March Legislative Report II

NASW-Michigan Legislative and Social Policy Update

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Medicaid Work Requirements

The most recent concerning legislation to be introduced is Senate Bill 897 from Senator Mike Shirkey (R-Hillsdale), which would call for work requirements for Medicaid recipients. While several other bills of this nature have been introduced since last fall (HB 5317, 5590, 5701), Shirkey’s bill has the most “teeth” and is the one most likely to get some traction due to his position in the legislature as the likely next Senate Majority Leader. A house version, HB 5716 has also been introduced by Rep. Lee Chatfield which mirrors the Senate Bill.

SB 897 comes on the heels of the Trump Administration’s recent announcement that CMS would begin approving waivers to allow such requirements to be put in place. It’s a rather unprecedented move being that 1115 waivers are traditionally granted to states’ that are piloting innovative or expanded services, not proposals to limit access. Since Medicaid’s inception, work requirements have never been in place.

SB 897 would require recipients who are “able-bodied” to work 30 hours per week in order to maintain coverage in the program – similar to requirements currently in place for food (FAP) and cash (FIP) assistance. DHHS would be penalized if the requirements are not put in place. Kentucky has already been approved for a similar waiver but is also facing lawsuits because waivers are theoretically supposed to “improve” health outcomes.

There are a number of issues with such a recommendation. One is cost – which may be the most convincing argument to derail the plan. Early estimates are as much as 500 million in administrative costs alone. This doesn’t include IT costs or more importantly – costs for uncompensated care. Opponents also argue that it will be bureaucratically complicated to implement and DHHS likely does not have the staffing to do it.

The bill does call for exemptions for traditionally excluded groups like those with disabilities. And while almost half who receive Medicaid already work, many recipients will lose It, including those who are: working less than 30 hours and for whatever reason cannot find more hours; working in industries where work hours fluctuate; experiencing mental illness and substance use disorder that impact their ability to work; waiting on disability to be approved; in hospice, clearly disabled, but do not apply for disability due to their short life expectancy; pregnant women and single mothers with no access to affordable daycare; experiencing an illness preventing them from working; going to school or a training program; aging out of foster care; retired and waiting for Medicare eligibility; or simply unable to find work.

NASW expects that hearing could begin as early as Wednesday March 21^st, but other possibilities exist in April and Early May. NASW will be looking to members to share stories of how this legislation will impact clients to help inform legislators of the human impact. We will also be opposing the bill in committee and looking for members who are willing to testify.

CARES Task Force Update:

As previously reported in January, the Michigan House of Representatives released their House C.A.R.E.S. Task Force final report. https://house.mi.gov/PDFs/HouseCARESTaskForceReport.pdf

The House C.A.R.E.S. (Community, Access, Resources, Education, and Safety) Task Force was a bipartisan group of legislators from the House of Representatives who aimed to identify problems and solutions for the Michigan mental health system, specifically where it intersects with criminal justice. The new report outlines a number of possible solutions that could help enhance current services, and reduce existing barriers to mental health care. The following are bills that have recently been introduced in response to the report:

HB 5085 would direct 4% of revenues from liquor taxes to Michigan’s local community mental health agencies for administration and delivery of substance use disorder prevention and treatment programs. At least 25% must be used for programs not exclusively related to alcohol. The bills would also direct DHHS to seek additional funds via federal funding, grants, and any available matching funds. The bill would equate to approximately $17m in additional funding for substance abuse treatment distributed via the ten regional Prepaid Inpatient Health Plans (PIHPs). The bill recently passed the House Health Policy Committee and now moves to the House floor – NASW supported.

HB5450-52 would eliminate the broad employment ban in licensed inpatient facilities for most misdemeanors and felonies and reduce the length of ban for more serious crimes. Employers would still have the choice of employing individuals or not. For certain felonies (such as causing death, criminal sexual conduct, felony firearm, and mis-prescribing of medications) the ban would be reduced from 15 years to 10 years. For certain misdemeanors (violent firearm and criminal sexual conduct), the ban would be reduced from 10 years to 5 years. The bill recently heard testimony in House Law and Justice Committee – NASW supported.

