January 11, 2021
Minutes
Minutes
Attendees via Zoom: Frederick Murphy, Barry Schklair, Heidi Mansir, Julie Brennan, Kate Simson, Lorraine Defreitas, Meagan Mayo, Sarah Robinson, Dan Bonner, Bonnie Robinson, Debbie Dionne, Robin Levesque, Teague Morris, Beth Morse, Sue Murphy, Staci Converse, Mark Kemmerle, Craig Patterson, Betsy Hopkins, Lily Lin, Sharlene Adams, Sierra Hillebrand, Anne Marie Riley, Helen Hemminger, Charlotte Kerkmann Brewington, Jessica Cavanaugh, Brenda Smith, Peter Stuckey, Teresa Barrows, Ed & Suellen Doggett, Amanda Hodgkins, Nancy Peavy, Margaret Cardoza, Laura Cordes, Beth Mylroie, Jessie Greenbaum, Kim Humphrey, Rachel Dyer, Ray Nagel, Andy Taranko, Stephanie Hatcher, Paula Bush, David Cowing, Bryan Gordon, Robert & Luann Lawler, Vickey Rand, Cullen Ryan, and a few people who joined the meeting in progress and left prior to its conclusion.
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speaker: Frederick Murphy III, State & Federal Health Adviser, Market Place Insurance Agency, LLC. MarketPlaceInsAgency.com Topic: An overview of Medicaid, Medicare, Medicare Advantage Plans, and Special Needs Plans (SNPs), including the differences between the various insurance options.
Cullen: Today we have Frederick Murph, State and Federal Health Adviser with Market Place Insurance Agency, LLC presenting an overview of Medicaid, Medicare, Medicare Advantage Plans and Special Needs Plans (SNPs), including the differences between the various insurance options and the additional benefits provided through SNPs. Fred has a rich PowerPoint that I had the pleasure of viewing prior to this meeting. I believe it will be very informative for this group. Thank you for being here, Fred!
Frederick Murphy: Thanks for having me here today. I’ve been doing this work for around 12 years now. I’ll go over the presentation, with the hope of informing everyone of options, including Special Needs Plans (SNPs) and Dual Eligible Special needs Plans (D-SNPs), among others.
Begin Presentation (Click here for the presentation)
Cullen: It appears that qualifying for and being enrolled in Medicare Parts A and B is a requirement for these additional plans. Can you tell us a little more about the eligibility requirements for Medicare Part A and Part B?
Fred: For Medicare Part A you have to have worked a certain number of hours in your lifetime to qualify. Once you meet Medicare Part A eligibility, you can then be enrolled in Part B. You have to have both to enroll in an Advantage Plan, an SNP, D-SNP, etc. Some people have never worked in their lifetime, which will exclude them from Medicare Part A eligibility and as such exclude them from Advantage Plans, SNPs, D-SNPs, etc. If you’re on Disability for a minimum of two years you can apply for Medicare, so there is no age requirement for Medicare this group of people.
Discussion:
-A parent stated that his son is permanently disabled as the result of a genetic abnormality at birth. However, he discovered when his son’s biological father, with whom they had no contact for decades, went on Medicare their son was then eligible for and enrolled in Medicare. This adds an interesting layer to Medicare eligibility. It was stated that children who are disabled before the age of 22 are eligible for SSDI once a parent (or possibly a grandparent) retires on social security. Once this “adult disabled child” has been on SSDI for 24 consecutive months the person is eligible for Medicare.
-It was asked when you have Medicare, Medicaid, and other insurance such as an SNP, which acts as the primary payer, the secondary payer, the payer of last resort, etc.
Fred: It starts with the Medicare company, the company you’re working with for your SNP. All your benefits go through your member ID with the SNP company. Then, it goes to Medicare and from that point MaineCare picks up the rest. Medicaid is always the payer of last resort. With each of these companies the contracts for SNPs with the state are very strict. For example, Aetna has been in the state forever and they’re just getting a contract for SNPs now. Billing always starts with the actual Medicare company.
-A parent stated that his daughter is on Medicare and MaineCare. She sees a doctor at Martin’s Point. She is not enrolled in an SNP or Advantage Plan. Martin’s Point would like to enroll her in their Advantage Plan. However, they don’t have an SNP, except for diabetes. It was asked if it is advantageous to consider her enrollment in the Martin’s Point Advantage Plan.
Fred: It depends where in the state you’re living. Generally, people who go to Martin’s Point use Martin’s Point’s Advantage Plan. However, Blue Cross & Blue Shield SNPs and Aetna SNPs also works with Martin’s Point. You don’t have to enroll in Martin’s Point’s Advantage Plan to receive care from Martin’s Point. There’s a lot more money and benefits included in an SNP versus a regular Advantage Plan. You don’t pay for anything for the SNP. The SNP coverage is paid for by Medicare and MaineCare. It’s just additional money and benefits given to these individuals to help them out. I have personally enrolled people into Advantage Plans who are dual eligible, because for whatever reason that plan was the best fit for those people. MaineCare will pick up all those charges. If it shows on the plan a PCP visit is a $10 co-pay, that’s wiped out because MaineCare picks up those charges. MaineCare will pick up charges, such as specialty care co-pays, out-patient hospital visits, etc. Out of pocket costs are zeroed out depending on MaineCare eligibility. Advantage Plans overall generally cover less and provide fewer benefits than SNPs and D-SNPs. In southern Maine you have Aetna and Blue Cross & Blue Shield for SNP plan administrators.
