children with various antipsychotic drugs, and both believe the drugs may be doing more harm than good at this point. To read more – http://kcur.org/post/kansans-developmental-disabilities-and-mental-health-issues-fall-care-gap

Kentucky

Kentucky’s Supreme Court on Thursday struck down a Louisville law mandating that the city’s local businesses pay their workers at a higher level than the state’s minimum wage. In a 6-1 ruling, the court said Louisville officials exceeded their authority when the city’s Metro Council passed a minimum wage ordinance in December 2014 calling for a gradual raise to $9 an hour by 2017. The measure, passed on a party-line vote, came as other cities and states passed increases as part of a national push by labor advocates to bring the minimum wage closer to cost of living standards. The only way Louisville and other Kentucky cities can pass a higher minimum wage is if the state’s General Assembly grants them that ability as “the sovereignty of the state still rules supreme,” Justice Bill Cunningham wrote.  Jefferson County Attorney Mike O’Connell, who represented the city in the suit, said in a statement he was disappointed with the ruling. The question now, he added, becomes if state lawmakers want to grant such powers to local governments.  A Louisville business and two statewide business organizations filed suit in February 2015 seeking to stop the hike from taking effect. However, a Louisville judge turned down that request in June just before the first raise took place.  Brent Baughman, a lawyer representing the Kentucky Retail Federation, the Kentucky Restaurant Association and Packaging Unlimited LLC, said his clients’ argument was never about the amount of the raise, but whether the city had the right to make the change.   Before Thursday’s ruling, the minimum wage in Louisville was $8.25, which is $1 higher than the current state and federal minimum.  Last November, officials in Lexington voted to gradually increase the minimum wage to $10.10 an hour by 2018. However, Thursday’s ruling now invalidates that law, said Susan Straub, a spokeswoman for Lexington Mayor Jim Gray.  To read more –http://mobile.reuters.com/article/idUSKCN12K2L9

Minnesota

The state program charged with integrating Minnesotans with disabilities into the mainstream workforce has quietly placed more than 1,000 people on indefinite waiting lists, the result of a surge in enrollments that could imperil new state efforts to expand disability hiring. In addition, Minnesota’s Vocational Rehabilitation (VR) program has rationed services for hundreds of clients and could be forced to turn away new applicants as it struggles with a looming financial shortfall and new federal workforce mandates.  State officials have projected that, without millions of dollars in new funding, the program could reach capacity by late 2017 and then would be forced to cease providing services for new enrollees. Those most affected would be young people with significant disabilities just out of high school, who are starting to transition into mainstream jobs, say vocational experts. Many would be left to fend for themselves in a state labor market regarded as unfriendly to people with disabilities, a population whose jobless rate is slightly more than twice that of the general population. “Our credibility is at stake,” said Kim Peck, the state’s director of vocational rehabilitation services. “Our staff didn’t sign up to put people on waiting lists.” Closing services for new enrollees, in Minnesota’s only state-funded vocational program for people with disabilities, could also hamper new efforts by the administration of Gov. Mark Dayton to improve their integration into the broader community. An ambitious plan of integration, approved by a federal judge last year, calls for state agencies to move nearly 20,000 people with disabilities into the competitive labor force by mid-2020, while expanding vocational services for young people. To read more – http://m.startribune.com/state-rehab-agency-in-crisis-thousands-of-disabled-minnesotans-face-uncertain-job-future/398276451/

Mississippi

In a year’s time, more than 100 people stayed in cells at the Lauderdale County Detention Facility, serving time only because they needed mental healthcare.  Many had committed no crime and simply needed a place to wait for an available bed at one of the region’s psychiatric care centers. With no other place to house these individuals, and so few beds available, Lauderdale County turned to its only remaining housing option – the county jail. “If you look at local government, the place that’s open 24/7 and the person who basically gets told to handle all the problems that nobody else can figure out is the sheriff,” said Ward Calhoun, chief deputy of the Lauderdale County Sheriff’s Department. “Because there is no other place to hold that individual, the courts order jails to hold that individual until a bed’s made available at a state hospital.” In 2011, the United States Department of Justiceinvestigated Mississippi and concluded the state’s mental health services violated the Americans with Disabilities Act by segregating people with disabilities – defined as mental, developmental and physical disabilities – in state institutions away from their communities. According to Olmstead, a Supreme Court decision from 1999, isolating those with disabilities from the community is discrimination. People with disabilities should be allowed to live in the most integrated – disabled and non-disabled together – setting possible. At least two dozen other states have had Olmstead complaints filed against them. To read more – http://www.meridianstar.com/news/local_news/jailed-for-mental-illness/article_b7e2bb8a-3fa1-59d4-a247-c720c81c6d52.html

