NEW YORK – As the U.S. Senate takes up its health care bill again this week, advocates for people with disabilities are concerned that cuts to Medicaid could limit benefits that provide critical care.

The Republican Party’s plan unveiled before the July 4 recess would cut Medicaid funds to New York by $7 billion over four years.

According to Heidi Siegfried, director of health policy at Center for Independence of the Disabled, New York, that could force the state to consider cutting benefits and services that Medicaid refers to as "optional."

"Rehab – like physical therapy, occupational and speech therapy – that is one New York cut five or six years ago,” she points out. “Prosthetic devices, durable medical equipment, like wheelchairs."

Though the number of Republican senators saying they won't support the GOP bill has grown, Siegfried fears the alternative that will emerge is likely to include deep cuts to Medicaid as well.

Services that make independent living possible also could be cut. Currently, Medicaid requires states to cover nursing home care, which Siegfried notes is very expensive and often contributes to declines in patient health.

"Services to keep people from going into a nursing home – like personal care aides and the services that you would need to continue to live in your own home – those are optional," she points out.

Siegfried explains that "mandatory" and "optional" are statutory terms that don't reflect medical necessity, but may influence decision-making.

Polling shows a majority of Republicans think of Medicaid as a "welfare program" rather than a health insurance program.

But Siegfried points out that Medicaid covers children as well as adults, and is especially critical for older New Yorkers and those with disabilities.

"We have to get people to understand that this is not just a program that serves low-income people, that it serves middle class people that have high needs," she stresses.





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A proposed measure in Illinois aims to improve access to the ballot for visually impaired voters.

Senate Bill 282, introduced by Sen. Julie Morrison, D-Lake Forest, would permit people who are considered blind or have low vision, or those with learning and physical disabilities equating to a "print disability," to vote electronically by mail.

Paula Balistreri, operations manager at the Central Illinois Center for the Blind and Visually Impaired, said there are challenges with the current process.

"Typically they will have a sighted person with them who will read it out loud and mark it for them," Balistreri explained. "It's tricky because not everyone has someone they want to share that with. To vote in person presents another whole list of challenges, not the least of which is how do they get there?"

Supporters believe the bill will allow people with visual impairments to mark their ballot confidentially, without the assistance of other people. However, there are some concerns the new provision will cause confusion, as federal law already mandates at least one touch screen and audio voting booth be at all polling locations for federal elections. There is also concern about security associated with electronic voting.

Opponents say the bill is unnecessary since currently at least one accessible voting machine is required at every polling location.

Aaron Ammons, Champaign County Clerk, added there are even better options, including the Express Vote machine used in his county for people with visual impairments.

"It will read the ballot to them and they can make choices on a pad," Ammons pointed out. "It certainly has Braille, and for those who are having low vision, we also have the ability to enhance the font as well as use different contrast."

People worried about electronic voting security are pushing back. A state board task force has regular meetings planned to get closer to a model. As of January this year, 31 states allow certain voters, including those with disabilities, to return absentee or mail-in ballots electronically.


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A man in Adel who is part of Iowa's community of people with disabilities has been successful in having an electronic door installed at the U.S. Post Office in town.

Robert Fisher, who uses a motorized wheelchair to get around, has been able to get pretty much anywhere he wanted to go until he got to his local post office. Until now, the Adel post office has not had a wheelchair friendly door.

Fisher, who has been forced to call the post office ahead of his arrival so someone could let him in, has finally succeeded after a monthslong battle in having an electronic, accessible button installed.

"I feel happy," Fisher said. "It feels rewarding. And other people can use, that too."

Prior to the installation of the button, Fisher had to prop the door open with his hands and feet while maneuvering his wheelchair inside, which he said felt demeaning. Fisher, who said, "my work is never done," is hoping to expand his efforts to other places in Iowa which are not as accessible to people with disabilities as they should be.

Brooke Lovelace, executive director of the Iowa Council on Developmental Disabilities, calls Fisher's success a step in the right direction and a significant accomplishment at the local level, but added Adel's post office door should start not only a statewide trend to increase accessibility in Iowa, but also serve as an opportunity for officials to reexamine the current Americans with Disabilities Act.

"To make it more modernized with what the standards are today, to truly be accessible," Lovelace urged. "It is 30 years old, and so let's open the ADA back up and see how we can update it to make it, so it meets everybody's needs."

While the Americans with Disabilities Act was signed by President George H.W. Bush in 1990, its roots actually date to the early 1970s, when the federal government started to define what discrimination meant in the context of being a disabled person.

With key deadlines approaching at the Iowa statehouse, advocates are calling on lawmakers to provide better wages for direct service professionals, the health care workers who support people with disabilities in the community.

At an average of about $14 an hour, the pay is poor and the work notoriously challenging, which makes it hard for providers to attract and retain workers in the field.

Mona Kenyon, CEO of Iowa City-based Systems Unlimited, a health care provider, they are 98% Medicaid funded, so companies like hers are calling on the state for higher reimbursement rates.

"People have other opportunities," Kenyon acknowledged. "We don't get the applications. We don't keep staff. It's a constant revolving door. So we're pushing to draw awareness and to say this is a real problem. "

Currently, 96% of provider agencies in Iowa have vacancies for direct service professionals.

Kenyon pointed out companies like hers often compete for workers with fast food restaurants because of the low pay, but noted the work providers do is valuable for people with disabilities and helps them stay in their homes.

"It can range depending on the needs," Kenyon explained. "People need assistance with personal care, with bathing, getting ready for their day, getting ready to go to work. Other people need help with grocery shopping, balancing their checkbook. So, it really does range, but without the direct support professionals, services cannot be provided."

To attract and retain more direct service professionals, Iowa's lawmakers are considering House File 264, which would eliminate the state income tax for in-home health care providers, saving them up to $1,300 a year.


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