Craig Patterson – DHHS/OADS: Do you have other staff working with you to assist people in person? I ask because the state has the Maine State Health Insurance Assistance Program (SHIP) and health insurance counselors that can assist people to explore Medicare Advantage Plans and SNPs. All of our Area Agencies on Aging provide this service. (to learn more contact your local Aging & Disability Resource Center by calling 1-877-353-3771 or by visiting the ADRC webpage).
Fred: Yes, I have a whole team. I’m actually working with the northern region of DHHS. They are compiling their clients and people from nursing homes and so forth to provide an evaluation even if they’re on a current plan, to see if they’re eligible for additional benefits on SNPs etc. We do have a full team and travel all over the state.
Cullen: Craig, if you could send me an email with the information on DHHS staff that provide this assistance, we can include that in the minutes so people will know all of their options. (Click here for the Maine State Health Insurance Assistance Program and Medicare Assistance section of the OADS website; click here for the State’s website on Maine’s Area Agencies on Aging; click here for the Maine Association of Area Agencies on Aging website.)
Fred: Right now, January 1st through March 31st, the first quarter of the year, is considered the open enrollment period. You’re eligible to enroll in an SNP during open enrollment. April 1st begins the next quarter. If someone is in an SNP and has discovered that it isn’t the right fit and a better SNP would be more advantageous, they can change plans every quarter of the year except the last quarter of the year (the 90 days leading up to January 1st).
-A parent stated that Fred walked him and his wife through all of this information for their son and he was incredibly helpful. It involved a last-minute plan switch in order to cover out-of-state medical care. Fred was invaluable throughout the entire process.
-A self-advocate stated that she is concerned that the contracted plan provider, the third-party insurance company, which is necessary for a SNP etc., is most likely a for-profit arrangement.
Fred: Are you talking about profit from the SNPs? All of these SNPs involve contracts with states. The federal government provides these companies a lump sum of money every year. When they have a contract with the state for SNPs, they can use that money for the plans to provide additional benefits to help them out in addition to what they’re not receiving. If they don’t use the federal money, they have to return it to the federal government at the end of the year. These companies make by through the government reimbursing them up to $1,000 per person when they sign an individual up for a plan. For instance, WellCare for people on MaineCare, the state has a contract with them for prescription drug coverage. States may have contracts with providers, but it doesn’t mean that just because someone is placed in a plan it’s the plan in which they must remain. People have options to go other routes.
-A self-advocate stated that people with ID/DD have historically been exploited. If someone is making a profit due to someone’s disability it can become problematic, and an opportunity for exploitation.
Fred: It doesn’t matter if it’s a for profit or non-profit, the companies will make money. There is no charge to the individual, and the government provides lump sums to companies in order to cover these additional benefits to which people would otherwise not have access. These plans were created not for Medicare companies to profit, but to use the money provided by the federal government to provide benefits people are not getting from the state.
-A special education teacher stated that this information is invaluable. It was asked when parents ask questions about the timeline for these benefits what the best answer would be.
Fred: After a two-year period of time on Disability they are eligible for Medicare. The first thing I would ask is if their child has been on Disability for more than two years. If so, I would recommend they call Medicare services and get them enrolled in Medicare. Then once they are on Medicare, have them look into SNP and D-SNP eligibility. This would help out the family as well as the individual.
Cullen: If people have additional questions, you can contact Fred ([email protected]), or look into the state resources Craig provided. Thank you for being here and explaining such complicated but important information, opening many people’s eyes to additional resources for the people about whom they care. Thank you again, Fred!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). meacsp.org Topic: 130th Legislature – Legislative agenda and priorities for the system of care for people with ID/DD.
Cullen: Today we have Laura Cordes, Executive Director with MACSP (Maine Association for Community Service Providers), discussing the 130th Legislature, including the Legislative agenda, bills to watch, and priorities for the system of care for people with ID/DD.
Laura Cordes – MACSP (Maine Association for Community Service Providers): I am happy to share the latest on what’s happening in the 130th Legislature. MACSP is the Maine Association for Community Service Providers. MACSP is an association of organizations that provide supports and services to children and adults with intellectual and developmental disabilities in Maine. The mission of MACSP is to represent individuals and organizations that support persons with disabilities to live, learn, and work in the community of their choice through legislative action, organizational advocacy, training, and public education. This work includes a lot of advocacy at the Legislature. On Friday, the Governor released her Biennial Budget. It came along with positive news – the growing deficit folks were aware of is looking to be less than what was originally forecasted. This news also means that there may be less of a likelihood of cuts in the Supplemental Budget for the current fiscal year, as well as the Biennial Budget (which begins 7/1/21). It also appears to include some MaineCare rate increases.
First, I wanted to share a link to the Governor’s Biennial Budget Request press release. I also wanted to share a list of bill titles that have been submitted, as well as the process through which this all will move. We don’t have bill language yet, but the requests filed provide a general idea of bills that could affect the ID/DD community, so we can have them on our radar, and weigh in on them as applicable. (Click here the information Laura covered, including information from the Governor’s Biennial Budget, bill titles, bill sponsors, links, etc.)
Laura: It appears that the Governor’s Biennial Budget Proposal is quite promising for the ID/DD community. It’s a long road between now and the end of the session when the Legislature will adopt the Biennial Budget, and the Supplemental Budget for the rest of the fiscal year, but it is definitely promising.
