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    • The Independent - Spring/Summer 2007

    • - The Independent - Autumn 2007
    • - The Independent - Spring 2008

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The Independent

1. Introduction from Deborah-Lisi-Baker
2. Editorials
   - Program Funds Adapted Telephone Equipment
   - What Is Community Worth And What Is It All About, Anyway?
3. COVE
4. VCDR
5. Food Resources
6. VCIL Voices
   - Are You Prepared For The Next Emergency?
   - PAC Gives Peers In The NEK A Reason To Celebrate
   - Chicago, The Experience
   - Thank You, VHCB!
   - Video Phones Provide Another Opportunity for the Deaf Community
   - For Joey Klein on His Birthday
   - Looking For Accessible Recreation And Sports Opportunities Or A Workshop On Wellness For People With Disabilities?
7. Second Spring
   - Second Spring´s Promise
   - Reflections On The Community Recovery Residence (CRR) In Williamstown
8. Assistive Technology
9. Living Well - check out the VCIL ReCycle catalog for used independent living equipment.
10. Disability Happens
11. Bulletin Board
    - Two Disability Organizations Merge
    - VCIL Invites You to Celebrate the 17th Year of the Americans with Disabilities Act

Editorials

COVE'S 2007 Legislative Report

• Choices for Care Waiver (H.537, sec,112(a)) - When Choices for Care was established more than a year and a half ago, the promise made was that any savings from reduced nursing home costs and other cost reductions were to be reinvested back into more and/or improved home and community-based waiver services.
  
  COVE and other advocacy groups strongly feel that this promise was broken in that $4.5 million of these savings were diverted this past year to meet unrelated budget pressures. Therefore, we worked hard this session and were successful in enacting a new statutory commitment that: 1) There would be no new applicants wait listed for CFC services in 2007 and 2) that the commissioner of the Department of Disability, Aging and Independent Living would make any future "savings" and "reinvestment" calculations/policy more transparent, so this dispute will hopefully not resurface in future years.
  
  The new statutory language we achieved is very good for the future of long-term care services. It will effectively assure that all future monies appropriated under Vermont's CFC long-term care waiver which remain unspent in any given year cannot be raided for other purposes, and will only be used for long-term care services. Furthermore, the monies can be used for a wider range of long-term services than just those covered under the CFC waiver, which heretofore did have a limiting effect on spending flexibility.
  
  Finally, it is important to note that the CFC appropriation approved by the Legislature for '08 is very healthy indeed. We believe, based on conversations with the administration, there is sufficient funding to avoid any recurrence of CFC waiting lists anytime during the next fiscal year, and hopefully beyond.
  
  
• Fuel Assistance; Raising the Asset Eligibility Test (H. 537, sec.142a) -- Vermont has historically had very healthy fuel assistance benefits which now are designed to cover approximately 62% of a low-income senior's bill. On the other hand, we have among the tightest eligibility levels in the country -- limiting access to those with incomes below 125% of poverty and who have virtually no liquid assets ($3,000). No state in New England has an asset test anywhere near this low, and the $3,000 figure has not even been adjusted for inflation in approximately 25 years.
  
  The result is that many low-income seniors, struggling to pay their fuel bills, and who have very small accounts saved for an emergency or for their final days or burial, cannot get any heating help whatsoever.
  
  Many VT programs including telephone lifeline, pharmacy, and even the newly established Catamount health care program (with an income threshold of 300% of poverty) do not have asset tests. COVE feels the time has come to raise or eliminate the asset/resource test for fuel assistance.
  
  While congressional delegations from northern tier states continue to push for at least level LIHEAP funding ($5.1 billion) out of Washington, as of now our sources say they are not hopeful. Thus, the likely impending cut in federal fuel assistance monies made our hoped-for asset eligibility expansion far more challenging.
  
  Nevertheless, the Legislature did approve raising the eligibility test from $3,000 to $5,000, which admittedly is far less than we had hoped (only a few hundred more households will gain eligibility). However, we were successful in adding language to the budget requiring the Agency of Human Services to study the possibilities and ramifications of raising the asset test further next year and beyond. So additional increases will be on the table for further discussion, once the study is finished next January.
  