HB 5487 would create a “universal credentialing” process whereby a licensed health professional who meets the criteria to be reimbursed by one Medicaid Health Management Organization (HMO), automatically can be reimbursed by ALL HMOs. The bill recently heard testimony in House Health Policy Committee – NASW supported.

HB 5439 would require the MDHHS to create and administer an electronic inpatient psychiatric bed registry for the purposes of identifying available beds in Michigan. Facilities would be required to provide real time status of available beds. The beds would be categorized by patient gender, acuity, age, and diagnosis. Qualifications for individuals in need would still be subject to the regular requirements of each facility. The registry would be made accessible to PIHPs, health plans, CMHs, hospitals, and other appropriate providers. The bill recently passed the House and now moves to the Senate Health Policy Committee for consideration – NASW supported

HB 5524 requires MDE and MDHHS to create a professional development course in "mental health first aid" for teachers identifying potential risk factors and warning signs, strategies for dealing with a crisis are included. The bill recently passed the House and now moves to the Senate Health Policy Committee for consideration – NASW supported

HB 5619 prioritizes individuals with certain mental illnesses and foster care children for CMH services. Currently, the Mental Health Code requires CMH to give priority to services for individuals with the most severe forms of serious mental illness, serious emotional disturbance, or developmental disability and for those with less severe forms who are in urgent or emergency situations. The bill would remove the term “most severe” and replace it with a list of priority populations including:

·       schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive compulsive disorder, delusional disorder, psychotic disorder not attributable to general medical condition, or borderline personality disorder, including any of the preceding co-occurring with substance use disorders;

·       Individuals with a serious mental illness or serious emotional disturbance whose level of functioning is determined to be severely impaired based on a DHHS-approved instrument for measuring severity of condition;

·       and children who require any level of mental health treatment and who are placed by DHHS into residential foster care.

Proponents maintain that to some degree this may help provide consistency across the state, whereas now the level of subjectivity and resources available in each CMH allows for inconsistency – ultimately leading to geography-based service determination. Proponents note that priority status does not guarantee acceptance for services or particular types of services and doesn’t preclude CMH from accepting non-priority status individuals. However, Medicaid services, if deemed required, must be provided promptly and a majority of state funding must be spent on priority clients.

Opponents maintain that this will take away local experts’ discretion to provide services based on need. If consistency across counties is to be reached we need to look at bolstering resources in counties that currently lack them. Striking out “most severe” potentially blurs the lines between the PIHP and HMO service populations and may be interpreted as shifting the responsibility for mild to moderate mental illnesses to the CMH without the shift of funding needed to provide those services. Opponents also argue the bill would create budget constraints by prioritizing foster children who may otherwise be served by the HMO system.

Driver Responsibility Fees

The Governor and GOP leadership recently came to an agreement on a bi-partisan, bi-cameral set of bills aimed to end “driver responsibility fees (DRF),” which are fees attached to past driving infractions, imposed by legislation back in 2003. In 2011, the fees were reduced, but the legislature, via HB 5040-5046, and 5079 & 5080, and SB 609-615, and SB 624-625, now aims at “total amnesty” by eliminating the fee altogether. The House bills call for total amnesty immediately whereas the Senate bills would phase in the amnesty over 6 years with immediate amnesty for any debt over 6 years old. It now seems the agreement will favor the House version of the bills in exchange for a tax deal that increases the personal income tax exemption to $4,900. The change is part of a legislative fix to restore the tax break after its use was rendered incompatible with the recent federal tax overhaul.

Unsurprisingly, DRFs hit low-income families and lower-skilled workers disproportionately, and directly contributes to the cycle of poverty. Some of the statistics are staggering: the average individual who owes a DRF owes $1,600, but some owe more than $10,000. Currently, more than 300,000 drivers have a suspended license because they cannot pay their DRFs. The vicious circle is that many of these drivers still have to get to work, and risk driving on a suspended license. If they are pulled over with a suspended license – or without insurance because they don’t have a valid license to get it – they are charged with another infraction that includes, you guessed it, another DRF assessment. And on the cycle goes.