-It was stated that DSP pay has been prioritized in order to attain and retain qualified staff to provide services to people with ID/DD. It was asked is the Budget includes rate increases for DSPs.
Laura: That’s a great question. This is certainly one of MACSP’s top priorities. MACSP is asking the state for emergency rate increases or a DSP stabilization fund in the Supplemental Budget. The DSP rate is $11.21/hour, almost a full dollar behind the increase to minimum wage. We’re looking at the details in the Biennial Budget to see if DSP rate increases are included as it is absolutely essential. As far as the bills, I looked at all of the bill titles and captured any that could pertain to the ID/DD community (see the link above for more information on these bill titles). When the bills are filed, they will come out of the revisor’s office with LD numbers, and at that point the bill text will be available. This will likely happen by the end of the month. In the document I highlighted bill titles of special interest, which we will be following closely. Including LR 887, An Act To Give Direct Service Providers Hazard Pay and To Pay Additional Pandemic Costs, and LR 1036, An Act To Eliminate the Waiting List for Older and Disabled Residents Who Are Eligible To Receive Home-Based Care. We did have a 10% rate increase for DSPs with the State’s K Waiver, through May, but that was very short lived. So, we’re looking to bring this back either in the Supplemental Budget, or through legislation. There was an enormous effort by allies and DSPs, regarding the bill to implement the Long-Term Care Workforce Commission recommendations last Legislative session; the bill has been resubmitted in this Legislature (LR 440). We know the pandemic has certainly compounded the DSP crisis. The Portland wage ordinance, requiring a time and a half emergency wage throughout the pandemic has been a significant challenge for service provision. Providers are challenged to continue to provide services in Portland due to this without any corresponding rate increases. LR 1821, An Act To Require a Municipality That Raises the Minimum Wage within That Municipality To Be Financially Responsible for an Increase in MaineCare Rates Caused by the Increase in the Minimum Wage, might help address this. There are numerous other bills pertaining to the rates and minimum wage. Included in the Governor’s Biennial Budget is establishing a mortality review panel for the ID/DD community, with LR 919, An Act To Enhance and Improve the Maine Developmental Services Oversight and Advisory Board and To Establish the Aging and Disability Mortality Review Panel (OAB), also addressing this.
There are a few MACSP priorities that may also be of concern to this group. LR 566, Resolve, Relating to Rule-making Authority To Ensure Continued Services for Children with Disabilities, relates to the MaineCare Section 106 proposed rule last year that had many positive pieces to it but would have negatively affected 3-5-year old’s in pre-schools. That rule was pulled, but Rep. Meyer moved forward, submitting a bill which would require anything that would come up around the 3-5-year-old population a major substantive rule. This would ensure the many moving parts pertaining to this age group (as well as the findings in the Public Consulting Group report) aren’t overlooked. LR 1677, An Act To Ensure Supports for Adults with Intellectual Disabilities or Autism with High Behavior Need, stems from a bill that passed in 2019. That bill, LD 1486, passed in 2019 and asked the Department to look at its crisis service system and study how they could support a rate to help people with high behavioral needs. This bill also asked the Department to look at rules pertaining to this. The report was ultimately released, in September of 2020, after the last Legislature adjourned. MaineCare went ahead with rules around this, though the rules were posted to a different Office, which made them more difficult to know about and find. The hearing regarding these rules was this fall and everything largely pertained to crisis services, not rates to address people with high behavioral needs. We’re happy that Rep. Meyer has introduced LR 1677 to ensure the that the rates for people with high behavioral needs does not drop off the radar. I also want to reference Rep. Millett’s bill, LR 1383, An Act To Appropriate Funds to Eliminate Waiting Lists for Home and Community-based Services for Adults with Intellectual Disabilities, Autism, Brain Injury and Other Related Conditions, which would eliminate the waitlists. Betsy Mahoney might be able to discuss LR 828, An Act To Keep All Maine Students Safe by Restricting the Use of Seclusion and Restraint in Schools.
Betsy Mahoney – Autism Society of Maine: One of our high priority items this year is Rep. Millet’s bill, LR 828. This is a very important issue and was included in a bill that passed last session but because it had a fiscal note died on the Special Appropriations Table, as did many other bills. The Coalition Against Restraint and Seclusion decided to file a stripped-down version of the bill in this Legislative session. We’re hoping to get the bill through this year, since it had great support last session and now does not have a fiscal note. Since the last Legislative session ended prematurely due to the pandemic, many duplicate bills that didn’t make it fully through the legislative process have been resubmitted this session.
-A parent stated that a number of people in this group have developed a first draft of a Legislative agenda – at least the bills submitted that could affect the ID/DD community. Targeted advocacy, and speaking with one unified voice, can have a lot of power. It was asked if a small subgroup could meet to go over these bills, collaborate with each other, determine the top handful of priorities behind which we could put all of our energy. This might be an efficient, effective strategy.
Laura: I think hearing what people are prioritizing, finding common ground, collaborating where we can, and combining our grassroot support is invaluable.
Betsy Mahoney: I would be more than happy to participate in a meeting regarding this, to develop an overall focus, identify leads for bills, etc.
Andy Taranko: We have to remember that these are just LRs, and many of them are duplicates. There are five or six bills pertaining to the Long-Term Care Workforce Commission, for instance. Bill titles are just one sentence describing intent. I would bet there will be movement behind the scenes before bills are printed to combine bills. There are also other items on the agenda, such as COVID and the economy. There are two years in each Legislature. They may move some of these bills to the next session of the 130th Legislature, because 1,800 bills, and the pandemic and the Biennial Budget is a very full plate for one session.