  
• Medicaid '08 Budget -- Just a few short years ago the administration was sounding the alarm of a $500 million deficit in Vermont's Medicaid program by 2010. The new Global Commitment Medicaid Waiver, which allows the state to draw down federal funds on previously state only funded programs (e.g. homemaker services), coupled with decreased caseloads for people seeking Medicaid, have brought projected Medicaid deficits down to manageable levels. Indeed the final FY'08 had no proposed benefit cuts in Medicaid and indeed has some provider increases such as for dentists, hospitals, doctors, nursing homes, community-based LTC providers and will restore chiropractic service in FY '09.
  
  
• Aid to the Aged Blind and Disabled (AABD) -- The state of Vermont supplements with state dollars (around $60/month) the Supplementary Security Income (SSI) check that our poorest Vermonters receive as their basic monthly living allowance. Each year the SSI portion of the check (around $550/month) receives a cost of living adjustment (COLA) based upon inflation. The governor's 2008 budget, as have several past budget proposals, sought to effectively deny these seniors and the disabled a portion of their SSI COLA , by reducing the amount of their AABD state supplement -- a $200K cut overall. We opposed this and the Legislature restored the cut.
  
  
• Direct Care Workers Registry (H.537, sec.274(a) (3)) -- A voluntary Internet-based registry of direct care workers was proposed by COVE with the help of the Better Jobs Better Care grant, and was included in the interim recommendations of the legislatively established direct care worker study committee.
  
  Access to the registry would be free to those looking to hire a direct care worker. A question still to be decided is whether background checks will be provided for those on the registry and who will pay for those checks.
  
  The registry would be developed by an independent contractor who has experience in implementing such registries in other states, and was projected to require startup costs of $100K from the state budget. In subsequent years ongoing funding should be less than $40K per year.

VCDR's 2007 LEGISLATIVE SUMMARY

• H.526 Education Quality and Cost-Control: General education costs will be controlled by a cap. High spending districts can only exceed the cap via a two-step process, in which the cap is overridden by a second vote. Critics of the 11th-hour agreement object that legislators had little time to consider the bill and school budget growth is affected by factors over which districts have little control.
  
  Special education costs will be monitored via annual review by Department of Education (DOE), to identify high and low spending districts. Districts that cannot justify high spending must develop a remediation plan. If the commissioner determines satisfactory progress is not made after two years, 10 percent of the district's special education expenditures reimbursement will be withheld in the ensuing school year. Another 10 percent can be withheld each year if DOE judges satisfactory progress is not achieved.
  
  We are concerned for a number of reasons. (a) Support by a panel of experts to high-spending districts in the original version of the bill was removed. (b) There is nothing to ensure pressure to reduce special education costs does not result in less efficacious services. (c) Low spending districts are reviewed as possible models for other districts, but not to verify whether they meet all requirements of the Individuals with Disabilities Education Act. (d) Withholding of federal funding will require compensation by state funding. This may further exacerbate public perception of special education as the primary "drain" upon the property tax and increase pressures to cut corners in this area.
  
  A study will examine how the Agency of Human Services, DOE and the Department of Employment & Training should provide special education services and other human services-related services for elementary and secondary students. The Vermont Parent Information Center and VCDR are named among participants in this study, to be submitted by Nov. 1, 2007. Additional charges include a study on Medicaid-funded educational services and a report on fiscal requirements of state and federal mandates.
  
  
• H.534 Prekindergarten Education: The bill outlines a process for establishing voluntary pre-K programs through public schools, a formula to determine the number of children counted toward the school's average daily attendance (ADM), and places a limit on the number of ADM placements that qualify for state funding. Of importance to disability advocates, the bill does not compromise inclusion by limiting pre-K programs to "at-risk" children, as proposed last year. It specifies that all children receiving early essential services can be included in the ADM count. A study to be performed by DOE and the Department of Children & Families (DCF) on the impact of the program is due by Jan. 1, 2010.

