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VCDR 2018 Legislative Platform

The Vermont Coalition for Disability Rights

Presents our Legislative Priorities for the 2018 Legislative Session.

Preserving a Legacy of Disability Rights and Services

Over the last four decades Vermont has established laws ensuring rights and services that support self-determination, inclusion, and equality of opportunity for individuals with disabilities and their families. These decisions have helped make Vermont a better place for individuals with disabilities and their families to live, work and contribute to our shared communities. Together we can preserve the civil rights and social services that have made this possible.

This year Vermont — like every state in the nation — is experiencing unprecedented change and uncertainty. Our 2018 Platform reflects this reality. Sweeping changes in civil rights, education, health care, workforce issues, and community development are being considered in every state and in our nation’s capital. As we consider change, we must find ways to preserve the gains of the past. Disability programs and policies that placed Vermont ahead of most of the nation are at risk. The community services and safeguards that Vermonters with disabilities depend on are underfunded and community nonprofits that provide essential services are unable to provide adequate wages and benefits to a workforce providing essential services.

We have the opportunity to build on what works well and to change things for the better by adopting fiscal strategies that support livable wages and adequately fund the programs that make it possible for people with disabilities and other Vermonters to succeed, thrive and contribute to Vermont.

We thank each of our Senators and Representatives for their service and look forward to working with you to secure Vermont’s legacy of laws and services that make disability rights and equality of opportunity a living reality in our state.

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The Vermont Coalition for Disability Rights thanks you for your service to ALL Vermonters!

 VCDR hopes that we can assist you throughout the session as you consider issues that affect the lives of your constituents with disabilities.

 

Please contact us for input and education on disability issues.

Learn about our member organizations and the many services they provide at our website: www.VCDR.org

 

Please contact our VCDR coordinator, Karen Lafayette, at 802-373-3366 or at kmlafayette@aol.com

or VCDR President Sarah Launderville

at 802-224-1817 or at slaunderville@vcil.org with any questions.

VCDR thanks the Vermont Developmental Disabilities Council, VCDR members and friends for their contributions and support of our work. For more information about particular bills and other VCDR advocacy activities, or to share your recommendations and concerns, contact us:

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11 EAST STATE STREET, SUITE #2

MONTPELIER, VT 05602

TEL: 1 (800) 639-1522 WWW.VCDR.ORG

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VCDR’s 2018 Legislative Platform

 

Budget and Policy Priorities

Health Care

Health Care

 

Health Care Reform: In recent years, Vermont has invested considerable resources in reforming health care delivery, improving health outcomes, and reducing health care costs. VCDR will continue to monitor these efforts and advocate for the following:

  • Health reform efforts – including the Medicaid Next Generation pilot – must preserve and strengthen Vermont’s person-centered and person-directed services and its community-based, disability long-term care system. Vermont’s Medicaid program must not be eroded by efforts to finance general health care reform, by the administrative cost associated with operating accountable care organization(s) (ACOs), or ACOs assuming downside risk in pay-for-performance

 

  • The implementation of Vermont’s all-payer waiver, updated global commitment waiver, and the statutory requirement to align Medicaid long-term services and supports with these agreements must be informed by robust engagement with individuals with the lived experience of disability, their families, and other

 

  • Enabling legislation for the Medicaid and Exchange Advisory Board should be strengthened to ensure that this board acts as a self-governing stakeholder group that advises the Secretary of Human Service, the Governor, and the legislature. The Board should be charged with reviewing and making recommendations regarding all aspects of the Medicaid program, including but not limited to, primary care and hospital services traditional, Medicaid long- term services and supports, the Medicaid to Schools Program, Early Periodic Screening, Diagnosis, and Treatment (EPSDT services for children), and pilot projects operating under the authority of the Green Mountain Care

 

  • Resources and planning for population-based approaches within health reform should prioritize the needs of groups that experience poor health outcomes disproportionately to the general population, including Vermonters with Accountable Care Organizations should view population health through the lens of health equity and distribute their resources accordingly.

 

  • Policies and procedures adopted in the service of health reform must ensure the continued protection of patient rights, including freedom from coercion, the security

 

of protected health information, and access to health information in an easy-to- understand format delivered in a patient’s preferred means of communication.

 

  • The use of Medicaid investment dollars must be deliberated in a transparent public process that seeks the greatest benefit for medically underserved Vermonters.

 

 

MEDICAID and BUDGET

 Budget Gap: VCDR believes that the perennial imbalance between state revenues and the programs needed to meet very basic needs may well be “structural”. We do not believe that this can be addressed by simply denying needs and cutting programs which ultimately help people live independently. Adapting our tax structure to current economic realities may well be the best way to avoid greater future expenditures.

