Bethesda Lutheran Communities, Inc.

FMAP: Federal Medical Assistance Percentages

Nearly all people with developmental disabilities supported by Bethesda Lutheran Communities rely, at least to some degree, on the Medicaid program to fund their most basic needs. In fact, nationwide, Medicaid accounts for 80 percent of all spending on developmental disability support services.

Medicaid has made it possible for thousands of people with intellectual and developmental disabilities to live independently and productively. Medicaid covers people when others won’t. Medicaid isn’t a choice – it’s their only chance.

Medicaid-funded services can include skilled nursing, speech therapy, occupational therapy, case management and supported community living arrangements that allow people to live in their communities instead of an institution.

The federal government matches eligible state expenditures, making Medicaid a joint federal and state partnership. Due to the current economic crisis, Congress has approved enhanced matching rates to assist states in weathering the downturn; however, these enhanced rates are set to expire in December 2010.

There are efforts in both the House of Representatives and the Senate to extend these enhanced rates by six months. This is a very high priority for Bethesda because in many of our states we have already assumed the enhanced rates would be approved and have included the extra revenue in our budgets.

In the 13 BLC states, three states have not finished budgets; three states have not assumed an enhanced rate and seven states have budgeted for this unapproved revenue of $4.865 billion. The following states have anticipated FMAP funds for the next fiscal year. Those states and the amount they stand to lose are as follows:

-    California – $1.5 billion
-    Colorado – $245 million
-    Illinois – $737 million
-    Kansas – Budget not yet approved, but House included $130 million
-    Michigan – $514 million
-    New Jersey – $490 million
-    Texas – $900 million
-    Washington – $479 million

Without these enhanced rates, it is likely that Medicaid reimbursement rates for developmental disability support services will be further reduced. It is critically important that all advocates contact their representative and urge them to support a six-month extension of enhanced Federal Medical Assistance Percentages (FMAP) rates to ensure continued access to developmental disability supports for people who need them. For more information or to locate contact information for your representative, visit the Bethesda Voices action center or call Mark Hagen, director of public policy at the Bethesda Institute at 920.206.4439.

Department of Justice Enforcement

In 2009, President Barack Obama issued a proclamation launching the “Year of Community Living” for people with disabilities. As part of this initiative, the President ordered the U.S. Department of Justice (DOJ) to redouble enforcement effort of the American’s with Disabilities Act (ADA) and the Supreme Court’s decision in Olmstead v. L.C., a decision that has often been called the “Brown v. Board of Education of the disability rights movement.”

Within the last month, the Department of Justice announced action in four separate cases for alleged failure to comply with the ADA. In Arkansas, the DOJ filed a suit alleging violations of the ADA at all six of Arkansas’ Human Development Centers (HDCs). The DOJ contends that Arkansas does not provide individuals with developmental disabilities support services in the “least restrictive appropriate environment” as required by the ADA and expanded upon in Olmstead v. L.C.

There are currently 1,100 people in Arkansas HDCs. DOJ argues that the state fails to encourage people to seek community-based supports or to educate people with disabilities and their families about community-based options. They further contend that Arkansas officials have failed to provide adequate community-based options as evidenced by the more than 1,400 people on waiting lists.

According to DOJ: Specifically, the State segregates hundreds of individuals with developmental disabilities in institutions that are not the most integrated setting appropriate to their needs, and fails to provide adequate community supports and services to individuals who are discharged from the institutions or who are at risk of institutionalization. Indeed, the State gives individuals with developmental disabilities the draconian choice of receiving services in segregated institutions or receiving no services at all.

The alleged discrimination goes to the heart of the ADA and Congress' intent to eliminate the segregation and isolation of individuals with disabilities. As Congress stated in the Findings and Purposes of the ADA: Historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem.

DOJ has also filed briefs in Florida, Illinois and New Jersey alleging failure to comply with provisions of the ADA. The briefs contend that all three states violate civil rights laws that require states to end discrimination against and unnecessary segregation of persons with disabilities.

"As the Supreme Court determined in the landmark Olmstead decision, unjustified institutionalization violates the rights of individuals with disabilities and stigmatizes them as unworthy of participation in community life," said Thomas E. Perez, Assistant Attorney General for the Civil Rights Division. "Florida, Illinois and New Jersey can provide community-based services to people with disabilities, and the law requires them to do so to prevent unnecessary institutionalization."

To learn more about these cases and other examples of the efforts of the Federal government to enforce the ADA and Olmstead v. L.C, visit the Americans with Disability Act website.