The Arc's 2015-16 Legislative Agenda

In partnership with:

  • American Association on Intellectual and Developmental Disabilities
  • American Network of Community Options and Resources
  • National Association of Councils on Developmental Disabilities
  • United Cerebral Palsy

I. INTRODUCTION

The Arc, the American Association on Intellectual and Developmental Disabilities (AAIDD), the American Network of Community Options and Resources (ANCOR), the National Association of Councils on Developmental Disabilities (NACDD), and United Cerebral Palsy (UCP) base their public policy views on the understanding that our constituents are full citizens and full participants in our democratic society. We work to shape a federal/state partnership that provides benefits, supports, and services for our shared constituency.

We envision a nation whose high expectations for all of our citizens with disabilities make possible the fulfillment of academic potential, productive employment in the community, active engagement in civic life, and full inclusion in society.

For decades, Congress has been taking important steps to affirm and secure the right of people with disabilities to a life in the community and to achieve that vision. Now, even under continuing fiscal constraints, is not the time to halt that forward movement. The vision is not only just, but affordable. People with disabilities want to live, learn, work, pay taxes, and be productive and fully included in their communities. People would rather live in the community than in nursing homes or institutions.

It is critical that, in all of their actions, Congress, as well as state and local governments, adhere to the principles established by landmark legislation for people with disabilities – the Individuals with Disabilities Education Act (IDEA) and the Americans with Disabilities Act (ADA). Both of these laws embody the fundamental values eloquently expressed in the Developmental Disabilities and Bill of Rights Act:

“Disability is a natural part of the human experience that does not diminish the right of individuals with developmental disabilities to live independently, to exert control and choice over their own lives, and to fully participate in and contribute to their communities through full integration and inclusion in the economic, political, social, cultural, and educational mainstream of United States society.”

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What are developmental disabilities?

Developmental disabilities are physical or mental impairments that begin before age 22, are likely to continue indefinitely, and result in substantial functional limitations in at least three of the following:

  • Self-care (dressing, bathing, eating, and other daily tasks)
  • Speaking and being understood clearly
  • Learning
  • Walking/mobility
  • Self-direction
  • Independent living
  • Economic self-sufficiency

Developmental disabilities may also result in a need for a combination and sequence of specialized, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are lifelong and require individual planning and coordination.

Some common types of developmental disabilities are cerebral palsy, intellectual disability, autism spectrum disorders, Down syndrome, Fetal Alcohol Spectrum Disorder, Fragile X, and epilepsy.

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What is intellectual disability?

Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior originating before the age of 18. The term intellectual disability covers the same population of individuals who were diagnosed previously with “mental retardation” in number, kind, level, type, and duration of the disability and the need of people with this disability for individualized supports and services. Furthermore, every individual who is or was eligible for a diagnosis of “mental retardation” is eligible for a diagnosis of intellectual disability.

Some federal laws that serve people with disabilities through established eligibility categories still use the term “mental retardation.” In 2010, the President signed Rosa’s Law, which directed the substitution of the term “intellectual disability” in federal education, health, and labor laws; however, the term remains in other federal laws. In 2013, the Social Security Administration replaced “mental retardation” with “intellectual disability” in its listing of impairments and other sections of its regulations. In addition, the Centers for Medicare and Medicaid Services issued regulations to change the terms for long term supports and services in the Medicaid program. The Congress should complete this transition by substituting the term “intellectual disability” for the term “mental retardation” whenever a law that uses that term is subject to reauthorization or amendment. This change should not in any way alter eligibility requirements or service availability since the change in terms is not intended to do so. In its 2014 decision in Hall v. Florida, the U.S. Supreme Court announced that it will use the term intellectual disability. It is expected that other courts will begin to follow suit.

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Use of Terms

The Arc, AAIDD, ANCOR, NACDD, and UCP support and advocate with and for individuals with intellectual, developmental, and other disabilities, as well as the families and others who support them. In this document, we often refer to these groups as “constituents” or “our constituency” if a public policy goal applies to everyone represented by our collective organizations. Additionally, throughout this document, we will refer to people who have intellectual and/or developmental disabilities using the acronym I/DD.

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Shaping Public Policy

The Arc, AAIDD, ANCOR, NACDD and UCP base their public policy views on the understanding that our constituents are full citizens and full participants in our democratic society. We work to shape a federal/state partnership that provides benefits, supports, and services for our shared constituency. All people with disabilities have the right to advocate for themselves at all levels of government.

While all five organizations support these policy goals, each organization may choose to emphasize goals specifically related to the nature of the individual organization and its respective constituents.

The Arc, AAIDD, ANCOR, NACDD, and UCP will continue to advocate in a bipartisan manner for public policies that address their needs.

The foundation for this public policy agenda for the 114th Congress is built on mission statements, principles, core values, position statements, and current policies of The Arc, AAIDD, ANCOR, NACDD, and UCP and on input from volunteers, members, and professionals from across the country.

For the 114th Congress, we present two tiers of priorities for our programmatic legislative agenda. The tiers are “priority agenda” and “other critical goals.” We will address any and all of these goals as issues relating to them arise.

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Implementation of Laws

The Arc, AAIDD, ANCOR, NACDD, and UCP closely follow how laws and policies are carried out so that our constituency is appropriately served. This includes influencing any changes in regulations through the public comment process as well as monitoring how the federal government implements, monitors, and enforces relevant federal programs. The Congress also plays a key role in this implementation process in several ways, including through its oversight function. We will continue to remain involved in the implementation of federal laws that affect people with I/DD whether through the administrative and regulatory process or through the ongoing Congressional oversight role or consideration of improvements or amendments to existing programs. The ongoing implementation of the Affordable Care Act (Patient Protection and Affordable Care Act, P.L. 111-148, and Health Care and Education Affordability Reconciliation Act, P.L. 111-152) will continue to be closely scrutinized, particularly any efforts to delay, repeal, or defund its implementation.

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II. FEDERAL FISCAL POLICY AGENDA

Introduction

Federal fiscal policy is the primary tool used by Congress and the Administration to address critical societal issues. In the past few years, fiscal policy has been focused on addressing annual federal deficits and long term debt. Federal fiscal policy can and should be used to decisively address the crises facing people with disabilities and their families. The Arc, AAIDD, ANCOR, NACDD, and UCP support federal funding for the program supports and services that are needed to enable people with disabilities and their families to be fully included in society.