Livable wage for direct support workers. There is growing recognition that we need an increase in wages to a reasonable level for individuals providing support to people with disabilities. Progress that was made through Act 82 and the appropriations process needs to continue. Throughout Vermont’s disability and long term support system stagnant wages have made it increasingly difficult for people with serious needs and the agencies that assist them to recruit and maintain a skilled and dependable workforce. This has caused agencies to move toward congregate programs to be able to provide coverage. VCDR supports the proposal of the State Developmental Services Standing Committee that a base wage of $15 an hour be created, something closer to a livable wage. (TASH, GMSA, VTDDC, DRVT)

 Rehabilitation Services for the Blind and Visually Impaired: Funding for services for rehabilitation services for the blind and visually impaired delivered through the Vermont Association of the Blind & Visually Impaired have not been increased in thirteen years despite rising caseload and needs. VCDR supports and increase of $100,000 ($200,000 total-Global Commitment) in order to reduce level of subsidization by VABVI, hire more teachers, and address need for technology training for the visually impaired. VABVI services help Vermonters stay independent and active in their communities, saving State money. Without these services a visually impaired person is 15 times more likely to end up in assisted living or a nursing home.

Pay Equity for Children’s Integrated Services (CIS) Professionals

CIS, a signature early childhood initiative in Vermont, maximizes children’s health, development, and learning by providing individualized support to families and specialized child care programs. CIS was designed to lessen, if not eliminate, the need for future services that are costlier and less efficient. However since CIS began in 2009, it has

been both underfunded and funding has remained flat. CIS providers can no longer pay their staff enough to avoid high turn-over rates and long vacancies. VCDR supports the Vermont Family Network and the Parent Child Center Network efforts to secure an increased investment in CIS, which would ensure continued progress on family safety and stability; optimal, healthy child development; and families’ access to quality early care and education.

Integrating Family Services (IFS): Implementation of the IFS initiative should be monitored to ensure that Vermont’s actual budget and policy actions are measured against the goals of the IFS initiative to ensure those actions are consistent with desired outcomes so that IFS realizes its potential for family directed services that effectively and responsively meet children and families’ needs. This laudable initiative is running in parallel with program and budget actions that appear to be undermining the “safety net” of services and family supports. Visible, authentic family and youth engagement is still needed in the design, implementation, and evaluation of the changes.

Early Periodic Screening Diagnosis and Treatment (EPSDT)

The federal government requires that states participating in Medicaid must offer benefits consistent with a broad definition of medical necessity known as EPSDT. These are comprehensive benefits that include all services that a child (under 21 years) needs to screen, diagnose, and “correct and ameliorate” his or her condition. EPSDT services may not be capped, managed within a fixed budget, or subject to waiting lists. Children with special health care needs, however, are often unable to access all medically necessary services. Problems have been reported in screening, primary care, developmental and mental health services, dental care, therapies, supplies and durable medical equipment, transportation to EPSDT services, and more. VCDR requests that the legislature require AHS to review funding levels and program management to ensure timely access to services consistent with the EPSDT standard including primary care, therapies, case management, medical supplies and equipment, and transportation for Vermont’s Medicaid eligible children.

Repeal the “tax” on low-income families with children: A recent law counting $125 of adult Supplemental Security Income (SSI) income against a household’s temporary cash assistance (or “Reach Up”) benefits every single month is driving adults with disabilities and their children deeper into poverty—as much as 10 percent farther below the federal poverty level in some cases. The reduction targets Vermont parents who, by Social Security Administration definition, are unable to work as a result of their unique disabilities. These parents need their SSI income to meet their needs related to disability, yet they are being “taxed” in order to reduce the Reach Up benefits designed to support other members of their household. Over 800 Vermont families are affected by the reduction.

Medicaid for Working People with Disabilities (MWPD): VCDR has long supported eliminating state policies that present barriers to employment for people with disabilities. MWPD enables work by preventing the loss of Medicaid eligibility despite employment. Progress has been made in working towards favorable rule changes, but it appears that CMS may not approve the spousal disregard of the MWPD beneficiary for purposes of figuring eligibility of the non-MWPD spouse for traditional Medicaid.

VCDR advocates for this and hopes to work with DVHA to persuade the federal government to support this policy change.

EDUCATION

 Legal Assistance for Families with Education Needs: VCDR recognizes the scarcity and expense of legal assistance to families of children with disabilities who are eligible for or on a Section 504 plan or an Individualized Education Program (IEP) at school.

Funding should be provided for a qualified, full-time, special education attorney or towards sustaining a bank of pro bono attorneys trained by the Disability Law Project in special education law.

Special Education in Private and Independent Schools: Some independent schools function as public schools in school districts that lack a public school. Since these schools receive public education funding, these schools should ensure open enrollment and serve students in all categories of disabilities. For these schools to deny admission of students with disabilities would be a civil rights violation.

