Newsletter
July, 2006
1. Please join us at our next statewide meeting on Saturday,July 15, 2006 from 10:30 - 2:30 at our regular location in the Lake Superior Room, Library of Michigan, 717 West Allegan, Lansing. (And please plan to join us at the same time at our next meetings on Saturday, September 16, 2006 and Saturday, November 18, 2006. Please note the September and November meetings will be held at a new location in the offices of the Michigan Quality Community Care Council, 1115 South Pennsylvania, Suite 203, Lansing, MI 48912. Directions will be included in the next newsletter.). New members always welcome!
2. State announces selection of four Single Point of Entry sites in the state; Single Point of Entry legislation faces significant opposition and delays in the state House of Representatives--In June, the state selected four Long Term Care Single Point of Entry (SPE) demonstration sites which are to begin operation no later than October 1, 2006. SPEs, which will be located in Detroit, Western Michigan, Southwestern Michigan, and the Upper Peninsula, are designed to be a single regional agency to which consumers can go to obtain information about long term care options, be assessed for all available programs, and receive assistance developing a person centered plan. SPEs were a key recommendation of the Governor’s Long Term Care Task Force when it issued its final report last summer. The Task Force envisioned that all regions of the state would be served by SPEs within three years.
According to the Michigan Department of Community Health (MDCH), the four demonstration sites encompass almost half of the state’s current Long Term Care Medicaid population and incorporate 36of the state’s 83 counties. In addition to these initial SPE awards, regional areas that will not have one of the demonstration projects now will receive planning grants from the state to help them obtain SPEs in the future.
Advocates favor SPEs because they are designed to give consumers more information, choice and control. SPEs already operating in many other states appear to be both cost-effective and consumer friendly.
Hospitals and other Medicaid providers in the regions in which the demonstration projects exist will be required by the state to make mandatory referrals of potential long term care clients to the SPEs. However, at least until SPEs are available statewide, both Medicaid consumers and consumers with other sources of payment will be able to choose whether or not to use them.
One of the major advantages of the SPE was intended to be that consumers would have real choice in the services and supports they received. While it is likely that many eligible consumers who use the SPE will want to choose MIChoice Home and Community Based Services over nursing home placement, it is unlikely that all consumers who select MiChoice will be able to obtain those services immediately. The availability of MiChoice services will depend on a number of factors including budget negotiations in the state legislature, internal decisions made by state health and budget officials, and criteria the state is likely to develop that will give consumers in the community who are at imminent risk of nursing home placement priority in obtaining MiChoice slots. The state will also continue to encourage nursing home residents to transition into the community and those individuals may also utilize the SPE to assist them in that process or seek assistance from ombudsman staff, MiChoice agencies, and local Centers for Independent Living.
At the same time that state is going ahead with the demonstration sites, legislation concerning SPEs is stalled in the legislature. HB 5389, which was introduced by Rep. Rick Shaffer with a remarkable 41 co-sponsors, would require the state to establish and maintain SPEs across the state. An amended version of the bill passed the House Senior Health, Security and Retirement Committee unanimously. However, the bill is being opposed by the nursing home industry and the hospital association. As a result, House leadership has so far refused to schedule the bill for a vote on the floor of the House. A wide array of aging and disability rights groups have worked hard to move the legislation forward and the Long Term Care Supports and Services Advisory Commission recently voted in support of the bill.
The Michigan Campaign for Quality Care has advocated for consumer friendly and effective SPEs with the Granholm Administration, the Governor’s Long Term Care Task Force, the Long Term Care Supports and Services Advisory Commission, and the legislature and will continue to do so.
Advocacy Homework!! – Call, write or email your state representative and tell him or her that consumers support the Single Point of Entry legislation (HB 5389) and want the House leadership to allow it to come up for a vote on the House Floor! For more information, see our website at www.campaignforqualitycare.org and click on "Action Alert."
3. Campaign and State Long Term Care Ombudsman meet with state officials to discuss problems with complaint investigations of nursing homes and enforcement of state and federal requirements in nursing homes – In June, Campaign statewide organizer Alison Hirschel and State Long Term Care Ombudsman Sarah Slocum, along with disability rights activist Dohn Hoyle, met with Janet Olszewski, the director of the Michigan Department of Community Health, and other state officials to discuss longstanding and critical problems with the state’s system of investigating nursing home complaints and sanctioning nursing homes that fail to meet state and federal requirements. The meeting resulted from a very lengthy and detailed letter Alison and Sarah wrote to Ms. Olszewski in the spring which gave specific examples of problems like serious complaints not being investigated for months, state surveyors being unwilling to substantiate complaints unless they observed the violations personally despite eye witness reports and documentation by the people who filed the complaints, complaints about serious issues being downgraded to lesser offenses, a lack of opportunities for consumers to provide in-put on nursing home regulatory issues, etc. Subsequently, Alison and Sarah wrote to Ms. Olszewski again and other advocacy organizations joined in the letter requesting a meeting.