NASW-Michigan, as in the past, supports this legislation and is pleased to see it moving to the Governor for a signature.

Child Custody Bills

Senate Bills 419-21, introduced by Senators Emmons, Pavlov, and Jones, respectively, were introduced in light of recent court decisions about child removals in neglect cases. The bills would define “neglect” in the juvenile code, Child Protection Law, and the Child Abuse and Neglect Prevention Act. Currently neglect occurs when a parent fails to provide adequate food, clothing, shelter, or medical care, but the statutes do not contain a standard definition of neglect. The definitions also do not take into account whether a parent has adequate resources and whether a parent was offered financial or other assistance to rectify the situation.

Furthermore, currently, when a child is removed based on neglect, any time the mother has a child in the future she is automatically flagged for an investigation. Judges have the discretion to terminate custody solely based on the previous removal regardless of the change in circumstances that led to the previous removal. The bills would require the court to make additional or different findings in order to terminate parental rights – a reflection of a 2016 Michigan Court of Appeals decision.

The bills have passed the Senate, the House Judiciary Committee, and now await action on the House Floor. NASW supports the bills.

Child Abuse Registry

A 3-bill package was recently introduced that creates a Child Abuse Offenders Registry, along the same lines as Michigan’s Sex Offender Registry. SB 261, 62, and 63 are awaiting a final vote on the Senate floor. In fact, the bills are modeled very closely to the existing registry, though it is a separate registry, not combined with the Sex Offender Registry (SOR). It would include both a law enforcement-only registry, and a registry viewable by the public, again, tracking Michigan’s SOR.

Criminal Sexual Conduct and Youth

House Bills 5530 and 5531 are sponsored by Rep. Lana Theis, a Republican from Livingston County. HB 5530 prohibits a student who was convicted as an adult or a juvenile of Criminal Sexual Conduct 1st, 2nd, 3rd, 4th, or attempted CSC, from attending that school again if the victim still attends that school. HB 5531 adds criminal sexual conduct to the zero tolerance/mandatory expulsion for a weapon statute. Both bills are currently in the House Law and Justice committee awaiting a hearing. HB 5532, sponsored by Rep. Sylvia Santana, is a companion bill to HB 5530 and rounds-out the 3-bill package.

Sexual Assault Package

A series of bills have recently been introduced following the sexual assault scandal of sports doctor Larry Nassar. One particular bi-partisan bill package, moving swiftly, was introduced, heard testimony, and passed out of Senate Judiciary all on the same day. The package includes Senate Bills 871-880. NASW-Michigan will continue to follow this and all related legislation keep members updated, and weigh in where and when it is appropriate. Briefly:

·       SB 871 (O’Brien) eliminates the statute of limitations for 2^nd degree criminal sexual conduct (CSC) violations in which the victim was under 18 and extend the statute of limitations for 3^rd degree CSC to 30 years after the offense or 30 after the victim turns 18, whichever is later. Currently the limitation is 10 years or age 21 of the victim, whichever is later 

·       SB 872 (Knezek) extends the statute of limitations for CSC retroactively, and adds a grace period for minor victims

·       SB 873 (O’Brien) would amend the Child Protection Law to extend reporting requirements to individuals employed in a professional capacity at a postsecondary educational institution and K-12 sports coaches and volunteers

·       SB 874 and 880 (Jones) would increase the criminal penalties for failure of a mandated reporter to report from a 90-day misdemeanor to a 2-year felony

·       SB 875 (O’Brien) Allows a survivor of child sexual abuse to file a Notice of Intent in a manner that protects his or her identity throughout the proceedings

·       SB 876 (Horn) would amend the Revised Judicature Act to specify that periods of limitations for claims against the State would not apply to a claim of sexual misconduct committed against an individual who was less than 18 years of age.

·       SB 877 (Knollenberg) ends governmental immunity for those who engage in childhood sexual abuse and those who enable childhood sexual abuse

·       SB 878 (Hertel) and SB 879 (O’Brien) increases the maximum criminal penalty for aggravated possession of heinous Child Sexually Abusive Material (CSAM) and over 100 images of CSAM to 10 years in prison and $50,000 fine. Also creates a mandatory minimum sentence of 5 years for repeat offenders.