• H.274 Adult Foster Care: The bill establishes equitable treatment of providers of child and adult foster care with respect to the homestead tax. Last year's legislation would have put a $6,500 cap on the exemption in 2008 taxes. The bill re-establishes and formalizes what has been practice over the years. The governor let the bill become law without his signature, but also indicated the administration hopes to reverse the decision.
• S.121 Relating to Autism Spectrum Disorders (ASD): AHS and DOE will develop a plan for a coordinated, lifelong system of care to address the needs of Vermonters with ASD. An important strength is the range of stakeholders with which AHS and DOE are instructed to collaborate on the plan. People with ASD and their families are to be represented across regions, diagnosis and severity of symptoms. Representation by family support organizations and professionals with established expertise in ASD is also specified. We appreciate the hard work of House and Senate Education Committee members and the unceasing advocacy of parents. The written plan is due to be presented to the governor and Legislature by Jan. 15, 2008.
• H:449 Transitional Youth: The first section of this bill extends supports to youth from 18 to 22 years aging out of foster care or who have recently left foster care. This will be beneficial to youth with disabilities in foster care who fall through the cracks for eligibility for Medicaid and other services. Participating youth are required to be employed or attend an educational or vocational program; youth with disabilities are exempted from this requirement.
  
  The bill also provides that there shall be no Medicaid prescription co-payments for young adults from age 18 to age 21.
  
  Additionally, the bill charges the Secretary of Administration, in consultation with AHS, the Department of Labor, the Department of Disabilities, Aging & Independent Living, the Department of Corrections, the Department for Children and Families, and DOE to study costs and benefits of providing transitional services to a youth up to 22 years who (a) has a functional developmental disability and has been receiving state-funded services or services under an individualized education program on or before the youth's 18th birthday; or (b) has been receiving state-funded services for severe emotional disturbance on or before his or her 18th birthday. Input from consumers, providers and representatives of disability advocacy organizations is to be summarized in the report, including the VT Developmental Disabilities Council, the VT Federation of Families for Children's Mental Health, and VCDR. Special thanks to members of the House Human Services Committee for their thoughtful work and persistent commitment to the needs of youth with disabilities.
  
  Initiatives not included in the bill were documented in a letter to the Secretary of AHS, calling for a comprehensive examination of the needs of the transition-age population. Among gaps cited in the letter are services to youth who meet a functional, but not categorical, definition of developmental disability and to youth with severe emotional disturbance who do not meet clinical eligibility criteria for youth for adult CRT services.
  
  
• H.137 Restoration of a Department of Mental Health and Commissioner of Mental Health: The bill establishes a Department of Mental Health and Mental Health commissioner. The department will be responsible for the Vermont State Hospital (VSH) and all other areas of children's and adults' mental health. Integration and coordination with the VT Department of Health (DVH) will be maintained and further developed under the new department.
• S.124 Planning and Evaluating Options for Inpatient Psychiatric Hospital Services (Vermont State Hospital): Concerns about progress and the extent to which options for replacing VSH have been adequately analyzed prompted appropriation of $100,000 for independent evaluation of the state's plan and alternatives, and the possibility of regaining certification and federal funding. A preliminary progress report is due by Sept. 1, 2007 and final report by Nov. 1, 2007. The governor allowed the bill to be enacted into law without his signature.
• S.128 Repeal of Sunset for Forensic Examinations at Designated Hospitals: A July 1, 2007, sunset for forensic evaluations at designated hospitals was repealed; assessments will continue to be performed at facilities across Vermont, and require that an individual be demonstrated to need treatment by a mental health professional and defendants who are not ordered to return to court or not in custody of the Department of Corrections be returned to the community.
• S.97 Correctional Facilities: A section that challenged the jurisdiction of the Human Rights Commission to investigate complaints of violation of Vermont's Public Accommodations Act was eliminated as the result of coordinated advocacy. Other parts of the bill direct attention to the needs of inmates with severe mental illness (SMI) and the possibility of broadening the SMI definition to extend superior protections to other groups with disabilities that similarly impact cognitive and behavioral function. The report is due on or before Jan. 15, 2008.