Cullen: People have offered to meet regarding determining legislative priorities. There would be time at the February meeting to continue this discussion as well, at which time we will hopefully have LD numbers and formal pieces of legislation. We will get much better intel in the next month or so, I presume. I suspect a working group in-between meetings will be helpful as well. If you are interested in participating, please email me and I will send out a group email to coordinate when this can occur.
Betsy Mahoney: It will be more of a challenge to do some of this advocacy from a distance. We will have to work harder to share information outside of the halls of the Capitol.
Laura: I’m happy to keep updating this document and have coordinated support behind these legislative efforts.
Cullen: Thank you, Laura, for all of this information. It’s certainly good news about the budget and it appears to be a promising list of bills. Thank you for taking the time to digest this and put it out into an understandable format. Well done!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkin – Associate Director, DHHS-OADS Disability Services: Regarding the budget, I think OADS Disability services did well in the Biennial Budget, such as adding 30 Section 29 slots per month, which will occur in the next biennium. It will not eliminate the Section 29 waitlist completely, but it will keep it fairly low, if it goes through. Also included in the budget, due in large part to the enormous advocacy by many in this group, is a public health nurse position to oversee the Mortality Review Panel. I hope it stays in the budget moving forward. There are rate increases proposed for Section 21 and Section 29, averaging out to $30 million per year in rate increases. The plan is to try to bring the rates up to at least reflect the current minimum wage, and so there’s consistency across the programs. It’s a bridge. We understand it will not meet all the needs completely, but we feel it’s a good start to the conversation. So, we’re excited about that. There will be a lot more information to share about this moving forward.
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa barrows: We’re working on the Transition Age Youth Roadmap strategy. Amanda Hodgkins has been working closely with OADS, taking all of your information and feedback and including it in our roadmap. One of the large gaps identified appears to be children’s case managers not understanding how to do referrals. We’re in the middle of working on a survey which will go out to case managers asking what information they would find most helpful. This will lead to trainings, and perhaps the development of a resources page. The overall Transition Age Youth Roadmap strategy is a massive undertaking and will take a while to fully implement.
-A self-advocate asked if there will be people with disabilities assisting with the survey. Having initiatives be inclusive of the voice of someone with ID/DD always betters the final outcome.
Teresa: That’s a very good point, which we will take into consideration. The survey is for the case management organizations, but you’re absolutely correct, it’s an important piece for us to consider, so thank you.
-A special educator stated that involving special educators, who are on the front lines with families, is imperative as well.
Cullen: Thank you for being here, Teresa, and continuing to provide updates on transition as that work progresses.
Special Education
The Public Consulting Group final phase II report “Maine Early Childhood Special Education Implementation Plan,” is now available on the Legislature’s website.
SMACT (Southern Maine Advisory Council on Transition)
SMACT meetings occur on the first Friday of each month, currently via Zoom. As a reminder, if you want to be on the email list feel free to email me ([email protected]).
Disability Rights Maine (DRM) Update:
Staci Converse: A lot of our advocacy has involved working with people on individual issues. For instance, if people are encountering instances where hospitals are not allowing visitors etc., please let us know because ADA regulations do not go away just because we’re in a pandemic. We’re also doing a series of trainings with SUFU (Speaking Up For Us), including a webinar on 1/15 on Supported Decision-Making. (Click here for DRM’s website, scroll down and events are on the right.)
Federal & Housing Updates:
Cullen: Senators Collins and King worked extremely hard, and did a remarkable job, at the end of December, for which they ought to be thanked. They both worked tirelessly, to not only pass the Coronavirus Relief Package, but also an omnibus FY 21 spending bill which provides significant increases to many areas, including HUD. These bills were well-crafted, bettered by both our Senators with both leading the effort to pass these critical funding bills. We have two heroic senators who have demonstrated outstanding leadership and have been champions for vulnerable populations in Maine.
Kate Simson – Senator Collins Office: It’s been a brief intermission, but I’m back in Senator Collins’ office in Portland, and very happy to be here today. You can feel free to reach me via email at any time: [email protected]
Below is the Federal Budget and Housing Update:
On 12/27 the President signed a package passed by Congress which included a $1.4 trillion FY 21 omnibus spending bill, funding the government through 9/30/21, and a bipartisan $900+ billion economic relief bill. In the FY 21 omnibus spending bill HUD received $49.6 billion - more than $12.4 billion above the president’s request, and $561 million above FY20 enacted levels. It largely funds HUD programs at or above levels proposed by the Senate in November, though not as high as levels proposed by the House. The spending bill likely provides enough funding to renew all existing voucher contracts for rental assistance. Beyond rental assistance, the spending bill provides level funding or moderate increases to all programs. The economic relief bill signed into law will provide:
State Legislature Update:
Laura Cordes – MACSP (Maine Association for Community Service Providers): No further updates were provided.
The next meeting will be on Monday, February 8, 2021, 12-2pm, via Zoom.
Featured Speakers: Rachel Dyer, Associate Director, Maine Developmental Disabilities Council, and Monique Stairs, Executive Director, SUFU. Topic: Person Centered Planning.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2021 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speaker: Frederick Murphy III, State & Federal Health Adviser, Market Place Insurance Agency, LLC. MarketPlaceInsAgency.com Topic: An overview of Medicaid, Medicare, Medicare Advantage Plans, and Special Needs Plans (SNPs), including the differences between the various insurance options.