Related:

HB 5407, introduced by Representative Hughs – Muskegon County, would require the presence of the defendant during presentation of victim oral impact statement(s) unless the judge deems that the defendant would be disruptive or presents a threat to the safety of any individuals present in the courtroom. Another consideration that will likely be added to the bill is allowing the survivor to request the perpetrator not be in the courtroom during the statement. The bill recently passed the House Law and Justice Committee and awaits action on the House Floor.

State Budget Update

Governor Snyder recently presented his FY 18-19 Budget recommendations. This kicks off a several month long process whereby the legislature will eventually come to an agreement on what to present back to the Governor in June as a final budget. What the Governor recommends doesn't always go, rather it sets the tone for the conversation that's to come - which NASW-Michigan will follow closely and provide input when necessary. What was recommended by Governor Snyder was largely "flat," meaning it is very close to the same spending as last year. There are a few items of note as follows:

Health

·       Supports Health Michigan Medicaid expansion with state match needed to continue the program

·       $0.50/hour increase for direct care workers 

Human Services

·       Continues "heat and eat" program that increases food assistance for families, people with disabilities and seniors

·       $1 million TANF increase - the first in years

Children

·       $5 million to support Early-On

·       Increased funding for foster care caseloads

·       K-12 per pupil increase from $120 to $240

Judiciary/criminal justice 

·       $1.5 mil GF for the Westside Residential Alternative to Prison alternative sentencing program

·       The MDOC will stop private food contracts and go back to in-house food provisions 

·       $46 mil for Indigent Defense Commission

·       $2 mil for Vocational Village, an MDOC technical skills training program

Flint 

·       $13.4 million for distribution of healthy food through food pantries, etc.; supporting new mothers w/ breastfeeding support and home visitations; behavioral/physical health services through schools; toxicological services/lead poisoning testing/water filters

·       $25.9 mil to replace pipes and meet the demands of Concerned Pastors lawsuit

·       Homeless 

·       $3.7 million GF to increase per diem rates for emergency homeless shelters from $12 to $16 per night per client served

Ongoing Budget Issue: Disabled, Aged, and Blind Medicaid

Medicaid redeterminations may be unintentionally hurting providers and clients. Over the past 2 years there has been a significant shift in enrollment patterns for Medicaid clients at a time when enrollment continues to increase. Almost 12,000 people statewide have been transferred from DAB -  a Medicaid program set-up specifically for the Disabled, Aged 65+, and Blind - to the Healthy Michigan Plan (HMP). According to the Community Mental Health Association of Michigan, this costs Community Mental Health providers across the state millions of dollars.

How? The current capitated rate for the DAB program is $262.39, while the Healthy Michigan Plan rate is only $27.30. From fiscal year 2016 to fiscal year 2017 the average monthly DAB enrollment dropped by 10,866 individuals, which represents a potential $29 million loss for the service providers. This could be even worse if those who left the DAB program were moved to the TANF program. In that case, the yearly losses would be as much as $32 million. Lending support to the theory that enrollment shifting is occurring is that during the same time period DAB enrollment decreased, overall Medicaid enrollment increased by 87,103 people. The CMHAM believes that the DAB issue has left a nearly $100 million hole in CMH budgets across the state. They are currently asking the legislature for a budget supplemental to cover the past losses and come up with a permanent fix in the future budgets. 

This shift affects not only the budgets of the service providers, but also the well-being of the clients. Those who are enrolled in DAB have their benefits protected as an entitlement, which means that changes to services must be medically necessary. Those who are enrolled in the HMP are not protected by this and their costs could rise after 48 months in the program.