Reductions in federal entitlement spending threaten our constituents. Medicaid, Medicare, Social Security, and Supplemental Security Income (SSI) are major targets to secure deficit reduction. Medicaid finances lifesaving health care and long term supports and services and the lives of the people receiving those supports are inextricably linked to any shift in Medicaid policy – at either the federal or state level. The very lives of our constituents are at stake in these policy deliberations. Some of the changes that have been proposed to the Social Security system, such as reduced benefits and increased retirement ages, could have a devastating impact on beneficiaries.

Like most Americans, we support the need for a strong economy. However, a truly strong and secure nation can only be achieved if:

  • Federal funding decisions and tax policy do not result in a federal budget that is crafted at the expense of people with disabilities;
  • Supports, services, and benefits critical to the well-being of people with disabilities and their families are protected, improved, and expanded while preserving the principles of independence, choice, and self-determination; and
  • When needed, the federal government leads or assists states in being fair and efficient in carrying out their responsibilities to people with disabilities and their families.

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Budget, Entitlements, and Appropriations

Congress has traditionally set fiscal policy through three major fiscal actions. These actions largely determine the actual funding for all disability benefits, programs, and services for the year:

  1. Adopting a budget resolution that sets annual revenue and spending limits. The budget resolution is the blueprint for discretionary and entitlement spending;
  2. Adopting annual appropriations bills which set spending levels for the many discretionary programs; and
  3. Enacting a reconciliation bill requiring relevant committees to revise tax policy and entitlement spending (such as Medicaid, Medicare, Supplemental Security Income, and Supplemental Nutrition Assistance Program (SNAP, also known as food stamps) to comply with the budget resolution.

However, in recent years Congress has not adhered to all of these steps due to disagreements over the role and size of the federal government and how to address federal deficits and the long term debt.

During the 114th Congress, our public policy goals are to:

  • Strengthen, not weaken, vital entitlement programs such as Social Security, Medicaid, Medicare, SSI, Temporary Assistance for Needy Families (TANF), and SNAP (food stamps);
  • Promote cost-effectiveness when such efforts do no harm to our constituents and allow them to live as independently as possible in the community;
  • Replace the scheduled automatic spending cuts that impact discretionary programs that support people with disabilities with a balanced deficit reduction package that includes revenue increases and no further cuts to programs that support people with disabilities and their families;
  • Ensure that the recommendations of non-Congressional commissions or bodies are given full consideration by the Congress and not placed on a fast-track to by-pass the legislative process;
  • Address the significant unmet needs, disparities, and inequities of people with disabilities and their families by expanding the federal government’s investment in people with disabilities to enable them to live and work as independently as possible in the community with appropriate and flexible long term individual and family supports;
  • Ensure that eligibility for services and benefits is not restricted and that the level of services and benefits for entitlement programs (such as Medicaid, Medicare, and Social Security) is not reduced or limited to achieve budget cuts;
  • Remove the Social Security Administration’s administrative budget from any budget cap requirements for the Departments of Labor, Health and Human Services, and Education; and
  • Oppose a Constitutional balanced budget amendment.

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Revenue and Tax Policy

During the 114th Congress, our public policy goals are to:

  • Reform tax policy in a manner that raises sufficient revenues to reduce the deficit and finance the federal government’s role in providing essential supports, services, and benefits for people with disabilities and their families;
  • Address the unmet needs of people with disabilities and their families before extending or making further tax cuts or reforming tax policy in a way that negatively impacts low wage earners and other vulnerable people;
  • Allow the expiration, roll back, or repeal of tax cuts and adjust other tax policies that put people with disabilities at risk;
  • Reject tax policies that help only the most wealthy, recognizing that such policies may be made at the expense of the least wealthy;
  • Assure that tax policies represent a sound investment and will not jeopardize the long term stability of people with disabilities and their families;
  • Raise revenues in a progressive manner without increasing poverty or income inequality;
  • Protect and enhance, not erode, services and benefits for people with disabilities;
  • Protect the Social Security trust funds for use by current and future beneficiaries;
  • Avoid creating impediments to the states’ ability to raise sufficient revenue to meet human needs; and
  • Assure the continuing ability of non-governmental entities to support people with disabilities and their families.

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III. PROGRAMMATIC AGENDA

Priority Agenda areas are those judged to be most likely to come before the 114th Congress; however, all are critical issues.

A. PRIORITY AGENDA

The Arc, AAIDD, ANCOR, NACDD, and UCP acknowledge that many vital federal laws affect our constituency. To further the promise of the Americans with Disabilities Act and the U.S. Supreme Court’s Olmstead decision, major programs which provide supports and services must be aligned with principles of encouraging and supporting non-discrimination and full, meaningful inclusion in community life. Such programs also must be accessible and available to those who need them and must be dependable, even in difficult economic times. Medicaid and Social Security, including Supplemental Security Income (SSI), provide crucial supports to our constituents; potential changes to either program, therefore, require significant attention to the potential impact on people with disabilities. The relationship between Medicaid and direct support professionals requires very close policy coordination. A free, appropriate education for students with disabilities remains the lynchpin to a productive and independent adulthood. Thus, the agenda related to Civil Rights; Community Based Long-Term Supports and Services; Direct Support Professionals; Education; Employment, Training, and Wages; Health Care; Medicaid; and Social Security/Income Maintenance constitute our highest priorities for the 114th Congress. For convenience, they are listed alphabetically.

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Civil Rights

Voting Rights Reform

People with disabilities, individually and collectively, offer an important and needed voice. Ensuring voting independence, accuracy, and access continue to be key issues for this constituency. The Help America Vote Act (HAVA) of 2002 required fully accessible voting machines for people with disabilities by January 1, 2006. This promise has not been fulfilled. According to a September 2009 Government Accountability Office (GAO) report, too many polling places and voting technology throughout the country remain inaccessible. Additionally, state laws requiring voter identification and/or voting machines with “paper trails” have created inconsistency in voting technology and confusion among voters with disabilities.