New Mexico

Gov. Susana Martinez signed into law Monday a budget-cutting bill that slashes funding for New Mexico colleges and universities, courts and most state agencies in response to a stomach-churning plunge in state revenues. However, the two-term Republican governor used her line-item veto authority to prevent $22 million in proposed cuts to K-12 initiatives run by the Public Education Department, saying the cuts would have gutted programs like free meals for students in high-poverty schools and stipends for teachers who perform well on the state’s evaluation system. “To make cuts as deep as the Legislature proposed in (the budget-cutting bill) would be to abandon our goals in education reform, and to abandon our schools and students as they strive to meet them,” Martinez said in her bill-signing message. Although the governor said she would direct PED to voluntarily reduce spending on such programs by $4.5 million, her veto drew criticism from one top-ranking lawmaker. Sen. John Arthur Smith, D-Deming, chairman of the Senate Finance Committee, said the move will increase pressure on Martinez and lawmakers to do additional belt-tightening during the 60-day regular session, which starts in January. “We still have hefty lifting to do, and that just adds to the workload,” Smith told the Journal . He also questioned whether the PED would be able to spend the entire $22 million, saying much of the money spared by the governor’s veto pen had gone unspent by the PED in the past year. The budget-cutting bill signed Monday by the governor calls for 5.5 percent spending cuts for most agencies, effective immediately.Some agencies will have smaller cuts, while Medicaid and child-focused services are among several programs exempted from the cuts. To read more –https://www.abqjournal.com/874228/gov-martinez-signs-budget-cutting-bill-but-keeps-veto-pen-busy.html

New York

New York State employees stole cash from the personal accounts of people with mental disabilities to pay for everything from live shows and restaurant outings to Wal-Mart shopping sprees,  according to a report released Thursday by the state’s inspector general. One of those employees with the Office for People with Developmental Disabilities, Lynn Knightner, stole money from developmentally disabled residents in West Seneca to take her family to see a performance of “How to Train Your Dragon Live Spectacular” in 2012. She also made “questionable” restaurant gift card purchases to restaurants her colleagues do not remember taking any of their residents to, according to the report. “With disturbing regularity we have seen the shameless preying on a vulnerable population by those charged with their care,” Inspector General Catherine Leahy Scott said in a statement. The pilfering of cash accounts maintained by the New York State Office for People with Developmental Disabilities was described as “widespread and prolific.” The report highlighted findings from 10 separate investigations across the state, from the Buffalo region to the Hudson Valley and found inadequate accounting safeguards and outright thefts. To read more – http://buffalonews.com/2016/10/20/report-shows-group-home-staff-stole-money-mentally-disabled-residents-across-state/

