Review of the 2022 Disability Policy Webinar Series from the ARC Michigan

I have been in semi-hibernation during the COVID pandemic and have not been following state and local disability policy as closely as I should. With regard to policy affecting people with Intellectual and Developmental Disabilities (I/DD) and their families, one way to catch up is to follow the ARC Michigan’s 2022 Disability Public Policy Webinar Series on Zoom. The Webinars are held every Friday in June with each week featuring a different topic and speakers. The Webinars are also archived for viewing later.

I have my differences with the ARC and other large advocacy organizations. Too often they do not represent the spectrum of views held by people with disabilities and their families. Many policy makers find it convenient to accept the views of well-funded advocacy groups as a proxy for individuals with I/DD and their families, thereby avoiding controversy and the unsettling reality of differences of opinion that they would otherwise have to confront. Nevertheless, the ARC policy seminar offers a variety of topics and includes knowledgeable speakers on state and federal issues affecting people with disabilities.

The ARC Michigan 2022 Public Policy Webinar #1: June 3rd, 2022

ThIs is the PDF handout for the first Webinar with Belinda Hawks from the Behavioral Health and Physical Health & Aging Services Administration (BHPHASA), Remi Romanowski-Pfeiffer from TBD Solutions, and Al Jansen, Senior Advisor to Director Hertel, Michigan Department of Health and Human Services (MDHHS)

This is the link to the Youtube video of the Webinar.  

The BHPHASA is new. It is the result of combining agencies under the MDHHS. 

From the Website:

“The Health and Aging Services Administration (HASA) was created under Executive Order 2021-14 combining Aging and Adult Services Agency and Medical Services Administration under one umbrella within MDHHS. Michigan's Medicaid Office is also part of HASA and the designated State Unit on Aging function will be fulfilled by HASA.”

The topics that I was especially interested in include the Direct Care Workers (DCW) crisis and the “Heightened Scrutiny” of settings receiving HCBS (Home and Community-Based Services) funding to assure that they provide access to “the community” based on the wishes and needs of the people living in these settings. There are other issues that will also be of interest to providers, local agencies, and people with disabilities, such as how the state is planning for recovery from the COVID pandemic and various scenarios to consider.

The Direct Care Workers (DCW) crisis - Allen Jansen, Senior to Elizabeth Hertel Allen Jansen, Senior Advisor to Elizabeth Hertel, Director of the MDHHS.

[Allen Jansen’s presentation begins at around 43 minutes on the Youtube video.]

National Data on DCWs (also known as DSPs or Direct Service Providers):

• 4.5 million direct care workers in the U.S.
• 40 to 60% rate of turnover
• 84% have no retirement benefits
• In 2019, 53% were women of color
• 47% qualify for public funded benefits
• In 2020, $20,200 was the median income
• By 2030, the predicted shortage of DCWs will be 151,000.

Michigan has a shortage of 36,000 care workers out of a workforce of approximately 165,000.

A state Direct Care Task Force has been created to establish priorities and make recommendations to the state. 

Also involved in discussions is the Quality Improvement Council (QIC). 

From the Website:

“The Quality Improvement Council directs the development and implementation of the behavioral health managed care programs and serves as the primary point of prioritization and integration of quality improvement activities.

“The Quality Improvement Council includes quality and administrative staff representatives from MDHHS, the PIHPs, CMHSPs, provider organizations, quality vendors and advocacy members.”

There are many job titles that fall under the broadly defined category of Direct Care Worker. Current efforts focus on improving wages and benefits for DCWs. The broad strategy for improvement includes establishing competency standards for the professionalization of the DCW workforce, designing a career pathway, elevating the value of DCWs (specifically identifying them as providing an essential service), and collecting data to demonstrate their impact:

The Governor’s proposed 2023 budget includes funding to stabilize DCW wages. At the time of the Webinar, a supplemental budget that includes additional wages for DCWs was stalled. 

Recommendations for improvement include setting a starting wage at $17 - $18/hour for DCWs and adjusting funding to cover added expenses to providers to pay supervisory personnel.