Cullen: Today we have Frederick Murph, State and Federal Health Adviser with Market Place Insurance Agency, LLC presenting an overview of Medicaid, Medicare, Medicare Advantage Plans and Special Needs Plans (SNPs), including the differences between the various insurance options and the additional benefits provided through SNPs. Fred has a rich PowerPoint that I had the pleasure of viewing prior to this meeting. I believe it will be very informative for this group. Thank you for being here, Fred!
Frederick Murphy: Thanks for having me here today. I’ve been doing this work for around 12 years now. I’ll go over the presentation, with the hope of informing everyone of options, including Special Needs Plans (SNPs) and Dual Eligible Special needs Plans (D-SNPs), among others.
Begin Presentation (Click here for the presentation)
Cullen: It appears that qualifying for and being enrolled in Medicare Parts A and B is a requirement for these additional plans. Can you tell us a little more about the eligibility requirements for Medicare Part A and Part B?
Fred: For Medicare Part A you have to have worked a certain number of hours in your lifetime to qualify. Once you meet Medicare Part A eligibility, you can then be enrolled in Part B. You have to have both to enroll in an Advantage Plan, an SNP, D-SNP, etc. Some people have never worked in their lifetime, which will exclude them from Medicare Part A eligibility and as such exclude them from Advantage Plans, SNPs, D-SNPs, etc. If you’re on Disability for a minimum of two years you can apply for Medicare, so there is no age requirement for Medicare this group of people.
Discussion:
-A parent stated that his son is permanently disabled as the result of a genetic abnormality at birth. However, he discovered when his son’s biological father, with whom they had no contact for decades, went on Medicare their son was then eligible for and enrolled in Medicare. This adds an interesting layer to Medicare eligibility. It was stated that children who are disabled before the age of 22 are eligible for SSDI once a parent (or possibly a grandparent) retires on social security. Once this “adult disabled child” has been on SSDI for 24 consecutive months the person is eligible for Medicare.
-It was asked when you have Medicare, Medicaid, and other insurance such as an SNP, which acts as the primary payer, the secondary payer, the payer of last resort, etc.
Fred: It starts with the Medicare company, the company you’re working with for your SNP. All your benefits go through your member ID with the SNP company. Then, it goes to Medicare and from that point MaineCare picks up the rest. Medicaid is always the payer of last resort. With each of these companies the contracts for SNPs with the state are very strict. For example, Aetna has been in the state forever and they’re just getting a contract for SNPs now. Billing always starts with the actual Medicare company.
-A parent stated that his daughter is on Medicare and MaineCare. She sees a doctor at Martin’s Point. She is not enrolled in an SNP or Advantage Plan. Martin’s Point would like to enroll her in their Advantage Plan. However, they don’t have an SNP, except for diabetes. It was asked if it is advantageous to consider her enrollment in the Martin’s Point Advantage Plan.
Fred: It depends where in the state you’re living. Generally, people who go to Martin’s Point use Martin’s Point’s Advantage Plan. However, Blue Cross & Blue Shield SNPs and Aetna SNPs also works with Martin’s Point. You don’t have to enroll in Martin’s Point’s Advantage Plan to receive care from Martin’s Point. There’s a lot more money and benefits included in an SNP versus a regular Advantage Plan. You don’t pay for anything for the SNP. The SNP coverage is paid for by Medicare and MaineCare. It’s just additional money and benefits given to these individuals to help them out. I have personally enrolled people into Advantage Plans who are dual eligible, because for whatever reason that plan was the best fit for those people. MaineCare will pick up all those charges. If it shows on the plan a PCP visit is a $10 co-pay, that’s wiped out because MaineCare picks up those charges. MaineCare will pick up charges, such as specialty care co-pays, out-patient hospital visits, etc. Out of pocket costs are zeroed out depending on MaineCare eligibility. Advantage Plans overall generally cover less and provide fewer benefits than SNPs and D-SNPs. In southern Maine you have Aetna and Blue Cross & Blue Shield for SNP plan administrators.
Craig Patterson – DHHS/OADS: Do you have other staff working with you to assist people in person? I ask because the state has the Maine State Health Insurance Assistance Program (SHIP) and health insurance counselors that can assist people to explore Medicare Advantage Plans and SNPs. All of our Area Agencies on Aging provide this service. (to learn more contact your local Aging & Disability Resource Center by calling 1-877-353-3771 or by visiting the ADRC webpage).
Fred: Yes, I have a whole team. I’m actually working with the northern region of DHHS. They are compiling their clients and people from nursing homes and so forth to provide an evaluation even if they’re on a current plan, to see if they’re eligible for additional benefits on SNPs etc. We do have a full team and travel all over the state.
Cullen: Craig, if you could send me an email with the information on DHHS staff that provide this assistance, we can include that in the minutes so people will know all of their options. (Click here for the Maine State Health Insurance Assistance Program and Medicare Assistance section of the OADS website; click here for the State’s website on Maine’s Area Agencies on Aging; click here for the Maine Association of Area Agencies on Aging website.)
Fred: Right now, January 1st through March 31st, the first quarter of the year, is considered the open enrollment period. You’re eligible to enroll in an SNP during open enrollment. April 1st begins the next quarter. If someone is in an SNP and has discovered that it isn’t the right fit and a better SNP would be more advantageous, they can change plans every quarter of the year except the last quarter of the year (the 90 days leading up to January 1st).