At the meeting, Ms. Olszewski agreed to have her staff develop regular opportunities for consumers to provide in-put on these issues and to look into providing funding for a mediation program to respond to less serious complaints. After a discussion concerning the fact that there are only a handful of complaint investigators to respond to several thousand complaints this year, Ms. Olszewski noted that the Bureau of Health Systems would be adding several additional complaint investigators but that the state’s budget situation made it impossible to hire as many investigators as would be required to respond to all complaints promptly. She also encouraged consumers to continue to raise these issues with legislators and the media and to support the state’s efforts to ensure nursing homes provide quality care. The Campaign and the State Ombudsman program will continue to talk to state officials about these important issues and to press for more extensive solutions.
Advocacy Homework – Tell your elected officials if you have a serious complaint about a nursing home to which you have not received a prompt and effective response. Ask them to ensure the state hires enough complaint investigators to handle the thousands of complaints the state receives each year. And let us know (hirschel@umich.edu or 517-324-5754) if you want to participate in consumer groups that meet with the state to address concerns about quality of care in nursing homes. We need to hear your stories and suggestions and show the Administration and the legislature that these issues matter to consumers and voters!
4. New federal law will require all citizens who are Medicaid recipients or applicants to provide proof of citizenship and identity; advocates fear that many long term care consumers will have difficulty providing necessary documentation– The federal Deficit Reduction Act requires states to obtain documentation of citizenship and identity for all citizens of the United States who apply for Medicaid or seek annual redetermination of Medicaid eligibility. Although the law is supposed to be effective on July 1, 2006, Michigan, like many states, is unprepared to comply with this burdensome and harmful provision and will not begin implementing it until September 1st or later.
The provision is likely to cause grave harm and injustice to many citizens who need and are eligible for Medicaid but who, for a variety of reasons, are unable to produce necessary documentation. Those who are most likely to be adversely affected by the new requirement include citizens who have dementia or other disabilities; low income older adults who never had birth certificates, passports, or other evidence of citizenship; disaster victims who have lost important documents; and homeless persons.
Although the federal government issued guidelines for implementing the new policy to states on June 9th, states remain confused about many issues. The guidelines create four levels of acceptable documentation that states must use in verifying an applicant’s or recipient’s citizenship status. Only if applicants or recipients demonstrate that they cannot obtain documents such as a passport or birth certificate can the state accept less reliable evidence of citizenship. If individuals are unable to produce any of the forms of documentation described in the guidelines, and only in the rarest circumstances, they may rely on an affidavit from at least two people, at least one of whom is not related to the individual, who have personal knowledge of the applicant’s or recipient’s citizenship. Current recipients will be given a "reasonable opportunity" to obtain proof of citizenship and their benefits cannot be terminated as long as they are deemed to be making a good faith effort to provide the necessary information. New applicants will not be able to get Medicaid coverage until they have provided acceptable proof of citizenship. This requirement will not have any effect on legal aliens who are eligible for or receive Medicaid.
The Michigan Campaign for Quality Care and other advocates are working closely with the state to ensure the provision does as little harm to vulnerable consumers as possible. We have already met on several occasions with state officials and will be consulted as the state develops its new policy. In anticipation of the new requirement, consumers and their families can start attempting to obtain evidence of Medicaid recipients’ or applicants’ citizenship. If you have questions about this issue, or if you are willing to share stories of how long term care consumers will be harmed by this requirement, please contact Alison Hirschel at (517) 324-5754 or hirschel@umich.edu.
5. Mike Head Named Director of the Office of Long Term Care Supports and Services – After months of delay, Michigan Department of Community Health (MDCH) Director Janet Olszewski has named Michael J. Head as the Director of the new Office of Long Term Care Supports and Services. This office is responsible for implementing the recommendations of the Governor’s Medicaid Long Term Care Task Force and overseeing long term care reform in the state. Mike has more than 30 years experience in the mental health and human services fields and has particular expertise in Medicaid. Since 2003, he has been in charge of several federal grants which support critical programs to reform Michigan’s long term care system. Alison Hirschel, the Campaign’s statewide coordinator, served as a member of the interview committee for this important position. She and other advocates will be meeting with him frequently to discuss long term care. The Campaign wishes Mike well in his new and important position!
The Governor’s 17 member Elder Abuse Task Force is preparing to conclude its work with a final report and 58 recommendations in six categories concerning:
1. Enhancing public awareness, oversight, and accountability
2. Preventing physical abuse, psychological abuse, and neglect
3. Preventing financial exploitation
4. Successfully reporting abuse
5. Effectively Investigating abuse
6. Aggressively prosecuting abusers
The Task Force will classify each recommendation as an urgent, important, or long term goal. The draft recommendations are available at http://www.miseniors.net/NR/rdonlyres/0E5BFE7E-BD49-4088-BF87-82A36BD83E11/0/ElderAbuseTFRecomm.pdf and these recommendations should be updated in the near future.