There is also a proposal to expand “residential models”. Belinda Hawks clarified that this is referring to the need for facilities to house people who are stuck in emergency rooms and hospitals with no place to go or are in nursing homes and want to get out. These would be home environments aligned with a psychiatric treatment facility model. The estimated need for such facilities is 48 beds for adults and 12 for children. 

“Heightened Scrutiny”

Heightened scrutiny is a process to determine whether a setting receiving HCBS funds allows sufficient access to the community to be eligible of funding under the CMS (Centers for Medicare and Medicaid Services) settings rule. 

Michigan does not set limits on the size of a setting. According to Belinda Hawks, no settings so far have been determined to be ineligible. The state is still reviewing settings. Compliance with the settings rule must be complete by March 2023. The Department expects to be finished reviewing settings by August or September 2022 to give providers enough time to make changes to comply or find other arrangements for residents of these settings. 

Providers have been notified if they under the HS process. The final determination is up to CMS.

****************
See also:  

DCW commentary from ARC Michigan

Michigan’s mental health system is failing many with severe autism
Thursday, May 16, 2019

Abelone Kelley June 10, 2022 0

Budget Alert from the Michigan Assisted Living Association (MALA)

This is from the Michigan Assisted Living Association (MALA) on increasing wages for direct care workers who provide services to people with developmental disabilities as well as those who are aging or have mental illness or physical disabilities. 

The only thing I would change about this appeal is to make sure it applies to direct care workers regardless of where the individual served lives. Workers in group homes, nursing homes, and other settings are as vital to the care of people with disabilities as those who are hired to work in the individual's own home.

****************************  

MALA Budget Alert - Your Action is Needed Now!

Your advocacy is urgently needed as the Michigan Legislature works on the state budget for the fiscal year beginning October 1, 2022. Please see the message and link below for you to communicate with your state legislators.

The behavioral health coalition, of which MALA is a member, is urging the Michigan Legislature to appropriate an additional $127.0 million in General Fund dollars. This funding equates to an approximate $4.00 per hour wage increase which would be in addition to the $2.35 per hour wage increase.

We expect the $2.35 per hour wage increase to be funded in the next fiscal year’s state budget. However, the potential exists for an additional wage increase particularly if the state revenue estimates released later this month are positive.

Please take a few minutes to contact your state legislators to urge their support for the additional funding referenced in the message below. An additional $4.00 per hour wage increase would result in an estimated average starting wage rate state-wide of $18.00 per hour for direct support staff. 

Please feel free to contact us if you have any questions related to this MALA Budget Alert.

ROBERT L. STEIN

General Counsel
, 734-525-2400,
rstein@miassistedliving.org
 

KATHLEEN M. MURPHY

General Counsel
, 734-525-2401,
kmurphy@miassistedliving.org

BRENDA L. ROBERTS

Director of Quality Assurance and Education,
734-525-2407,
broberts@miassistedliving.org

Please Support Michigan’s Direct Care Workers

When a Michigan resident experiences a mental illness or developmental disability, they should be able to hire the help they need to ensure their safety and wellbeing. But right now, they can’t.

In today’s tight labor market, it is difficult to find a Direct Care Worker, whether you are looking for care for yourself, a loved one, or hiring an employee for your agency. This leaves our state’s most vulnerable residents at risk.

Our coalition proposes a General Fund appropriation of $127.0 million in FY 23 which would increase the average starting wage rate in the behavioral health system to approximately $18.00 per hour. That’s what many entry-level jobs pay across the state right now and is the least we can do to compensate our Direct Care workforce.

With significant amounts of GF dollars and pandemic-related federal funding available to the state right now, Michigan has a once-in-a-lifetime opportunity to address the long-standing direct care workforce crisis in a meaningful and sustained manner.

Let’s reach out and make it happen.
 

Click Here

Abelone Kelley May 06, 2022 0

Michigan Direct Care Workers for People with Disabilities are Facing a Cut in Pay

Michigan Direct Care workers were given a pittance of a wage increase of $2 per hour to continue providing care to people with developmental and other disabilities during the Covid Pandemic. It helped, but now direct care workers will be losing even that if the state does not move to fund these workers.