During the 114th Congress, our public policy goals are to:

  • Provide strong enforcement of the Help America Vote Act (HAVA) of 2002 addressing the right of people with disabilities to vote privately and independently in any federal election, to rectify continuing failures to meet the provisions of the law, and to make recommendations for improvement;
  • Ensure that any new voting reform legislation provides equal and full access to voting systems and polling places for voters with disabilities and does not disenfranchise voters with disabilities;
  • Ensure that requirements for voter identification and/or voting technology do not hinder or discourage voting by people with disabilities; and
  • Ensure adequate funding for the Protection and Advocacy for Voter Access programs.

Other Civil Rights

During the 114th Congress, our public policy goals are to:

  • Promote and protect equal rights of children and adults with disabilities in all parts of the world, by supporting the ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD);
  • Protect and promote stronger enforcement of existing civil rights laws for people with disabilities, particularly the Americans with Disabilities Act; Individuals with Disabilities Education Act (IDEA); Fair Housing Act; Civil Rights of Institutionalized Persons Act (CRIPA); Sections 503, 504, and 508 of the Rehabilitation Act; Help America Vote Act (HAVA); National Voter Registration Act (“motor voter”); Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act; Genetic Information Nondiscrimination Act; and Air Carrier Access Act;
  • Increase funding for federal government entities that enforce disability rights laws, including the Equal Employment Opportunity Commission (EEOC), and civil rights offices in the Departments of Justice, Health and Human Services, Housing and Urban Development, Labor, Education, Homeland Security, and Transportation;
  • Preserve and enhance all federal protection and advocacy programs for people with disabilities;
  • Preserve and enhance legislation and social programs that protect the rights of children and youth with disabilities, particularly those who are served by foster care systems;
  • Enact protections, including sanctions, against abuse, neglect, and inappropriate non-emergency use of physical, mechanical, and chemical restraints and seclusion in all settings;
  • Ensure that legislation addressing issues such as physician-assisted suicide, stem cell research, end of life care, organ transplants, and research on human subjects includes protections against abuse and discrimination on the basis of disability; and
  • Create and fund a research and training effort focusing on international cooperation on disability.

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Community-Based Long Term Supports and Services

The demand for community-based long term supports and services (LTSS) continues to be a critical issue in the 21st century. However, the nation has lacked a comprehensive, proactive national public-private system of delivery. The current system is a patchwork of inadequate funding—with the largest source of federal funds provided by the Medicaid program that requires most people to be impoverished to receive services. With the first of the “baby boomers” retiring, the need for qualified support workers and family caregivers will exacerbate severe inequities in the ability of individuals with significant disabilities of all ages to live in integrated settings of their choice.

In order to meet this national challenge, the federal government must take the lead in developing a coordinated, comprehensive approach to LTSS. Since Medicaid has become the core of federally supported LTSS, the philosophy of the Medicaid program must be changed to reflect the preference for community-based services over institutional services. In addition, the need for supports outside of the Medicaid program must be addressed. Significant progress was made with the enactment of the Community Living Assistance Services and Supports (CLASS) Act, as part of the Affordable Care Act, to establish a national long-term supports insurance program. This insurance plan was designed to assist people in meeting their needs and allow many to avoid impoverishing themselves to become eligible for the Medicaid program. However, because Congress repealed the CLASS Act as part of the American Taxpayer Relief Act its promise has yet to be realized. The needs still exist and will continue to grow.

To meet these challenges, during the 114th Congress our public policy goals are to:

  • Expand, modernize, and, where appropriate, maintain national policies that provide individual supports. Such supports should encourage individual control of services, self-sufficiency, and personal responsibility among our constituents. Such a system should avoid the need for people to impoverish themselves to qualify for services. Supports and services must be:
    • person-centered and self-directed;
    • inclusive of personal assistance services and technology appropriate for each individual;
    • designed and implemented to meet individual needs;
    • widely accessible; and
    • provided in the community.
  • Promote development of legislation consistent with the goals of inclusive participation, personal choice, personal responsibility, integration, and independence;
  • Ensure adequate funds for federal monitoring, enforcement, and implementation of the U.S. Supreme Court’s Olmstead decision;
  • Provide incentives to community-based organizations to utilize innovative technologies to enhance delivery of supports and services, such as home monitoring and communications technologies; and
  • Amend federal law to allow military and other federal employee pension and survivor benefits to be paid to a trust established for an individual with disabilities to allow for the long-term support of the individual.

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Direct Support Professionals

A well-trained, fairly compensated direct support professional workforce is essential to providing the necessary supports and services to our constituents where they live and work. Medicaid is the primary source of funding for the programs employing these workers. The current Medicaid reimbursement system, and cost cutting actions by state legislatures and Medicaid officials, has exacerbated the workforce crisis already hampered by low wages, a lack of health insurance, high turnover, and a shortage of staff. Demand for these workers from private industry and other human services sectors is also high, leading to competition among industries for workers. These problems have been compounded over three decades, leading to a crisis that presents a grave threat to the lives of our constituents and their families.

During the 114th Congress, our public policy goals are to:

  • Ensure adequate funding so that direct support professionals are paid a living wage, including appropriate benefits, at the same level of pay and benefits that states provide for staff working in state-operated programs;
  • Require that states develop and implement a plan to address all relevant components that drive the crisis, including low wages and reimbursement rates, high turnover, and inadequate training;
  • Require any state and federal minimum wage increases or changes in employment standards be reflected in state reimbursement rates for services;
  • Establish an incentive program of increased Medicaid reimbursement for states that commit to eliminating the wage differential between workers in various service settings;
  • Support authorizing legislation and ensure financial support, including payment of wages, to provide pre-service and in-service training and other relevant educational opportunities for direct support professionals to meet the diverse needs of individuals with disabilities; and
  • Implement programs aimed at the direct support labor market to increase the pool of available workers and improve recruitment, retention, training, and supervision of direct care professionals to better serve individuals with disabilities.

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Education

Public education for all is a cornerstone of our democracy. It is the mechanism by which this nation prepares all students to pursue the benefits of freedom and to exercise fully their rights and responsibilities as citizens. The Individuals with Disabilities Education Act (IDEA) ensures that children with disabilities not only have the right to attend public schools but have access to the general education curriculum and meaningful educational experiences. Similarly, the Elementary and Secondary Education Act (ESEA), also known as the No Child Left Behind Act (NCLB), recognizes that our educational system must ensure that all children have access to a high quality education. Accordingly, leaders must seek to better align special education and general education laws.