It is not clear why or how this is being done. It is possible that caseworkers are making the enrollment changes thinking they are helping their clients. However, it is clear that this is not helping. NASW-Michigan is hoping to raise awareness of this issue so that social workers will ensure that this is not happening in their county offices. -

National Budget Update

From the National Office of NASW: In the early morning hours of Friday, February 9, by a vote in the Senate of 71-28 and 240-186 in the House, Congress passed, and the President signed a bipartisan budget deal. The Bipartisan Budget Act of 2018:

• Increases federal spending by about $400 billion over the next two-years;
• Outlines two-year spending cap levels, which raise nondefense by $63 billion in Fiscal Year (FY) 2018 and $68 billion in FY19 and raise defense spending by $80 billion in FY18 and $85 billion in FY19;
• Creates another six-week continuing resolution (CR) - funding the government until March 23 - so Congress can rally around a FY18 Omnibus spending package;
• Raises the Debt Limit through March 1, 2019;
• Adds $89.3 billion in disaster aid; and
• Extends and addresses a number of outstanding Medicare provisions and other legislative priorities.

Coming in at just over 600 pages, the budget package contains many provisions that impact the social work profession and our clients.  Below are key highlights of this budget compromise:

Extends Children Health Insurance Program (CHIP):

The Congressional Budget Office (CBO) found that the longer Congress funded CHIP, the more money it saved.  CBO's findings prompted Congress to act and pass another four-year extension to CHIP in this budget bill.  The four-year addition, along with the six-year extension passed in January's CR, means CHIP is reauthorized for another 10 years!  This is a major win for more than nine million children and families.

Prioritizes Mental Health and Addiction Treatment:

NASW members know firsthand the importance of mental health and have seen the direct impact the opioid epidemic has had on our communities and clients.  In the Bipartisan Budget Act of 2018, Congress authorized $6 billion over two years for mental health programs and to combat the opioid crisis.  While there is more work to be done, Congress' actions are a step in the right direction and these resources are vital to our efforts.

Supports Public Health Programs:

Community Health Centers (CHCs): After being passed over in January's CR, CHCs received an extension and a mandatory funding increase in the Bipartisan Budget Act of 2018.  Originally funded at $3.6 billion per year, CHCs will now receive $3.8 billion for FY18 and $4 billion for FY19.  Supplemental grants are also authorized for centers that implement "evidence-based models that increase access to high-quality primary care."  This is a top priority for NASW, and we are happy to see this increase and extension of the CHCs.

National Health Service Corps: Supported by both Democrats and Republicans the National Health Service Corps received a two-year extension of current funding, $310 million per year, for both FY18 and FY19.  These funds ensure that clients in areas of national need continue to receive the health care services they rely upon.

Includes Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program:

After concerns last month that MIECHV programs could face an enrollment freeze adversely impacting children and families, Congress finally acted!  Under the Bipartisan Budget Act of 2018, MIECHV will receive level funding of $400 million per year for FY18 through FY22.  NASW has been an ardent supporter of MIECHV and is pleased to see a four-year extension to this valuable program.

Focuses on Family Services:

The spending bill also included the Family First Prevention Services Act (FFPA), a longstanding priority for many focused-on child welfare reform efforts.

States will also have access to federal funds available under IV-B and IV-E programs that focus on:

• Partial federal reimbursements for states to provide "services that enable children to remain safely at home, or with a kin care provider, instead of entering foster care."  These services range from mental health and substance abuse prevention and treatment services to parenting skills training.
• Continued funding for Child Welfare Services program and the Promoting Safe and Stable Families program through FY2021.
• An additional $8 million in FY18 for grants to support the recruitment and retention of high-quality foster families.
• Reauthorizing adoption and legal guardianship incentive programs at the same level, $43 million, per year through FY2022.
• Providing $5.8 billion for Child Care Development Block Grants.

Included in the FFPA is also a provision from the bipartisan Child Welfare Oversight and Accountability Act, requiring States to compile an annual child maltreatment death data and provide information on what States are doing to develop and implement statewide multidisciplinary fatality prevention plans.

Other Key Provisions:

The budget deal also includes various Medicare extenders, one-year extension to a number of tax breaks, the closing the Medicare Part D prescription drug benefit "donut hole" in 2019 - a year earlier than anticipated, and a permanent repeal to the Medicare therapy cap.  In addition to other funding efforts, $4 billion was allocated to rebuild veterans' hospitals and clinics and $20 billion was included for infrastructure projects, such as, surface transportation and clean drinking water.