South Carolina

County agencies responsible for caring for thousands of intellectually disabled state residents have failed to adequately protect the money and property of those they are caring for, according to audits of the agencies. In more than half of audits conducted during the past three years, dozens of county disabilities and special needs boards were cited for failing to properly manage the funds and property of consumers, the term used to describe the disabled who receive services from the agencies. The internal audits by the state Department of Disabilities and Special Needs also cited many boards for sloppy financial management, including personal use of board credit cards, inadequate cash and inventory controls and spending issues. DDSN Commissioner Vicki Thompson of Seneca said commissioners are aware of county audits as they are done but she has not seen a compilation of issues found by auditors to spot systemic issues. “We don’t have a summary of internal audits so we can identify systemic weaknesses, which we certainly have, and then dig deeper to find out if our administrative directive is not clear or our training not good enough,” she said. “We’re not looking at the right data to be able to fix anything.” The Greenville News obtained the audits through a Freedom of Information Act request and reviewed them as part of an ongoing examination of the care of the state’s vulnerable adults and the agencies responsible for that care. DDSN contracts with the county agencies, each of which is overseen by a board, to provide a bevy of services, including residential care, to more than 20,000 people, including intellectually disabled, those with autism, spinal cord or brain injuries. Only three of 48 audits found no problems. Those were for the Richland-Lexington counties board, the Marion County board and the Jasper County board. Among the findings:  Some agencies improperly required consumers to pay for items that should have been provided by Medicaid or the agency, the audits found. Some did not complete required background checks of their employees, including direct care staff. One agency failed to report a series of thefts of consumers’ property to DDSN while another was late in filing critical incident reports. Boards for nine of the agencies were cited for failing to meet because not enough members showed up, for having members who had missed too many meetings, or for failing to follow the state Freedom of Information Act, according to the audits. In one case, auditors faulted an agency for nepotism after a board member’s wife was hired. In another case, male board members were called out for inappropriately visiting the rooms of female consumers at night.  The audit findings concerning the Sumter board were so serious that DDSN required the board to undergo governance training, records show. The audits are performed about once every three years, and those with findings trigger follow-up examinations, said Lois Park Mole, a DDSN spokeswoman. Each of the county boards promised corrections with most of the findings but some follow-up audits found the same problems. In 16 of 18 follow-up audits, records show auditors cited the agencies for problems, repeat or new. DDSN Commissioner Eva Ravenel, of Charleston, said she believes most of the problems found in audits are not the result of intentional misconduct. “One of our main problems is that we have underpaid people and we are asking them to do big jobs and these people are not really savvy in taking care of people’s finances and writing it down,” she said. “I really don’t think we have bad people. I think we have people who just don’t have that expertise. They don’t have that education to do what’s necessary and we don’t give them enough training to do it.” Sen. Thomas Alexander, a Walhalla Republican who chairs the Senate finance subcommittee with oversight of DDSN, said he is pleased the agency is conducting audits of county boards. But he said he is concerned that so many continue to have problems.  “They need to be more aggressive at finding these issues and getting them resolved once you find them,” he said. “The agency (DDSN) contracts with these folks so they should be holding them accountable.” Sen. Kevin Bryant of Anderson, who serves on the Senate Medical Affairs Committee, said the audits concern him. “When they tell us they are underpaid and they’re wasting their money on computers and iPads, and then come to us and say they need more money, it seems contradictory,” he said. “We see this all through government. Agencies come to us and tell us how much more money they need and then we look at how they are spending it and are wasting it. It’s one of the things we have to deal with. It’s not just DDSN.” Executive directors of the county agencies reached by The News said that the audits require them to submit a plan of correction and then to report when the problems are resolved. Each said the findings viewed by the newspaper had been corrected. The most common finding by auditors involved controls meant to protect consumers’ funds and personal property. In 28 of 48 audits, auditors said boards did not always properly maintain and account for consumers’ money or property. In some cases that meant a failure to properly record bank signature cards, in others it meant not reconciling bank statements in a timely manner. In still others it meant a lack of documentation for how consumers’ funds were spent. To read more – http://www.thestate.com/news/politics-government/state-politics/article110075332.html

South Dakota

Three months into state government’s 2017 fiscal year, South Dakota’s economy isn’t close to generating enough tax revenues to cover the 2017 budget set by the Legislature. Taxable sales for July through September ran 1.8 percent behind the similar quarter one year ago. Making the arithmetic more complicated was the decision by Gov. Dennis Daugaard and majorities in both chambers of the Legislature to increase the state sales tax rate to 4.5 percent from 4 percent. The tax increase was targeted for improving teacher salaries and providing property-tax relief for businesses. Combined with other spending increases, sales tax revenue needs to climb 16.9 percent to cover the budget. Now more growth is needed to also offset the first-quarter downturn. “We need about 20 percent (growth) the rest of the year,” state economist Jim Terwilliger told the business people and university faculty members around the table in the governor’s large conference room at the Capitol. South Dakota’s agriculture sector, which depends on crop and livestock prices set nationally and globally, is part of the weakness. The peaks seen in the 2011-2013 period are replaced by deep slumps of late. To read more –http://www.capjournal.com/news/weak-economy-could-require-state-government-budget-cuts/article_f46d38c4-9b3b-11e6-974a-5791f6aefe14.html

Vermont

In January, Vermont will become the first state in the nation to move to a voluntary all-payer accountable care organization model, the CMS announced Wednesday. The Vermont program is modeled after a similar one from Maryland, but the Maryland program covers only hospitals. The Vermont ACO will cover Medicare, Medicaid and commercial payers, requiring those who participate to pay similar rates for all services. The CMS is giving Vermont $9.5 million in start-up funding to support the transition. The demonstration, funded through a 1115 waiver, will last five years. “This model is historic in terms of its scope, aiming to include almost all providers and people throughout the state in an all-payer ACO model to drive improved quality, better care coordination, healthier people, and smarter spending,” the CMS’ Chief Medical Officer Patrick Conway said in a statement. “We will become the first state in America to fundamentally transform our entire health care system so it is geared towards keeping people healthy, not making money,” said Vermont Gov. Peter Shumlin, who earlier this year traveled to Washington to negotiate a deal with HHS Secretary Sylvia Mathews Burwell.  The state aims to have 70% of its insured residents covered by an ACO by 2022. The model will be considered an advanced alternative payment model under the new Medicare reimbursement program, making participants eligible for a performance bonus. Vermont will limit annual per capita expenditure growth for major payers to 3.5% and Medicare growth to at least .1 to .2 percentage points below projected national growth. State officials have also said they are looking to improve access to primary care and treatment for substance abuse, mental health and chronic disease.  To read more –http://www.modernhealthcare.com/article/20161026/NEWS/161029930