To ensure that the goals of the IDEA and ESEA are met, students with disabilities must be held to the same high expectations as their peers without disabilities, and their academic progress must be accurately measured and reported. In addition, student assessments and educational services must be culturally competent and all facets of the educational system must share responsibility for the academic and social outcomes of all children.

Students with disabilities face multiple attitudinal, environmental, financial, and support barriers in accessing postsecondary education. During a student’s education there will be several major transitions, such as moving from early intervention to preschool, from elementary to secondary education, and ultimately, from the school system to adult living, including employment and/or higher education. The Higher Education Opportunity Act (HEOA) offers an opportunity for students with intellectual disability to overcome some of those barriers and have access to a postsecondary education that was, until recently, unavailable.

During the 114th Congress, our public policy goals are to:

IDEA Program Structure

  • Reauthorize IDEA and reject any legislation that results in the diminution of the guarantee of a free, appropriate, public education;
  • Fully fund all components of IDEA and provide increased funding for Part C, Head Start, and other early intervention programs; and
  • Ensure that initiatives such as charter schools, vouchers, and individual education savings accounts do not adversely affect (1) public education; (2) the access of students with disabilities, especially those categorized as having intellectual disability (who historically have extremely low rates of inclusion in these initiatives), to inclusive educational settings; (3) the guarantee of a free, appropriate public education for all students with disabilities; and (4) guaranteed access of students with disabilities to the regular curriculum in ESEA.

IDEA Service Provisions

  • Align the age of transition services to be consistent with the pre-vocational provisions in the Workforce Innovation and Opportunity Act of 2014;
  • Develop and require implementation of policies that support portability and continuity of student IEP's across jurisdictions;
  • Ensure appropriate assessments for all students with disabilities by developing universally designed assessments that accurately measure the progress of students with disabilities;
  • Ensure appropriate early intervening services and culturally competent assessments to prevent inappropriate classifications;
  • Promote universal design for learning guidelines in curriculum and in educational practices so that instructional goals, methods, materials, and assessments incorporate flexible approaches that can be customized and adjusted for individual needs; and
  • Expand the design and use of assistive technology as appropriate for all students.

IDEA Civil Rights

  • Amend IDEA’s due process provision to place the burden of proof on school systems rather than parents; and
  • Amend IDEA to allow courts to reimburse parents’ or guardians’ expert witness fees incurred as part of the due process proceedings.

IDEA Enforcement

  • Ensure monitoring and enforcement of the major components of IDEA, including least restrictive environment (LRE), due process, transition, cultural competence, and individualized education programs (IEPs), are properly and fully implemented, and ensure authorized penalties for noncompliance are enforced;
  • Amend IDEA’s IEP provision (614(d)) to ensure that, in the case of a child who does not yet have a symbolic mode of communication (oral language, augmentative communication system, and/or manual signs), a funded plan for developing a communication system for that child becomes a part of the IEP to include multiple use technologies, consistent with ADA Title II and 504;
  • Ensure enforcement of IDEA provisions regarding disciplinary practices to prevent unwarranted suspensions, expulsions, and referrals to the juvenile justice system;
  • Ensure enforcement of IDEA provisions to address the overrepresentation of students with disabilities in the juvenile justice system, and support appropriate services and successful reentry to community schools; and
  • Amend IDEA to provide better portability of federally guaranteed services and promote stability in the implementation of Individualized Education Programs (IEPs).

Elementary and Secondary Education Act

  • Reauthorize ESEA and better align it with IDEA to ensure a meaningful education through access to the general education curriculum, related services, and programs such as health and physical education;
  • Adopt and use a consistent method to calculate and report graduation rates that accurately accounts for the academic achievement of all students, with data broken down by types of disabilities;
  • Adopt new policies to significantly reduce the unacceptably high dropout rate of students with disabilities;
  • Support training, research initiatives, and programs to enhance effective transition services from secondary education to postsecondary education and employment;
  • Enhance adult education, vocational training, post-secondary education, and lifelong learning opportunities for students with disabilities, particularly students with intellectual and/or multiple impairments;
  • Require that any federal funds used to construct and renovate schools enable such schools to become fully accessible;
  • Promote universal design for learning guidelines in curriculum and in educational practices, so that instructional goals, methods, materials, and assessments incorporate flexible approaches that can be customized and adjusted for individual needs; and
  • Expand the design and use of assistive technology as appropriate for all students.

Early Intervention and Preschool Programs

  • Mandate the early intervention program under IDEA (Part C);
  • Increase funding for early intervention and preschool programs;
  • Enhance the development, implementation, and execution of Child Find Programs and other related resources to ensure early detection and early access to services;
  • Ensure adequate funds are allocated to conduct research and the development of evidence-based practices from early intervention through postsecondary education to support learning of students with disabilities; and
  • Support efforts to ensure that young children with disabilities receive early intervention services in their natural environments.

Higher Education

  • Fully fund disability provisions in Title VII of the Higher Education Opportunity Act, including the Model Comprehensive Transition and Postsecondary Programs and Coordinating Center, National Technical Assistance Centers, and Programs to Provide Students with Disabilities with a Quality Higher Education;
  • Ensure students with intellectual disability enrolled in postsecondary education programs have access to work-study programs and federal financial aid;
  • Establish a Unified Education Curriculum and standards incorporating special education course work and practicum experiences for all general education candidates to receive full teaching licensure and certification so that all educators and staff are prepared to serve and support diverse learners in inclusive settings;
  • Support greater inclusion of youth with disabilities in all career and technical program options in the reauthorization of the Higher Education Act; and
  • Ensure that students with disabilities and their families have access to necessary funding to attend post-secondary education programs.

Restraint, Seclusion, and Aversive Interventions

  • Enact protections, including sanctions, against abuse, aversive interventions, and the inappropriate non-emergency use of physical, mechanical, and chemical restraints and seclusion for all students in schools; and
  • Provide funding and require school personnel to be trained in positive behavioral supports and appropriate behavioral interventions for all students.

Personnel

  • Expand and improve in-service and pre-service personnel preparation under Part D of IDEA, NCLB, and the Higher Education Act so that all special and general education teachers are highly qualified and develop programs to expand the pool of undergraduates majoring in special education; and
  • Reject attempts to lower the ESEA standards for “highly qualified” teachers.