Overall Non-Defense Analysis

According to the Center for Budget and Policies Priorities (CBPP), the bipartisan Congressional  budget deal would substantially boost overall non-defense appropriations - these appropriations fund programs including education, job training, and infrastructure.  The problem with the deal is that are funded at levels that are below the rate of inflation covering the past eight years.  Therefore, these programs will essentially remain under funded during the two-year period of the budget agreement.

The budget agreement did raise the limits on both defense and non-defense spending for 2018 and 2019. However, because the 2011 Budget Control Act and sequestration process kept those appropriations so low, any increase only moves the budgets to a level to meet realistic budget needs. For example, the new agreement would raise the non-defense cap by $63 billion in 2018 and $68 billion in 2019, as compared to where they were at the sequestration levels. This will help mitigate some of the harm done in the past, and help meet the needs of vulnerable households.

Department of Justice

The Justice Roundtable and other criminal justice coalition are concerned that the two-year Congressional budget deal will leave crucial programs in jeopardy- a number of key programs are slated for cuts.  The concerns of the advocacy community are that DOJ programs have to be funded at levels that meet the growing needs. We are focusing on funding of DOJ's Office of Justice Programs (OJP). Of particular concern are;

• Office of Violence Against Women, and
• COPS Office in the final FY18 and FY19

The problem is that federal funding to support of these programs has declined steeply in recent years. Since FY10, the state and local justice assistance grant programs have been cut by up to 40 percent.  The coalitions are fighting against any further reductions in these programs.

What's next?

While the passage of the Bipartisan Budget Act of 2018 averted another government shutdown, there are still many legislative items on the "to-do" list.  Outstanding priorities impacting NASW members and clients in the coming weeks, include:

Deferred Action for Childhood Arrivals (DACA)/Dreamers Bill:

One item that did not make it into this budget agreement was a DACA solution.  With the March 5, 2018 deadline fast approaching, Congress has only a few short weeks to reverse Trump's decision to rescind DACA and protect 800,000 young people and their families.  As Congress works to find a compromise, NASW continues to express the need to protect this program and is working diligently to hold Congress accountable to find a solution before the March deadline. The Supreme Court declined to take up a key case dealing with the DACA program. The result is DACA will stay in place until, or if, the Supreme Court takes it up.

Stabilization of Health Insurance Markets:

While a bipartisan priority, this effort has taken a backseat in recent weeks.  Congress, however, will need to get back on track and focus on health care marketplace stabilization efforts.  This includes passing bipartisan solutions to avoid drastic premium hikes in 2019 and to stunt the exodus of insurers from the marketplace. NASW is committed to the stabilization of the health care marketplace so all citizens have access to high-quality, affordable health care.

President's Budget:

The President's FY19 budget is expected to be unveiled this week.  The President's budget is offered to Congress as a blueprint of the Administration's federal priorities and informally kicks off the Congressional appropriation season.  While the President's budget is unlikely to comport with the spending deal reached last week, Congress will ultimately work through its own process to set programmatic funding for FY19. As always, the President's budget will serve more as a signal to Congress of policy priorities for the year ahead rather than a strict spending plan.

FY18 and FY19 Funding of the Federal Government:

The six-week long CR, agreed upon in the Bipartisan Budget Act of 2018, gives Congress until March 23, 2018 to coalesce around an Omnibus FY18 budget plan.  Should an Omnibus deal go through, it would fund the federal government through the end of FY18 - September 30, 2018.

While Congress continues to finalize the FY18 budget, they will also kick off the FY19 appropriation season.  We are hopeful that with the two-year budget deal and set spending caps, the FY19 process will run smoother than the FY18's budgetary rollercoaster. Time will tell.

Throughout these conversations, NASW will continue to voice our support for funding federal programs imperative to social workers, the broader profession, and our clients.  As we look ahead to FY19, we will keep you updated on areas where you can weigh in and voice your support for these vital federal initiatives.

Washington Update

https://www.socialworkers.org/advocacy/washington-update