• S.7 Compassionate Use of Marijuana for Medical Purposes (Medical marijuana): The bill allows a greater range of seriously ill Vermonters to register to grow marijuana for relief of a disease, condition, or treatment that is chronic, debilitating, and produces severe, persistent and one or more intractable symptoms. It increases the allowable number of plants for personal use and lowers the annual registration fee. The governor has allowed the bill to become enacted into law without his signature.
• H.44 Patient Choice and Control at End of Life (Physician-assisted Death): In what was a surprising outcome to many, the House defeated a bill to allow physicians to prescribe a lethal dose of medication if requested by terminally ill patients with less than six months to live. As the bill was emotionally debated on the floor, an increasing number of legislators concluded that there were just too many unanswered questions to enact a law of such monumental significance and with irreversible consequences.
• S.115 Increasing Transparency of Prescription Drug Pricing and Information: The Office of Vermont Health Access (OVHA) will maintain a pharmacy best practices and cost control program, including an evidence-based preferred drug list, a utilization review board, and strategies for negotiating with pharmaceutical manufacturers to lower the cost of prescription drugs. A joint pharmaceuticals purchasing consortium will be offered on a voluntary basis to private insurers, with mandatory participation by state or publicly funded health programs by Jan. 1, 2008. It is not known what action the governor will take.
• H.531 An Act Relating to Ensuring Success in Health Care Reform and H.229 An Act Relating to Corrections and Clarifications to the Health Care Affordability Act of 2006 and Related Legislation: Coverage for Catamount and VHAP will be retroactive to the date of application rather than beginning on the date the application is processed. H.531 charges the commissioner of the Department for Children and Families with studying costs and benefits of providing similar date-of-application eligibility for beneficiaries of state-funded pharmacy programs. H.531 also sets goals for coordinating outreach activities to people eligible for Catamount and VT public health care programs.

• H.523 An Act Related to Moving Families out of Poverty: Vermont's Temporary Assistance to Needy Families (TANF/Reach Up) program provides benefits to very low-income families with children. Per federal law, the bill increases the number of Reach Up participants engaged in work activities. It also maintains state-funded programs that do not meet federal funding requirements.
  
  Of interest to parents with disabilities or parents of children with disabilities, H.523 creates Reach First, a new program that serves families when they initially apply for benefits to give assistance for up to 120 days. Reach First: a) emphasizes giving families orientation to available services and in-depth assessment of service needs before development of a family development plan and b) allows the state to set up state-funded programs that do not use federal TANF money for vulnerable groups, including families in which the parents have disabilities; families in which one or more child has a disability and in which a family member is considered a work-eligible individual; and families in which the parents or caretakers have an application pending for Supplemental Security Income.
  
  
• H.527 The State's Transportation Program: The bill adds $156,800 state and $43,200 federal one-time funds to the public transit Elders and Persons With Disabilities Program (E&D), for critical care transportation services not covered by Medicaid. Funds will be held in reserve by the Agency of Transportation and released only if shortfall occurs as a result of unanticipated need for critical care services. A study committee will develop recommendations for program stability and funding predictability. We appreciate the Legislature's responsiveness to need in this area, but are concerned that original objectives of the E&D Transportation Program have not received explicit attention; these have often been sacrificed to meet the demand for critical care transportation not covered by Medicaid.