-A parent stated that Fred walked him and his wife through all of this information for their son and he was incredibly helpful. It involved a last-minute plan switch in order to cover out-of-state medical care. Fred was invaluable throughout the entire process.
-A self-advocate stated that she is concerned that the contracted plan provider, the third-party insurance company, which is necessary for a SNP etc., is most likely a for-profit arrangement.
Fred: Are you talking about profit from the SNPs? All of these SNPs involve contracts with states. The federal government provides these companies a lump sum of money every year. When they have a contract with the state for SNPs, they can use that money for the plans to provide additional benefits to help them out in addition to what they’re not receiving. If they don’t use the federal money, they have to return it to the federal government at the end of the year. These companies make by through the government reimbursing them up to $1,000 per person when they sign an individual up for a plan. For instance, WellCare for people on MaineCare, the state has a contract with them for prescription drug coverage. States may have contracts with providers, but it doesn’t mean that just because someone is placed in a plan it’s the plan in which they must remain. People have options to go other routes.
-A self-advocate stated that people with ID/DD have historically been exploited. If someone is making a profit due to someone’s disability it can become problematic, and an opportunity for exploitation.
Fred: It doesn’t matter if it’s a for profit or non-profit, the companies will make money. There is no charge to the individual, and the government provides lump sums to companies in order to cover these additional benefits to which people would otherwise not have access. These plans were created not for Medicare companies to profit, but to use the money provided by the federal government to provide benefits people are not getting from the state.
-A special education teacher stated that this information is invaluable. It was asked when parents ask questions about the timeline for these benefits what the best answer would be.
Fred: After a two-year period of time on Disability they are eligible for Medicare. The first thing I would ask is if their child has been on Disability for more than two years. If so, I would recommend they call Medicare services and get them enrolled in Medicare. Then once they are on Medicare, have them look into SNP and D-SNP eligibility. This would help out the family as well as the individual.
Cullen: If people have additional questions, you can contact Fred ([email protected]), or look into the state resources Craig provided. Thank you for being here and explaining such complicated but important information, opening many people’s eyes to additional resources for the people about whom they care. Thank you again, Fred!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). meacsp.org Topic: 130th Legislature – Legislative agenda and priorities for the system of care for people with ID/DD.
Cullen: Today we have Laura Cordes, Executive Director with MACSP (Maine Association for Community Service Providers), discussing the 130th Legislature, including the Legislative agenda, bills to watch, and priorities for the system of care for people with ID/DD.
Laura Cordes – MACSP (Maine Association for Community Service Providers): I am happy to share the latest on what’s happening in the 130th Legislature. MACSP is the Maine Association for Community Service Providers. MACSP is an association of organizations that provide supports and services to children and adults with intellectual and developmental disabilities in Maine. The mission of MACSP is to represent individuals and organizations that support persons with disabilities to live, learn, and work in the community of their choice through legislative action, organizational advocacy, training, and public education. This work includes a lot of advocacy at the Legislature. On Friday, the Governor released her Biennial Budget. It came along with positive news – the growing deficit folks were aware of is looking to be less than what was originally forecasted. This news also means that there may be less of a likelihood of cuts in the Supplemental Budget for the current fiscal year, as well as the Biennial Budget (which begins 7/1/21). It also appears to include some MaineCare rate increases.
First, I wanted to share a link to the Governor’s Biennial Budget Request press release. I also wanted to share a list of bill titles that have been submitted, as well as the process through which this all will move. We don’t have bill language yet, but the requests filed provide a general idea of bills that could affect the ID/DD community, so we can have them on our radar, and weigh in on them as applicable. (Click here the information Laura covered, including information from the Governor’s Biennial Budget, bill titles, bill sponsors, links, etc.)
Laura: It appears that the Governor’s Biennial Budget Proposal is quite promising for the ID/DD community. It’s a long road between now and the end of the session when the Legislature will adopt the Biennial Budget, and the Supplemental Budget for the rest of the fiscal year, but it is definitely promising.
-It was stated that DSP pay has been prioritized in order to attain and retain qualified staff to provide services to people with ID/DD. It was asked is the Budget includes rate increases for DSPs.
Laura: That’s a great question. This is certainly one of MACSP’s top priorities. MACSP is asking the state for emergency rate increases or a DSP stabilization fund in the Supplemental Budget. The DSP rate is $11.21/hour, almost a full dollar behind the increase to minimum wage. We’re looking at the details in the Biennial Budget to see if DSP rate increases are included as it is absolutely essential. As far as the bills, I looked at all of the bill titles and captured any that could pertain to the ID/DD community (see the link above for more information on these bill titles). When the bills are filed, they will come out of the revisor’s office with LD numbers, and at that point the bill text will be available. This will likely happen by the end of the month. In the document I highlighted bill titles of special interest, which we will be following closely. Including LR 887, An Act To Give Direct Service Providers Hazard Pay and To Pay Additional Pandemic Costs, and LR 1036, An Act To Eliminate the Waiting List for Older and Disabled Residents Who Are Eligible To Receive Home-Based Care. We did have a 10% rate increase for DSPs with the State’s K Waiver, through May, but that was very short lived. So, we’re looking to bring this back either in the Supplemental Budget, or through legislation. There was an enormous effort by allies and DSPs, regarding the bill to implement the Long-Term Care Workforce Commission recommendations last Legislative session; the bill has been resubmitted in this Legislature (LR 440). We know the pandemic has certainly compounded the DSP crisis. The Portland wage ordinance, requiring a time and a half emergency wage throughout the pandemic has been a significant challenge for service provision. Providers are challenged to continue to provide services in Portland due to this without any corresponding rate increases. LR 1821, An Act To Require a Municipality That Raises the Minimum Wage within That Municipality To Be Financially Responsible for an Increase in MaineCare Rates Caused by the Increase in the Minimum Wage, might help address this. There are numerous other bills pertaining to the rates and minimum wage. Included in the Governor’s Biennial Budget is establishing a mortality review panel for the ID/DD community, with LR 919, An Act To Enhance and Improve the Maine Developmental Services Oversight and Advisory Board and To Establish the Aging and Disability Mortality Review Panel (OAB), also addressing this.