An opinion piece from Bridge Michigan, “Michigan direct care workers, families headed for choppy waters” by Robert Stein, Todd Culver, and Robert White, 12/02/20, warns of what lies ahead if state government does nothing to prevent this undermining of an already fragile system of care for people with disabilities.

Robert Stein is general counsel of the Michigan Assisted Living Association, Todd Culver is CEO of Incompass Michigan and Robert White is a parent advocate.

Here are some excerpts:

"Many people are approaching the end of 2020 with a sense of relief and hope for a better new year. But for those Michigan families who care for someone with a mental illness or developmental disability, Jan. 1, 2021 is a day fraught with dread.

"That’s the date Michigan’s budget will no longer provide its $2 hourly pay increase for the direct care workers these families rely upon. As a result, they may lose the help and support they need to manage their busy households, continue their employment and ensure the best possible help for their loved ones." 

Last Spring, “more than $100 million in federal funds was matched by a generous $40 million in state appropriations to ensure ongoing direct care worker support.” 

“…The work our state’s direct care workers do is arduous, important and noble, and their positive impact is widespread, with over one million Michiganders relying upon the support direct care workers provide.“

If nothing happens, direct care workers will receive a cut in pay. 

“This will exacerbate Michigan’s direct care worker shortage. Current turnover in the field already is a staggering 37 percent and growing. Meanwhile, demand for the services these workers provide has never been higher. The COVID-19 pandemic and all the stress and uncertainty it has produced has undoubtedly strained the collective mental health of Michiganders, and families throughout the state are struggling to deal with the fallout.“

...“Direct care worker salaries are tied to state Medicaid funding, which, at present, are exceedingly low. Today’s workers currently receive, on average, a starting wage of $10.70 per hour, with many receiving minimal or no additional health or other benefits. When one considers that the average starting wage at a retail outlet or a fast-food restaurant is typically anywhere from $11 to $14 per hour, it’s clear to see that we can and must do better for Michigan’s direct care workforce. “

As we know, COVID-19 has not gone away and neither has the burden on people with disabilities, their families, and direct care workers to maintain some sense of normality and hope for the future. Direct care workers’ wages “…should continue to reflect the extraordinary responsibility they bear. “ 

“We urge state policy leaders to act before the end of the year to continue the funding needed to extend the $2 per hour as a permanent increase through 2021 to ensure the well-being of everyone.”

************************

This is a good time to figure out who your state legislators are, if you do not already know, and keep those contacts available for the year ahead. You may get to know individual aides who work for legislators and the governor and have an easier time of getting your message across.

Here are some useful contacts:

Contact the Governor 

Find your state representative

Find your state senator

 Update from a FaceBook comment: "The gov's office submitted a supplemental budget request on 12/3, one of the items is an extension of the $2/hr increase through March 31. Still a drip-drip-drip approach, but better than cutting it at the end of the month."

Abelone Kelley December 05, 2020 0

Michigan workers eligible for tuition-free community college and more unemployment benefits

According to an article on Mlive.com, "Michigan front-line workers eligible for tuition-free community college under state program", 9/10/20, by Lauren Gibbons:

"Michigan residents without college degrees who’ve worked through the COVID-19 pandemic can now apply for tuition-free community college, Gov. Gretchen Whitmer announced Thursday morning.

"The Future for Frontliners program, initially announced by the governor in April, is open to workers without an associate or bachelor’s degree who were deemed essential during the COVID-19 pandemic.

"To be eligible, workers must have worked at least part-time for 11 of the 13 weeks between April 1 and June 30 and were required by their job to work outside their home at least some of the time.

"The program is funded by $24 million from the Governor’s Education Emergency Relief, part of the federal funding Michigan received from the CARES Act, according to a press release from the governor’s office. The state estimates 625,000 workers could be eligible for the program...."