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Employment, Training, and Wages

The vast majority of our constituents who are of working age remain unemployed or under-employed. In fact, people with disabilities constitute the segment of our society that is least employed. Given the slow recovery from the recent years of overall high unemployment in the private sector, people with I/DD face a daunting task in securing employment. They can be employed in the community and should earn competitive wages. They should be supported to make informed choices about their work and careers and have access to the resources to seek, obtain, and be successful in community employment.

Thus, during the 114th Congress, our public policy goals should help our constituents reach their full potential and become as independent as possible through integrated employment by:

Wages and Integrated Work Environments

  • Supporting “Employment First” policies as a strategy to increase opportunities for competitive, integrated employment of individuals with I/DD;
  • Building infrastructure and creating incentives for employers or other solutions that will expand work opportunities for individuals with significant disabilities in integrated employment at competitive wages;
  • Expanding training and technical assistance to community rehabilitation providers to transition from the use of subminimum wages and nonintegrated environments;
  • Building infrastructure and supports needed to phase out the issuance of subminimum wage certificates including putting in place transition services and safeguards to protect the interests of any people with I/DD affected by this shift;
  • Conducting oversight on and strengthening of the Department of Labor’s monitoring of compliance under the Fair Labor Standards Act and other federal nondiscrimination requirements; and
  • Increasing and indexing the federal minimum wage to increase economic security for people with disabilities and their families.

Vocational Rehabilitation

  • Supporting implementation of the Workforce Innovation and Opportunity Act (WIOA), toward maximizing employment outcomes, and improving transition outcomes, for people with I/DD; and
  • Increasing funding for state vocational rehabilitation programs significantly above the required Consumer Price Index (CPI) level, transitioning to postsecondary opportunities, supported employment, workforce development programs that help our constituents find and keep jobs and have more career options, and building infrastructure and creating incentives for employers that will expand work opportunities.

Procurement and Contracting

  • Modernizing the Javits-Wagner-O’Day (JWOD) Act to expand integrated employment opportunities and ensure that people with significant disabilities remain a priority for participation in the program;
  • Expanding employment opportunities by establishing federal procurement preferences for all employers who employ people with disabilities; and
  • Assuring that federal employees with disabilities do not lose their federal employment status due to outsourcing.

Employment Standards and Benefits

  • Supporting policies that expand workplace flexibility;
  • Assuring that part-time, supported, or periodic employees are included in any proposal that expands or extends fringe benefit coverage; and
  • Expanding access to family and medical leave and supporting paid leave policies, including by mandating employers to provide a reasonable amount of paid sick leave and requiring payers to recognize these costs in their reimbursement.

Other

  • Assuring that people with intellectual disability, cerebral palsy, and other disabilities can access all relevant work programs, including business development opportunities;
  • Providing technical assistance to service providers for the purpose of expanding and improving their capacity to provide supported employment, customized employment, and other supports and services that will enhance opportunities for integrated employment consistent with best, promising, and emerging practices;
  • Requiring the Department of Labor’s Employment and Training Administration to link youth transition services to support competitive, integrated employment using youth resources, including internships and apprenticeships;
  • Increasing the number of people with disabilities employed by the federal government and federal contractors through streamlining hiring processes, strengthening affirmative action requirements, and improving education and recruitment efforts; and
  • Fully implementing the Medicaid Home and Community-Based Services (HCBS) waiver program and State Medicaid plan Section 1915(i) option to promote competitive, integrated employment.

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Health Care

Our organizations are committed to maintaining the comprehensive health care reforms achieved in the passage of the Affordable Care Act (ACA). With the enactment of the ACA, we have made significant progress towards accomplishing our nation’s goal of universal access to high quality affordable health care for all Americans. The ACA includes historic coverage expansions, nondiscrimination and health insurance reforms, strengthened prevention provisions, and numerous enhancements to Medicare, Medicaid, and other provisions that will significantly benefit people with disabilities. It is critical that the essential benefit package designed for the new health care exchanges meet the needs of people with disabilities and special health care needs. Protecting the significant achievements of the ACA will be our highest health care priority. In addition, our organizations will work to advance the legislative agenda that was not addressed by the ACA or only partially addressed.

To achieve these goals, during the 114th Congress, our public policy goals are to:

Affordable Care Act (ACA)

  • Ensure that the ACA is not partially or fully repealed. In particular, the provisions that meet the needs of our constituents for quality, accessible, appropriate, comprehensive, affordable, portable, and non-discriminatory coverage must be protected;
  • Ensure that the ACA is adequately funded to accomplish the significant goals of the Act for our constituents;
  • Ensure that HHS fully implements the essential health benefits requirements, in particular habilitation;
  • Fund demonstration programs to implement individual care coordination for individuals with disabilities, particularly those who have complex and chronic health care needs;
  • Expand vision and preventive and restorative dental coverage under the ACA;
  • Ensure that there is transparency in health plan selection and that plans have an adequate network of providers and access to medical and other specialists;
  • Protect the Prevention and Public Health Fund and increase funding for primary and secondary prevention and wellness programs for individuals with disabilities;
  • Ensure that privately run wellness programs do not discriminate against people with disabilities or health conditions;
  • Expand funding for training of all health care providers about the needs of children and adults with disabilities, including practices to prevent secondary conditions and to help transition youth with disabilities to adult care providers;
  • Ensure that people have access to affordable prescription drugs; and
  • Ensure that all demonstration pilot grants address the needs of people with disabilities.

Medicaid/Medicare/Children’s Health Insurance Program (CHIP)

  • Protect existing health care entitlements under Medicare and Medicaid;
  • Ensure that there is seamless transition between Medicare, Medicaid, and the health insurance exchanges to ensure continuity of care when an individual’s income or job situation changes;
  • Expand access to, and ensure that cost-cutting strategies do not compromise access to, durable medical equipment, including complex rehabilitation technology and other rehabilitative therapies and services, and that Medicare is responsive to the unique health care needs of our constituents;
  • Phase out Medicare’s 2-year waiting period under which people with disabilities qualify for Medicare coverage 24 months after receipt of Social Security Disability Insurance (SSDI) benefits;
  • Eliminate Medicare’s “in the home” restriction for coverage of mobility devices (e.g., wheelchairs and scooters) for those with expected long-term needs;
  • Extend funding of CHIP to ensure continued access to affordable coverage for children; and
  • Require the Centers for Medicare and Medicaid Services (CMS) to authorize payment for commercial, off-the-shelf, multiple-use technology to support people with I/DD.