There are a few MACSP priorities that may also be of concern to this group. LR 566, Resolve, Relating to Rule-making Authority To Ensure Continued Services for Children with Disabilities, relates to the MaineCare Section 106 proposed rule last year that had many positive pieces to it but would have negatively affected 3-5-year old’s in pre-schools. That rule was pulled, but Rep. Meyer moved forward, submitting a bill which would require anything that would come up around the 3-5-year-old population a major substantive rule. This would ensure the many moving parts pertaining to this age group (as well as the findings in the Public Consulting Group report) aren’t overlooked. LR 1677, An Act To Ensure Supports for Adults with Intellectual Disabilities or Autism with High Behavior Need, stems from a bill that passed in 2019. That bill, LD 1486, passed in 2019 and asked the Department to look at its crisis service system and study how they could support a rate to help people with high behavioral needs. This bill also asked the Department to look at rules pertaining to this. The report was ultimately released, in September of 2020, after the last Legislature adjourned. MaineCare went ahead with rules around this, though the rules were posted to a different Office, which made them more difficult to know about and find. The hearing regarding these rules was this fall and everything largely pertained to crisis services, not rates to address people with high behavioral needs. We’re happy that Rep. Meyer has introduced LR 1677 to ensure the that the rates for people with high behavioral needs does not drop off the radar. I also want to reference Rep. Millett’s bill, LR 1383, An Act To Appropriate Funds to Eliminate Waiting Lists for Home and Community-based Services for Adults with Intellectual Disabilities, Autism, Brain Injury and Other Related Conditions, which would eliminate the waitlists. Betsy Mahoney might be able to discuss LR 828, An Act To Keep All Maine Students Safe by Restricting the Use of Seclusion and Restraint in Schools.
Betsy Mahoney – Autism Society of Maine: One of our high priority items this year is Rep. Millet’s bill, LR 828. This is a very important issue and was included in a bill that passed last session but because it had a fiscal note died on the Special Appropriations Table, as did many other bills. The Coalition Against Restraint and Seclusion decided to file a stripped-down version of the bill in this Legislative session. We’re hoping to get the bill through this year, since it had great support last session and now does not have a fiscal note. Since the last Legislative session ended prematurely due to the pandemic, many duplicate bills that didn’t make it fully through the legislative process have been resubmitted this session.
-A parent stated that a number of people in this group have developed a first draft of a Legislative agenda – at least the bills submitted that could affect the ID/DD community. Targeted advocacy, and speaking with one unified voice, can have a lot of power. It was asked if a small subgroup could meet to go over these bills, collaborate with each other, determine the top handful of priorities behind which we could put all of our energy. This might be an efficient, effective strategy.
Laura: I think hearing what people are prioritizing, finding common ground, collaborating where we can, and combining our grassroot support is invaluable.
Betsy Mahoney: I would be more than happy to participate in a meeting regarding this, to develop an overall focus, identify leads for bills, etc.
Andy Taranko: We have to remember that these are just LRs, and many of them are duplicates. There are five or six bills pertaining to the Long-Term Care Workforce Commission, for instance. Bill titles are just one sentence describing intent. I would bet there will be movement behind the scenes before bills are printed to combine bills. There are also other items on the agenda, such as COVID and the economy. There are two years in each Legislature. They may move some of these bills to the next session of the 130th Legislature, because 1,800 bills, and the pandemic and the Biennial Budget is a very full plate for one session.
Cullen: People have offered to meet regarding determining legislative priorities. There would be time at the February meeting to continue this discussion as well, at which time we will hopefully have LD numbers and formal pieces of legislation. We will get much better intel in the next month or so, I presume. I suspect a working group in-between meetings will be helpful as well. If you are interested in participating, please email me and I will send out a group email to coordinate when this can occur.
Betsy Mahoney: It will be more of a challenge to do some of this advocacy from a distance. We will have to work harder to share information outside of the halls of the Capitol.
Laura: I’m happy to keep updating this document and have coordinated support behind these legislative efforts.
Cullen: Thank you, Laura, for all of this information. It’s certainly good news about the budget and it appears to be a promising list of bills. Thank you for taking the time to digest this and put it out into an understandable format. Well done!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkin – Associate Director, DHHS-OADS Disability Services: Regarding the budget, I think OADS Disability services did well in the Biennial Budget, such as adding 30 Section 29 slots per month, which will occur in the next biennium. It will not eliminate the Section 29 waitlist completely, but it will keep it fairly low, if it goes through. Also included in the budget, due in large part to the enormous advocacy by many in this group, is a public health nurse position to oversee the Mortality Review Panel. I hope it stays in the budget moving forward. There are rate increases proposed for Section 21 and Section 29, averaging out to $30 million per year in rate increases. The plan is to try to bring the rates up to at least reflect the current minimum wage, and so there’s consistency across the programs. It’s a bridge. We understand it will not meet all the needs completely, but we feel it’s a good start to the conversation. So, we’re excited about that. There will be a lot more information to share about this moving forward.