In addition, according to another Detroit Free Press article, "State of Michigan: Unemployed workers will receive $300 federal benefit within 10 days" by Adrienne Roberts, 9/10/20:

"Michigan workers filing for unemployment benefits will receive the extra $300 federal benefit within 10 days, the state's Unemployment Insurance Agency said Thursday.

"The payments are retroactive, and will be paid out for the weeks ending Aug. 1, Aug. 8 and Aug. 15 initially, Steve Gray, the director of the UIA, said in a release.

"The benefit, funded by the Federal Emergency Management Agency (FEMA), is available to states for up to six weeks, which would end Sept. 5. The UIA has applied for the additional three weeks of funding, according to the release..."

For details, read the full article and this update from the Michigan Unemployment Insurance Agency.

Abelone Kelley September 11, 2020 0

Michigan: more information on pay increases for Direct Care Workers

This is a letter from the Michigan Department of Health and Human Services, Behavioral Health and Developmental Disabilities Administration, to PIHPs (regional administrative agencies that pass on Medicaid funding to local Community Mental Health agencies).

It deals with proposed Medicaid funding changes that have not been approved yet by CMS (the Federal Centers for Medicare and Medicaid Services) and are subject to change.
 
"...The purpose for sharing this information is to let you know what we are working on and to keep you as informed as we can as we all work to manage this crisis...."
 
*************************** 
April 30, 2020

TO: Executive Directors of Prepaid Inpatient Health Plans (PIHPs) and Community Mental Health Services Programs (CMHSPs)
 
FROM: Jeffery L. Wieferich, M.A., LLP, Director JW
Bureau of Community Based Services
Behavioral Health and Developmental Disabilities Administration

SUBJECT: Funding Information
 
[See the full letter here. It is missing its original formatting, but is the best I can do for now.]
 
Excerpt on pay increase:

Direct Care Wage Increase
The Direct Care Wage increase is intended to be effective from April 1, 2020 to June 30, 2020. [emphasis added] The increase does have limited funding and a limited scope of which workers are included. The behavioral health direct care workers impacted by this increase include those providing:

• Community Living Supports
• Overnight Health and Safety Supports
• Personal Care
• Prevocational Services
• Respite
• Skill Building.

There will be a Medicaid L-letter coming out shortly with this information.

The wage increase will be pushed out through the PIHPs in the same manner as the last two wage increases and funding will support the $2 an hour increase along with an additional 12% employer cost.

Please let us know if you have any questions.

cc: Allen Jansen

Abelone Kelley May 01, 2020 0

Delaware families lead the way for better pay and working conditions for caregivers

 

A Delaware advocacy group, Families Speaking Up , has been renamed A-Team Delaware, joining a national movement for choice in day and residential services.

From the Website:

"If you haven’t heard, Families Speaking Up has rebranded as A-Team Delaware. We are excited to be taking the grass-roots work we’ve been doing for the last several years statewide, with one chapter that meets in New Castle County and one that meets on the border between Kent and Sussex Counties. As one of the newest A-Teams in the United States, we have become a part of the national movement for choice in day and residential services. We would encourage you to visit ATeamUSA.net for more information about the other states that have joined this movement. Although our name has changed, our goals remain the same — to ensure that all voices are heard when policies are being made that affect people with intellectual and developmental disabilities and their families."

Delaware is experiencing the same crisis in caregiving for people with intellectual and developmental disabilities (I/DD) as the rest of the country. Low pay and poor working conditions for Direct Support Professionals (DSPs) have resulted in extreme difficulty in hiring qualified people as caregivers and rapid turnover of workers. Families and other advocates thought they had found a solution when legislation passed last year to fully fund the needs of I/DD adults:

"The McNesby Act passed unanimously in 2018, which promised full funding for adults with I/DD in the next three years. Direct Support Professionals are an endangered workforce in Delaware and often leave the jobs they love for higher paying jobs in other industries. It has reached crisis levels and the Joint Finance Committee only put a Band-Aid on the wound yesterday. 

 "Wearing our green shirts, we held our rally and sat in Legislative Hall during the FY 2020 budget markup for several days. Despite our best efforts, only $2.2 M was added to $1.8 M in the budget for a total of $4 M. Read this press release from the Ability Network of Delaware to learn more."