• Sick Building Hazards: The commissioner of the Department of Buildings and General Services and the commissioner of the Department of Health will develop a protocol for identifying and addressing current and potential health hazards in state office buildings, due Jan. 15, 2008.
• Catamount Health Assistance; Global Commitment Waiver: Based upon response from the Centers for Medicare and Medicaid Services by July 31, 2007, the Commission on Health Care Reform may recommend to: a) proceed with all or some programs associated with Catamount Health, b) delay some or all programs, suspend new enrollment, or c) restrict eligibility to a lower income.
• Chiropractic Coverage: As of July 1, 2008, chiropractic coverage for adult beneficiaries in Medicaid and VHAP programs will be reinstated with rates comparable to payments to other health care providers.
• Dental: Most enacted dental initiatives are advantageous for consumers. However, an increase in provider rates was enacted without a simultaneous increase in the cap on the benefits adults on Medicaid receive. Thus, adults on Medicaid will now be eligible for fewer procedures/services per year.
• New Grievance and Appeal Rules for Global Commitment and Choices for Care: The Legislature will monitor implementation of rules, the number and types of grievances, internal appeals, appeals to the human services board, and the number of internal appeals that were reversed by an independent decision-maker.
• Choices for Care (CFC) Long-Term Care Waiver: Last year's Appropriations bill instructed that savings due to the implementation of the CFC waiver be reinvested in home- and community-based services. Advocates objected when AHS announced the transfer of approximately $1.8M in state funds to other areas of the budget in the Budget Adjustment Bill of FY'07. OVHA contended this was not savings, but an overestimate in the program's first year budget. Advocates countered that a portion of this "overage" resulted from keeping about 90 people on the waiting list for months, trimming services, and failure to invest in services consistent with the intention of the waiver. While the Legislature ultimately approved the transfer of funds, it sought to clarify what constitutes savings, ensure people are moved from the waiting list on a timely basis, and protect demonstrated savings against future diversion.DAIL will submit quarterly reports about utilization of services and expenses under CFC and a plan articulating the method for determining savings, how the savings will be reinvested, and numbers of people receiving each category of service. Unspent appropriated funds shall be carried over to the next fiscal year.
• Aid to the Aged, Blind and Disabled (AABD): Due to work of advocates, this is happily a "non-issue." The governor's budget included a cut to the Supplementary Security Income (SSI) annual cost of living adjustment to people with disabilities and seniors as part of their monthly payment. This would have pushed vulnerable Vermonters further into poverty; the Appropriations Committees rejected the cut.
• Substance Abuse & Co-occurring Disorders: VDH will convene a task force to identify current substance abuse treatment services and how they may be integrated for a community- and recovery-based system Jan. 15, 2008. In response to inadequate FY'07 funding to programs for youth with co-occurring disorders, VDH will ensure full funding for mental health and substance abuse services for eligible children, youth and adults, and CRT program participants. A report to the Legislature in January will identify spending to date and assess adequacy of funding to complete the fiscal year.
• Success Beyond Six: AHS and DOE will convene a summer study to the impact of fiscal caps under the Global Commitment upon Success Beyond Six, which has provided a means of funding school-based community mental health services through Medicaid billing.
• Developmental Services, Mental Health & Substance Abuse funding: This is the final year of a three-year administrative commitment to a 7.5% increase to the areas of Developmental Services, Mental Health, and Substance Abuse. As a result of a careful and cooperative process that maximized use of available resources, projected caseloads were covered and an increase given to providers. Special thanks to Commissioner of Finance Jim Reardon.
• Mental Health: An Advisory Council for Mental Health Services Transformation replaces the current Futures Advisory Committee and broadens the scope to include all mental health programs, services, and supports. Representation will include consumers and family members. A July 1, 2009, sunset is identified.Total appropriations in the VDH budget for the Vermont State Hospital in FY '08 are $20,861,837.
• Traumatic Brain Injury Study Committee: This study will include assessment of need for support by Vermonters affected by traumatic brain injury, stroke and substance-induced brain injury and analysis of insurance coverage for these conditions. VCDR applauds this initiative, but notes representation by advocacy groups and consumers is absent. We urge the study committee to invite full participation by these stakeholders. The report is due by Dec. 15, 2007.
• Home Access Program (HAP): DAIL, in cooperation with the Vermont Center for Independent Living, will report on the number of people with physical disabilities at significant risk of, or living in, nursing homes and other inappropriate settings, and the degree to which additional funding to HAP would allow individuals to live in the most integrated setting possible. HAP has been demonstrably under-funded for a number of years. As of January there was a three-year waiting list of 195 people; the cost of eliminating that waiting list was estimated at $1.5M. The report is due on Jan. 15, 2008.
• One-time Funding:
  - DAIL received $60,000 to establish a Caregiver Registry.
  - DOE received $400,000 to transfer to the DOC for its special education program.