Mental/Behavioral Health

  • Ensure that the most appropriate mental/behavioral health services are widely available to people with I/DD who need them across the lifespan, including EPSDT, Medicaid, private health insurance, and others;
  • Provide training to providers of mental/behavioral health services to enable competency in meeting the needs of people with I/DD;
  • Increase training to mental/behavioral health professionals regarding the screening for and ruling out of psychiatric disabilities in people with I/DD;
  • Assure that community-based first responders (e.g., police, emergency medical services, emergency room personnel) are equipped with knowledge about working with people who have I/DD and are experiencing a behavioral and/or mental health crisis;
  • Ensure that the provisions of the Mental Health Parity and Addiction Equity Act along with the mental/behavioral health and substance abuse services provisions in the ACA are fully implemented; and
  • Ensure sufficient reimbursement rates for mental/behavioral health service providers in order to promote improved access to needed services.

Other

  • Enact legislation to reduce harmful chemical exposures that are associated with intellectual and developmental disabilities; and
  • Ensure full implementation of the Autism CARES Act of 2014.

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Medicaid

Medicaid is an essential lifeline for most people with significant disabilities. Medicaid is overwhelmingly the largest funding source of long-term individual and family supports in the federal/state I/DD service system, and the primary source of health care payment for many of our constituents. For the increasing number of individuals with disabilities living with aging parents, Medicaid will continue to be essential to meet their future need for long term supports and services.

Despite improvement, the state of the national economy continues to place undue pressure on the states. Many states have frozen already inadequate reimbursement rates and reduced services with devastating impact on people with disabilities, their families, and their communities. Today, many of our constituents cannot get health care and long-term services. Further shifting responsibility for Medicaid to the states and allowing states to reduce eligibility and benefits would place many of our constituents, and our nation’s health, therapeutic, and long-term support systems for vulnerable populations, at enormous risk. Decreased Medicaid budgets also mean that hundreds of thousands of people with I/DD will remain on waiting lists across the country.

Medicaid is also a powerful driver of economic activity at the state and local levels. When people with disabilities do not receive needed services, the ability of family members to be employed is often jeopardized. When Medicaid-funded service provider agencies are able to retain staff positions, unemployment is reduced and money gets put into the hands of individuals who will spend it. In addition, Medicaid reduces health care costs by allowing people with disabilities to utilize home and community-based supports and services rather than costly and unnecessary institutionalization.

Numerous improvements were made to the Medicaid acute and long term supports and services programs through enactment of the Affordable Care Act of 2010 (ACA). These program improvements must be properly implemented at the federal and state levels in order to work most effectively for people with disabilities. States must be provided with clear guidance on how to effectively use the flexibility and options created by the ACA.

During the 114th Congress, our public policy goals are to:

Overall Structure

  • Maintain the individual entitlement to a full range of Medicaid health and long term supports and services (LTSS) for all eligible children and adults with disabilities;
  • Oppose Medicaid deconstruction or any moves to provide states with flexibility that eliminates basic protections for eligible individuals with developmental disabilities or the imposition of entitlement caps, Medicaid block grants, per capita caps, allocations, provider tax changes, and other proposals that shift costs to states, allotments, or other mechanisms that cause reductions in eligibility, services, or protections for our constituents;
  • Reject efforts to repeal, weaken, or block implementation of relevant provisions of the Affordable Care Act;
  • Require CMS to provide thorough and consistent review of all state plan amendments and waivers to ensure compliance with the ADA and Olmstead; and
  • Require CMS and the states to provide full and timely public access to state Medicaid plans and waivers, including current and proposed amendments and related public comment, in formats accessible to stakeholders.

Eligibility

  • Encourage state implementation of the Medicaid expansion as authorized by the Affordable Care Act;
  • Encourage state implementation of the option in state Medicaid plans for families of children with disabilities to buy into Medicaid if private health insurance is not available or does not meet their needs;
  • Encourage full implementation by states of options to establish Medicaid buyin programs for people with disabilities who work;
  • Ensure that Medicaid eligibility rules and processes do not place undue burdens on applicants and beneficiaries who do not have access to birth or citizenship documentation; and
  • Protect and improve the ability of families and individuals to establish trusts to benefit Medicaid eligible beneficiaries with I/DD and ensure the integrity of pooled trusts which serve such families and individuals.

Benefits

  • Prohibit issuance or implementation of any regulations that limit or eliminate services;
  • Ensure that Medicaid-eligible children with disabilities continue to obtain health-related services during the school day and receive any necessary transportation to those services;
  • Ensure protections for people with disabilities who are dually eligible for Medicaid and Medicare to ensure that they have timely and affordable access to all medically necessary services, supports, and medications under Medicaid, Medicare, and Medicare prescription drug plans;
  • Protect the entitlement to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program and support sanctions against states that fail to properly implement it;
  • Expand access to dental and vision services;
  • Promote polices that ensure adequate networks of providers and access to medical and other specialists as needed;
  • Require the Centers for Medicare and Medicaid Services (CMS) to issue guidance to states that will result in expanded coverage of appropriate assistive technology and technology-enabled supports for Medicaid beneficiaries, including eliminating barriers to multi-use and commercial off-the-shelf technology that could support independent living in the community;
  • Ensure Medicaid reimbursement for a 30-day emergency supply of medication in anticipation of potential disasters, epidemics, or other emergencies;
  • Support the continuation and expansion of habilitation services under the Medicaid rehabilitation option and other appropriate options and ensure that our constituents have supports, services, and training available to teach them to achieve self-determination and increase independence, productivity, and full citizenship through greater mental, physical, and social development; and
  • Ensure the availability of adequate transportation to facilitate full community participation.