This disappointing turn of events was followed up by an opinion piece at Delaware Online by Micki Edelsohn, "Be fair to those who care for adults with intellectual disabilities", June 12, 2019: 

Although our son Robert has an intellectual disability due to a difficult birth, our goals for Robert were the same as our older son, Andrew: to get the best education, reach his potential and someday live in his own home, have a job and enjoy his community.

While Robert was still in school, we began our dream of raising the funds to build a group home where he could live with his peers, with staff support. In February 1990 a miracle happened: a chance meeting with Charlie Cawley, former CEO of MBNA America Bank. After learning of our plans, to our amazement and delight, he committed that MBNA fund the first group home and, in addition, hire the residents.

That initial home was the catalyst. We established a non-profit, Homes For Life Foundation and created a partnership. Homes For Life raised the funds and deeded the debt-free homes to the Arc of DE. State government then contracted with provider agencies to hire the direct support professionals (DSP’s) to support the residents.

It was a win-win for the families and for the state, now given affordable housing.

Thirty years later, Homes For Life has built 25 group homes and purchased two condos where 104 adults with intellectual/developmental disabilities (I/DD) live. One thing has become very clear, the home is worthless without the dedicated direct support professionals, whose job it is to provide the appropriate support needed.

But today, the State of Delaware has turned its back on the agencies that provide the workforce to care for the most vulnerable people in our society. DSPs have not been paid a living wage.

The state’s payments to these non-profits only support a wage of $9 an hour. One agency lost 95 percent of their DSPs last year due to low wages; another had a turnover rate of 87 percent, and the turnover rate for most agencies is around 50 percent a year.

Even the most effective business leader could not operate in an environment with a turnover of employees at such high levels.

In 2018, the Michael McNesby Full Funding for Adults with I/DD Act was passed unanimously by both houses of the General Assembly and signed into law with great fanfare by Governor Carney. The Act ensures that funding for services be brought up to levels recommended by the Department of Health and Social Services (DHSS), namely $42 million over the next three years.

Despite the need for $14 million dollars this year and the promise made, only $4 million is in this year’s budget.

Without properly paid direct support professionals, the residents cannot survive. The beautiful neighborhood homes will slowly disappear — homes worth millions of dollars, with contributions by hundreds and hundreds of donors (individuals, corporations and foundations) hoping to give a “home for life” to an adult with I/DD.

How can this happen? Gov. Carney and our legislators must fulfill their promise to fully fund the McNesby Act. The lives of our loved ones with I/DD are at stake.

**************************

Teaming up with a national movement for choice, green T-shirts, rallies, opinion pieces and letters to the editor and legislators, and a great big billboard advertising the cause ... This is a great example for other family advocacy groups to follow.

Micki and Lanny Edelsohn are founders of the Homes for Life Foundation in Wilmington Delaware.

Abelone Kelley July 10, 2019 0

Washtenaw County: Disability Town Hall on Impact of the Direct Care Worker Shortage on PWD

Saturday, June 15th, 2019, 10:30 a.m. - 12:30 p.m.

Washtenaw Community College

Morris Lawrence Building, Room 101

4800 E. Huron River Drive, Ann Arbor, MI

"Inadequate wages, tied to Medicaid funding, have created a Direct Care Worker shortage. Provider agencies cannot compete with other businesses that offer higher wages. People with disabilities rely on direct care workers for essential support services to access their communities. This is ours to fix."

Next steps? Actions to take?

Panelists: [State] Senator Jeff Irwin; [State] Representative Yousef Rabhi; Robert Stein - MALA; Laura De Palma - Caring Majority

RSVP appreciated: kgrant@communityalliance.com

Abelone Kelley May 27, 2019 0

Legislative Forum on the Direct Care Worker Crisis in Michigan

This announcement is from the CMHAM (Community Mental Health Association of Michigan) Weekly Update for March 29, 2019:

"Coalition Announces Legislative Forum on Michigan’s Direct Care Worker Crisis A group of statewide advocacy organizations, including the CMH Association of Michigan, is holding a legislative forum to highlight the state’s direct care worker crisis. The details of the event are provided below."