Food Resources to End Hunger

• You can have money in the bank. You can have up to $3,000 in the bank and still get food stamps.
• You can get more food stamps each month if you receive fuel assistance. If you get fuel assistance, you can get more food stamps each month. Even if you live in subsidized housing or your heat is included in your rent, you may be able to get fuel assistance.
• You can get food stamps without going to the food stamp office. If you cannot get to the food stamp office and do not have a friend or family member who can go for you, you can talk to a worker on the phone or at your home instead of going to the food stamp office.
• Your food stamps can be deposited into a bank account. If everyone in your food stamp household is 65 or older or disabled, you do not have to use the food stamp card. Instead, you can get food stamps in the form of cash deposited right into your bank account. You can use cash or a check to buy food. If you do not have a bank account, you can get food stamps in the form of cash on the food stamp card.
• You can get more food stamps if you have monthly medical expenses. You may be able to get more food stamps each month if you have medical costs not covered by insurance. These costs will be deducted from your income and can help you get more food stamps. Medical costs are things like: over-the-counter medications, insurance premiums, medical supplies, dentures, prescriptions and a home health aide.
• You can get food stamps if you own a car and your home. You can own a car of any value and own your home and the land you live on and still get food stamps. These things will not be taken away from you if you apply for food stamps.
• You can save money in a PASS plan and get food stamps. If you get SSI and have a PASS plan, the money you save in your PASS plan does not count against you when you apply for food stamps.
• You do not have to reapply for food stamps as often as other people. If everyone in your food stamp household is 65 or older or has a disability, you will be able to get food stamps for 1-2 years before you will be asked to fill out another application.
• You can get help with your food stamp application at your local Area Agency on Aging if you are 60 or older; or Community Action Agency if you are person with a disability and under 60.

• Commodity Supplemental Food Program (CSFP). This program provides food to people 60 and older, pregnant and postpartum women who do not get WIC benefits, and children from age 5 to 6. Eligibility is based on income. Food packages are delivered to sites around the state, and participants pick up their food package. For more information and an application, call 800-214-4648. This is a free call.
• Serve New England.Serve New England is a food-buying program. Every month Serve participants can order frozen meats, vegetarian items, fresh fruits and vegetables, while saving about 30 percent off the retail price of these foods. Serve accepts food stamps to pay for food packages. Anyone who volunteers at least two hours per month anywhere in his or her community can participate. Volunteer service is "anything you do for someone else, outside of your immediate family, without pay," such as giving an elderly neighbor a ride to the doctor´s office, helping out at your local food pantry, or watching a neighbor´s kids while she works. For more information, check out Serve New England or call toll free, 1-888-742-7363.
• Eat For Health, A Program Of The Vermont Department Of Health
  
  If you're healthy and want to stay that way, do you know what to eat?
  
  If you're living with a health condition and want to feel better, do you know what to eat?
  
  Suggestions on what and how much to eat can be confusing, especially when you are hearing conflicting advice. Now there's a Web site sponsored by the Vermont Department of Health to help you find practical information you can trust on food and nutrition, healthy cooking, health eating and what makes a healthy diet: http://vermonthealth.gov/eatforhealth.

VCIL Voices

Second Spring

• Vision and hearing - for example, magnifying machines and assistive listening devices.
• Speech communication - for example, electronic augmentative communication devices.
• Learning, cognitive, developmental - for example, electronic organizers and specialized calculators.
• Mobility, seating and positioning - for example, walkers or power wheelchairs.
• Aids to daily living - for example, switch-adapted small appliances or multi-sensory alerting devices.
• Environmental adaptations - for example, lifts, lighting controls and ramps.
• Transportation and vehicle modifications - for example, modified vehicles, hand controls, or extended directional mirrors.
• Computers and computer-related - for example, alternative keyboards and mice, software and hardware that make computers accessible.
• Recreation, sports, and leisure - for example, mono skis and tandem bikes, switch adapted toys and games, musical instruments, and adapted hunting and fishing equipment.

Disability Happens

Bulletin Board