Washington

Under a nearly approved waiver, the state of Washington will focus on the social needs of its Medicaid population and leverage partnerships between providers and social support groups in an attempt to improve patients’ quality of care. The CMS has granted Washington preliminary approval to overhaul its Medicaid program (PDF). As part of the five-year waiver, for which the state will receive $1.5 billion in federal funds, the state will launch delivery-system reform initiatives and expand options for long-term services and supports. The approval is expected to be finalized in the next few weeks once the state and the CMS hash out special terms and conditions. State officials sought out the waiver as a way to help address Washington’s ballooning Medicaid population, which jumped nearly 60% since 2013 to 1.7 million enrollees according to federal data. Medicaid spending jumped from around $7.8 billion to $10.4 billion during the same period. The waiver allows for three major changes: the first is creating accountable communities of health to operate across the state. Each region will find new ways to craft delivery system reforms that take into account social conditions that can affect health. The idea stems from the CMS Innovation Center and reflects the government’s goal to shift from fee-for-service to value-based care. The model aims to address issues such as housing instability and quality, food insecurity, utilities and transportation. Federal law prohibits Medicaid from paying for housing outright, so the state program will instead help people find appropriate housing and provide tenant support. The state would also offer job coaching and training. Accountable communities of health and their provider partners can receive bonuses for meeting certain benchmarks. The community health models also will team up with managed-care plans in the state to move 90% of Medicaid payments to a value-based model by 2021. To read more – http://www.modernhealthcare.com/article/20161019/NEWS/161019902

Wisconsin

Wisconsin school districts will lose $2.4 million in state aid this year to fund 202 students with disabilities in private schools, state figures show. Milwaukee Public Schools and 21 other districts will be affected by the new Special Needs Scholarship Program, which allows qualifying resident students to attend private schools on state-funded tuition vouchers worth $12,000 annually. Many of the new vouchers are supporting children who were already attending private schools. One school-choice advocate said more children qualified for the program than anticipated and the funding mechanism will need to be addressed in the next legislative session. But the bigger story is that there’s a limited amount of school funding to go around, and more children in private schools are qualifying for a share of it than ever before. And children with special needs are expensive to educate no matter where they go to school. “What I’m excited for is the addition of resources,” said Dwayne Jobst, principal of the 310-student Lake Country Lutheran High School in Hartland. The school will receive $108,000 this year for nine students who qualified for special-needs vouchers, including five students who were already attending the school. The way Jobst sees it, the state gets its money from taxpayers, and his private school’s parents are taxpayers. “Should they not have some say in where their money goes?” he asked. Down the road in Hartland, Arrowhead Union High School officials opened their state aid figures this month to find a new deduction of $84,000 to pay for seven resident children using special-needs vouchers. The method for paying for special-needs vouchers results in districts with declining enrollment, like Arrowhead, losing a separate cushion of funding. That amounted to an additional $20,000 loss from last year, Business Manager Steve Kopecky said. “It’s a new tweak we have to budget for,” he said. Districts can recoup some of the aid losses through a complicated funding formula. But over time, most districts would still face a gap of at least $2,000 per participating child each year. Milwaukee Public Schools has the largest number of resident children using new special-needs vouchers. The district will lose about $1.8 million in state aid to pay for about 150 resident students. Milwaukee suburban districts have just one to three resident students using special-needs vouchers, and for some, the impact is minimal. The Waukesha School District will lose $48,000 to pay for four resident students in private schools. That’s barely noticeable on a balance sheet for a district with about 13,000 students. To read more – http://www.jsonline.com/story/news/education/2016/10/23/special-needs-vouchers-cost-districts-24-million-aid/92515608/

Wyoming

The state of Wyoming will still be about $156 million short for the 2017-18 biennium that began July 1, according to a revenue report released this morning. That’s even after budget cuts that were made last spring. If a required transfer of revenue to the state budget reserve account is removed from the equation, the state will still be about $52 million short. Those figures come from the Consensus Revenue Estimating Group’s annual October report. As a result, Gov. Matt Mead said the state could consider using some money from its stabilization, or rainy day, account. Mead said the full effect of cuts earlier this year has not been felt, and further cuts could result in employee layoffs and loss of more services. The governor will release a budget proposal by Dec. 1 that will be considered by the Legislature in 2017. To learn more about the new CREG report, read the full story in Tuesday’s Wyoming Tribune Eagle and at WyomingNews.com. http://www.wyomingnews.com/news/new-mead-says-wyoming-could-use-rainy-day-fund/article_fef1f112-9a10-11e6-b62e-d39b653cbfa6.html