Another category of independent schools are schools designed to serve a specific type of disability. These specialized schools function as “alternative placements” for children whose needs cannot be met in the public school setting. Placements run along a continuum ranging from the least restrictive environment of the typical classroom to the most restrictive environment, which are, for the most part, specialized independent schools. The decision to place a child in an alternative placement is made because there is a need for a specialized environment to address extremely intensive needs that cannot be adequately addressed in a less restrictive setting. For this category of schools, it would be unreasonable to require the school to serve children in every disability category. These independent schools play a valuable role in supporting students with intensive levels of need and without them, the continuum of placements would be severely curtailed.

CIVIL RIGHTS

 Safeguarding Civil Rights and Protections: VCDR will monitor and oppose legislative proposals that may diminish the civil rights of people with disabilities and mental health issues. Vermont has created the country’s least institutional system of care but issues of access, accommodations, and involuntary treatment are still important in an era of budget constraints and misplaced fear of people who seem “other.”

People with Disabilities in Prison. VCDR advocates for change in the way people with serious disability and mental health issues are treated in Vermont’s prisons.

  • People ordered by courts to a hospital for psychiatric evaluation should in-fact be admitted to psychiatric units where they can receive appropriate care, not to prison.
  • Segregation is not treatment. Vermont should reduce or eliminate the holding of people with mental health issues or serious functional impairments in settings so restrictive that they exacerbate individuals’ mental health conditions. In order to make this possible the State needs to develop the capacity envisioned in Act 78 for inpatient level of
    • Individuals who have served their minimum sentences without incident are generally released from our prisons. Prisoners with disabilities should be supported to attain safe, supported, community placements so that timely release is an equal

 

Use of Force in Emergency Departments? When force is used to prevent an injury on a psychiatric unit, the Department of Mental Health (DMH) collects data. That data is shared with the “Emergency Involuntary Procedures (EIP) Review Committee” and the Mental Health Care Ombudsman. VCDR advocates that the Legislature also require hospitals to report these uses of seclusion and restraint to the DMH when they occur in Emergency Departments where many people in crisis are held for considerable lengths of time. Patient specific use of force should be reported to the Mental Health Care Ombudsman and aggregate data to the EIP Review Committee.

Expand Protections for Crime Victims with Disabilities: Currently, the Vermont Rules of Evidence allow “hearsay evidence” from a child or person with a psychiatric, intellectual, or developmental disability who is a victim of a crime in cases of sexual abuse (VRE 804a). VCDR believes, along with the Vermont Network Against Domestic and Sexual Violence (The Network), that this should be expanded to include crimes involving serious bodily injury. The rules should also prohibit taking the deposition of a child who is a victim of a physical assault except by agreement of the parties or after court approval and further, to require a hearing before a court may issue a subpoena for a victim’s personal records (VRE 807).

Alternatives for people in crisis: Other jurisdictions have created alternative models for assisting individuals in crisis. VCDR believes that setting up facilities, largely staffed with peers, whose primary function would be to de-escalate and attend to an individual’s human needs would reduce the pressure on Vermont hospitals and reinforce the community basis of our mental health system.

SERVICES & NEW INITIATIVES

 

Traumatic Brain Injury Trust Fund with a dedicated funding source: A TBI Fund was set up at the end of the 2008 legislative session dedicated to filling the gaps in services and support for people with brain injuries and to develop programs designed to reduce the incidence of brain injury in Vermont. The Brain Injury Association of Vermont (BIA-VT) proved the success of this approach by piloting a Neuro-Resource Facilitation Program for injured veterans, but one-time funds were used and ongoing sustainable funding has not been addressed. Twenty other states have established funds for similar purposes and have created sources of revenue appropriate to the challenges faced by individuals with Traumatic Brain Injury, many of whom have been injured in motor vehicle accidents. VCDR advocates either adding a $1 surcharge on motor vehicle registrations or dedicating a portion of penalties for violation of motor vehicle safety statutes, including DUI to support the Trust Fund.

Home Modification: For Vermont seniors and individuals of any age with disabling health conditions, everyday living environments can interfere with mobility, safety and productivity. Home modification investments can make living independently at home possible, avoiding or delaying costly institutionalization. VCDR proposes to create a State income tax deduction to mitigate the expense of home modifications required by a disability or physical hardship. The credit would be for a percentage of the expense or $9,000.00, whichever is less. The percentage of the deduction that may be taken varies depending on the income of the person claiming the deduction.

Support for Peer Initiatives: The state should continue and expand support for Peer initiatives and organizations “of, by and for” people with disabilities. VCDR supports advocacy within the budget process for adequate funding of organizations and projects like: Vermont Psychiatric Survivors, the Green Mountain Self-Advocates, Another Way Drop-in Center, Alyssum, Soteria VT, Pathways VT, Deaf Peer Services, Vermont Family Network, Vermont Federation of Families for Children’s Mental Health, the Wellness Workforce Coalition, and other developing peer-run services.

This is particularly important as the state budget “tightens” with the pressure of developing expensive residential and inpatient services.