Home and Community-Based Services (HCBS)

  • Change Medicaid policy to mandate home-and community-based services and require a waiver to provide services in large institutions;
  • Change Medicaid law so that consumers and families can choose to exercise control over resources to better meet their individual needs;
  • Ensure the full implementation of the Community First Choice Option which allows states to provide comprehensive community-based services with an incentive of a six-percent increase in the federal matching rate for such services;
  • Ensure full implementation of the amended Section 1915(i) Medicaid state plan option for home and community-based services that allows states to serve people who do not yet need an institutional level of care;
  • Ensure full implementation of all other long term services provisions and expansions included in the Affordable Care Act to meet the needs of people with disabilities, including the state rebalancing provisions, expansion of the Money Follows the Person demonstration program, expansion of the Aging and Disability Resource Centers, and the spousal impoverishment provisions;
  • Revise Medicaid law to require states to serve all federally Medicaid eligible people with developmental disabilities and not a subset of the population under HCBS;
  • Ensure that people who receive Medicaid funded HCBS are able to choose integrated settings of their choice and to choose with whom to live and from whom to receive their services;
  • Enact a requirement that states implement the Community First Choice (CFC) Option;
  • Protect the implementation and enforcement of the HCBS settings rule so that it truly meets the intent of full integration and inclusion of people with disabilities in the community;
  • Fully implement the Medicaid Home and Community-Based Services waiver (HCBS) program and State Medicaid plan Section 1915(i) option to promote competitive, integrated employment; and
  • Ensure that amount, duration, and scope of home and community-based services are provided on the basis of individual need identified through a person centered planning process.

Removal of Institutional Bias

  • Address unmet needs in the community by removing the institutional bias for Medicaid long term supports and services by amending the Medicaid formula for cost-sharing with the states to provide a greater fiscal incentive for supporting individuals in the community rather than in institutions; and
  • Decouple eligibility for the home and community-based waiver from eligibility for institutional services.

Portability

  • Improve Medicaid so that benefits are portable from state to state and so that beneficiaries and families are not disadvantaged or deprived by moving from one state to another;
  • Support clarification that states have current authority to facilitate portability; and
  • Support a project by CMS to demonstrate interstate portability of benefits with state coordination and cooperation.

Reimbursement Rates

  • Increase federal funding for home and community-based services (HCBS);
  • Ensure that states set and update reimbursement rates annually so that they reflect the actual cost of providing Medicaid funded supports and services, particularly state and federal mandates, adequate wages and fully funded benefits for direct support professionals, and reimbursement rates and fees for health care practitioners; and
  • Require strong federal oversight of the adequacy of rate methodologies to ensure rates are sufficient to comply with federal and state mandates.

Managed Care

  • Ensure that individuals receiving services in a managed care system have the right to a person-centered plan which is generated by an assessment and a care coordination model which are relevant to the needs of people with I/DD;
  • Ensure that individuals have the right to have their person-centered plan developed in conjunction with an entity of the individual’s choosing independent of the provider and the managed care organization;
  • Recognize the necessity of Health Information Technology (HIT) or Electronic Health Records (EHR) for effective care coordination of acute and long term supports and services for people with disabilities, and provide adequate federal funding assistance;
  • Recognize the paucity of experience and claims data for managed care for LTSS and reject proposals to mandate the states to move people with disabilities who are dually eligible for Medicaid and Medicare into managed care programs until sufficient, reliable claims and outcome data from demonstration projects are collected and analyzed;
  • Maintain the prohibition against the mandatory placement of children with disabilities into Medicaid managed care without an approved waiver;
  • Require CMS to provide strong federal oversight in states where acute, behavioral health care and/or LTSS are provided through Medicaid managed care or other integrated care programs;
  • Require transparency and meaningful opportunities for stakeholder engagement during all phases of the development and adoption of financing and service delivery changes; including concept development, contract specifications, evaluation, oversight and CMS review of waiver applications/state plan amendments;
  • Require states to build rate setting methodology by collecting at least 2–3 years of Medicaid (and, as appropriate, Medicare) claims data, including acute, behavioral health and LTSS claims, as available and appropriate. Acute and behavioral health claims data should not be used to determine costs of LTSS as those supports are not medically based. LTSS data need to be established and tracked over time relying upon LTSS claims (realizing there are limited data) as a baseline and then incorporating costs as determined through person-centered planning;
  • Require states to articulate explicit performance outcome measures and metrics in purchasing specifications and contract language with providers under fee for service or other entities the state uses such as accountable care organizations (ACOs) or managed care entities (MCEs). In addition to acute and behavioral health outcomes, non-clinical LTSS performance measures and metrics must also be articulated that incorporate independence, productivity, integration, inclusion, and self-direction into all RFPs and contracts;
  • Require states to structure assessment, care coordination, and rate setting methodology to include financial incentives to achieve person-centered outcomes consistent with the principles of Olmstead and the ADA; and
  • Require states to commission an independent evaluation of their managed care programs and other integrated care models and include the findings and conclusions from this evaluation in a state’s renewal request.

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Social Security/Income Maintenance

Social Security is not only a retirement program. It is an insurance program to protect against poverty in retirement or as a result of disability or death of a family wage earner. The Social Security Act provides Old Age, Survivors, and Disability Insurance under Title II of the Act, Supplemental Security Income (SSI) under Title XVI of the Act, and related health insurance under Medicare (Title XVIII) and Medicaid (Title XIX). Approximately one-third of all Social Security checks go to non-retirees, including over ten million people with disabilities. These beneficiaries include workers with disabilities and people with disabilities who are dependents and survivors of disabled workers, retirees, and deceased workers. Many depend solely on their Social Security or Supplemental Security Income benefits and related health coverage for their basic survival. Discussions about Social Security reform, however, usually focus on retirement benefits and seldom address potential effects on people with disabilities in the retirement, disability, and survivors programs.

We support efforts to ensure the solvency of the Social Security Trust Funds over a 75-year time frame while preserving the program’s basic structure and strengthening its insurance functions. We do not support efforts to create private accounts out of the Social Security Trust Funds. The impact of the resulting market risk, benefit cuts, or additional trillions of dollars in deficits would be devastating for people with disabilities.