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa barrows: We’re working on the Transition Age Youth Roadmap strategy. Amanda Hodgkins has been working closely with OADS, taking all of your information and feedback and including it in our roadmap. One of the large gaps identified appears to be children’s case managers not understanding how to do referrals. We’re in the middle of working on a survey which will go out to case managers asking what information they would find most helpful. This will lead to trainings, and perhaps the development of a resources page. The overall Transition Age Youth Roadmap strategy is a massive undertaking and will take a while to fully implement.
-A self-advocate asked if there will be people with disabilities assisting with the survey. Having initiatives be inclusive of the voice of someone with ID/DD always betters the final outcome.
Teresa: That’s a very good point, which we will take into consideration. The survey is for the case management organizations, but you’re absolutely correct, it’s an important piece for us to consider, so thank you.
-A special educator stated that involving special educators, who are on the front lines with families, is imperative as well.
Cullen: Thank you for being here, Teresa, and continuing to provide updates on transition as that work progresses.
Special Education
The Public Consulting Group final phase II report “Maine Early Childhood Special Education Implementation Plan,” is now available on the Legislature’s website.
SMACT (Southern Maine Advisory Council on Transition)
SMACT meetings occur on the first Friday of each month, currently via Zoom. As a reminder, if you want to be on the email list feel free to email me ([email protected]).
Disability Rights Maine (DRM) Update:
Staci Converse: A lot of our advocacy has involved working with people on individual issues. For instance, if people are encountering instances where hospitals are not allowing visitors etc., please let us know because ADA regulations do not go away just because we’re in a pandemic. We’re also doing a series of trainings with SUFU (Speaking Up For Us), including a webinar on 1/15 on Supported Decision-Making. (Click here for DRM’s website, scroll down and events are on the right.)
Federal & Housing Updates:
Cullen: Senators Collins and King worked extremely hard, and did a remarkable job, at the end of December, for which they ought to be thanked. They both worked tirelessly, to not only pass the Coronavirus Relief Package, but also an omnibus FY 21 spending bill which provides significant increases to many areas, including HUD. These bills were well-crafted, bettered by both our Senators with both leading the effort to pass these critical funding bills. We have two heroic senators who have demonstrated outstanding leadership and have been champions for vulnerable populations in Maine.
- There was a motion, which was seconded and approved unanimously, to send letters of thanks to both Senator Collins and Senator King, thanking them for their outstanding leadership regarding the stimulus and the FY 21 omnibus spending bills.
Kate Simson – Senator Collins Office: It’s been a brief intermission, but I’m back in Senator Collins’ office in Portland, and very happy to be here today. You can feel free to reach me via email at any time: [email protected]
Below is the Federal Budget and Housing Update:
On 12/27 the President signed a package passed by Congress which included a $1.4 trillion FY 21 omnibus spending bill, funding the government through 9/30/21, and a bipartisan $900+ billion economic relief bill. In the FY 21 omnibus spending bill HUD received $49.6 billion - more than $12.4 billion above the president’s request, and $561 million above FY20 enacted levels. It largely funds HUD programs at or above levels proposed by the Senate in November, though not as high as levels proposed by the House. The spending bill likely provides enough funding to renew all existing voucher contracts for rental assistance. Beyond rental assistance, the spending bill provides level funding or moderate increases to all programs. The economic relief bill signed into law will provide:
- $288 billion in another round of small business aid through the PPP program;
- Funding for federal unemployment benefits at $300 per week for 16 weeks (into April 2021);
- Direct stimulus payments based on income ($600 per individual, $1200 for couples, and an additional $600 per child);
- $25 billion in rental assistance through the Coronavirus Relief Fund
- $26 billion in nutrition/agriculture assistance – including a temporary 15% increase in SNAP through 6/30/21, expansion of the Pandemic-EBT program to cover families with children in child care, provisions to make it easier for people to qualify for SNAP (excluding pandemic Unemployment benefits as income), temporary increase in WIC, funding for senior nutrition programs including Meals on Wheels;
- Tens of billions of dollars to other priorities, such as childcare, transportation, education, and vaccine distribution;
- An extension of the deadline from December 30, 2020 to December 31, 2021 for funds provided by Congress in the CARES Act through the Coronavirus Relief Fund (CRF);
- A permanent floor for the 4% credit in the Low-Income Housing Tax Credit (LIHTC) program. This change will make it easier to secure the financing needed for affordable housing projects and will assist in restarting stalled LIHTC projects throughout the country and in Maine; and
- An extension of the CDC’s Eviction Moratorium through 1/31.
State Legislature Update:
Laura Cordes – MACSP (Maine Association for Community Service Providers): No further updates were provided.
The next meeting will be on Monday, February 8, 2021, 12-2pm, via Zoom.
Featured Speakers: Rachel Dyer, Associate Director, Maine Developmental Disabilities Council, and Monique Stairs, Executive Director, SUFU. Topic: Person Centered Planning.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2021 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].