**********************************

LEGISLATIVE FORUM ABOUT THE DIRECT CARE WORKER CRISIS IN MICHIGAN!

WHEN: FRIDAY, APRIL 12, 2019, 8:30-10:00 AM

WHERE: IN THE GRAND ROOM OF THE KENT ISD EDUCATIONAL SERVICE CENTER

2930 Knapp St NE, Grand Rapids, MI 49525 PARKING IN LOT #11

WHY: 50,000 DIRECT CARE WORKERS ARE NEEDED TO PROVIDE CRUCIAL SUPPORTS AND SERVICES TO INDIVIDUALS WHO HAVE A MENTAL ILLNESS AND/OR DEVELOPMENTAL DISABILITY. THE COMMUNITY MENTAL HEALTH SYSTEM ALONE PROVIDES SERVICES TO APPROXIMATELY 300,000 MICHIGAN CONSTITUENTS. THIS SYSTEM DIRECTLY OR INDIRECTLY IMPACTS MORE THAN TWO MILLION MICHIGAN CITIZENS.

Inadequate wages, which are tied to Medicaid funding, have created a Direct Care Worker shortage. Turnover rates average 37%, and providers cannot compete with other businesses that offer higher wages, often with fewer work demands. People with disabilities who rely on direct care workers for essential supports are unable to access their communities, attend college, work and live full lives.

To RSVP and/or request more information or a reasonable accommodation, please contact Salli Christenson at 800 292-7851, ext. 130 or salli.c@arcmi.org

*********************************

Here are more CMHAM weekly updates

From the CMHAM Website: 

"The Community Mental Health Association of Michigan (CMHAM) is the state association representing the state’s public Community Mental Health (CMH) centers, the public Prepaid Inpatient Health Plans (PIHP) public health plans formed and governed by the CMH centers) and the providers within the CMH and PIHP provider networks..."

Abelone Kelley April 10, 2019 0

Michigan minimum wage increase and new paid sick leave requirements go into effect

These should help improve working conditions for Direct Support Professionals who work with people with disabilities, but they don’t go nearly far enough to stabilize the workforce. For people making more than minimum wage, the increase theoretically puts upward pressure on all low wage jobs.

The Michigan minimum wage has increased from $9.25/hour to $9.45/hour. An article form the Detroit Free Press, “Michigan paid sick leave changes: What to know about new law” by Micah Walker, 3/29/19, explains the new sick leave law.

These policies would have been more generous had the voters been allowed to vote on a proposed minimum wage increase and if a paid sick leave policy that was approved by voters had not been not been almost gutted during the lame duck legislature in December 2018.

“The paid sick leave law comes after activists gathered enough signatures to get the issue on the Nov. 6 ballot. However, instead of allowing it to go on the ballot, Republicans in the Legislature adopted the proposals in September and two days after the November election introduced bills to gut the laws they had passed just a few months earlier. If the proposals had gone to the ballot and passed by voters, it would have taken a three-fourths majority to amend the laws.”

The sick-leave law applies to workplaces with 50 or more employees, which includes full-time and some part-time employees with a lot of exemptions allowed.

Employees can take paid leave for:

• A physical or mental illness, injury, or health condition affecting themselves or a family member.
• Medical diagnosis, care, or treatment of themselves or a family member
• Preventive care for themselves or a family member
• If the employee or a family member is the victim of sexual assault or domestic violence
• For the closure of the employee's place of business by order of a public official
• To care for a child whose school or daycare has closed by a public official
• The employee's or a family member's exposure to a contagious disease
• To relocate
• To obtain legal services

The Act requires an employer to pay employees at a rate equal to or greater than the normal hourly wage, base wage, or minimum wage. The employer does not have to include overtime, vacation, bonuses, commissions, supplemental pay, price-rate pay or gratuities when calculating the pay rate. 

Read the article for more details.

Abelone Kelley March 30, 2019 0