People with severe disabilities have experienced increasingly long delays and decreased service in accessing critical Social Security benefits for many years. Processing times grew, especially at the hearing level where delays reached intolerable levels. In some hearing offices, claimants waited more than two years to receive a hearing and decision. After years of advocacy efforts, Congress and the Administration began to devote substantial resources to reducing the backlog and the waiting times began to come down. However, with the recent economic crisis and the aging of the population, the Social Security Administration is receiving hundreds of thousands more applications than usual and the backlogs are growing and pressures in the claims and hearings offices are growing again despite the increased resources. Behind the numbers are individuals with disabilities whose lives have unraveled while waiting for decisions – families are torn apart; homes are lost; medical conditions deteriorate; once stable financial security crumbles; and many individuals die.

During the 114th Congress, our public policy goals are to:

Overall structure

  • Protect and expand the effectiveness of income support programs and their related health coverage programs in the Social Security Act, including the Old Age, Survivors, and Disability Insurance (Title II) programs, Supplemental Security Income (SSI) (Title XVI) program, Medicare (Title XVIII), and Medicaid (Title XIX);
  • Reject any proposal to privatize or otherwise diminish Social Security trust funds or revenues dedicated to the trust funds;
  • Support proposals to ensure the long-term solvency (over 75 years) of the Social Security Trust Funds through adjustments that spread the costs and preserve current and future benefits, through options such as expanding the earnings that are subject to the Federal Insurance Contributions Act (FICA), increasing FICA rates, or expanding the base of workers who participate in the Social Security system;
  • Reallocate Social Security payroll taxes to extend the solvency of the Disability Insurance Trust Fund after 2016;
  • Make adjustments to ensure the solvency of the Social Security programs through changes made outside of a deficit reduction context;
  • Reject proposals to increase the retirement age, change the benefit formula, reduce annual cost-of-living adjustments, or otherwise cut benefits;
  • Maintain the insurance protections of the Title II programs for people with disabilities; and
  • Recognize that intellectual disability, cerebral palsy, and most other developmental disabilities are lifelong conditions. Therefore, maintain SSI and Title II as cash assistance programs that are relevant and viable for children and adults with these conditions.

Definition of Disability

  • Reject any proposal that would further narrow the definition of disability and lead to the loss of critical supports and services for children and adults with significant disabilities; and
  • Increase the Substantial Gainful Activity (SGA) level at least to the level used for people who are blind.

Administrative Issues

  • Fully fund the administrative expenses of the Social Security Administration (SSA) to ensure that the service needs of the public are met, particularly for people applying for disability benefits and those who request a hearing;
  • Monitor changes in the process for determining disability and ensure the protection of claimants’ due process rights to an individualized decision, including the right to a full and fair administrative hearing by an independent decisionmaker who provides impartial fact-finding and adjudication;
  • Require the Social Security Administration (SSA) to minimize overpayments by establishing an efficiently working, beneficiary-friendly, system for collection of earnings reports and adjustments of benefits payments. Require SSA to waive non-fraudulent overpayments when SSA has failed to notify the beneficiary within a reasonable time period; and
  • Provide oversight to review and improve the representative payee system.

Supplemental Security Income

  • Substantially increase the resource limit for SSI to the level it would have been had it been indexed for inflation since inception. Annually index the SSI resource limit for inflation;
  • Increase the SSI earned and unearned income exclusions to the level they would be had they been indexed for inflation since inception, and index for inflation annually thereafter;
  • Extend continued Medicaid eligibility for SSI/Medicaid beneficiaries who earn their way into the Title II Disability Insurance program so that they may continue to have the supports necessary to work;
  • Permanently extend eligibility for SSI to refugees, asylees, and other immigrants who are disabled or elderly;
  • Enact a program to allow SSI beneficiaries to maintain resources dedicated for housing purposes; and
  • Ensure that SSI beneficiaries can participate in appropriate Individual Development Accounts, retirement plans (such as 401(k) accounts), and other similar accounts without jeopardizing their eligibility for SSI.

Retirement, Survivors, and Disability Insurance

  • Eliminate the 5-month waiting period for eligibility for Title II disability benefits and eliminate the additional 24-month waiting period for Medicare for Title II beneficiaries with disabilities;
  • Enact an earnings offset work incentive for Title II beneficiaries with features that parallel work incentives for the SSI program; and
  • Enact simplification of work incentives, including allowing on-going presumptive re-entitlement to Title II disability benefits and on-going eligibility for Medicare for those who lose benefits due to work but continue to be disabled.

Disabled Adult Child (DAC) Benefits

  • Improve requirements for “disabled adult child” eligibility to eliminate work disincentives;
  • Exempt Disabled Adult Child beneficiaries from the Family Maximum when they are not living in the household of the parent/spouse; and
  • To eliminate potential disincentives for adoption, ensure that individuals who adopt children with special needs are not affected by application of the family maximum with respect to those adopted children.

Employment Issues

  • Provide cash assistance outside of Social Security and SSI to assist working individuals with disabilities in meeting their disability-related costs, regardless of their income or assets;
  • With the aim that everyone should earn at least minimum wage, ensure that people who work in sub-minimum wage or wage-subsidized situations have FICA taxes paid on their behalf and receive appropriate work credits for Title II and Medicare eligibility;
  • Enact technical and substantive changes to the Ticket to Work and Work Incentives Improvement Act to ensure the Act operates as intended for our constituents; and
  • Ensure that beneficiaries have access to information about work incentives and employment services, benefits counseling, and legal advocacy under the Work Incentives Planning and Assistance (WIPA) and Protection and Advocacy for Beneficiaries of Social Security (PABSS) programs.

Other

  • Ensure adequate benefit levels and protect buying power through appropriate cost of living adjustments;
  • Provide workers who leave the workforce temporarily to care for a family member, including a child or adult with a disability, with a credit toward their future Social Security benefits (currently these workers receive no credit toward their Social Security benefits during the years they are out of the workforce for caregiving, which can greatly reduce any future Social Security benefits);
  • Eliminate marriage penalties in Social Security disability policy;
  • Permanently authorize the Social Security Administration’s authority to conduct demonstration programs, so long as beneficiaries are protected from any disadvantage as a result of participating in demonstration projects;
  • Exclude the AmeriCorps State and National and AmeriCorps National Civilian Community Corps program payments for purposes of determining Title II Disability program eligibility and benefit amounts; and
  • Support development of interdisciplinary teams of clinicians with specialized developmental and assessment expertise to provide expertise for adjudicators who determine eligibility for disability benefits.

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