BLOG : The Future of CDPAS with Trump as President

Like most people throughout the United States, we at Concepts of Independence have been working to digest and understand the consequences of the recent election. In my capacity as the Director of Policy for Concepts, the obligation to follow healthcare policy is my primary responsibility. So far, it's just too early to say definitively what will happen with President-elect Trump.

Since the election, very understandably, the disability community and many advocates are concerned about healthcare policies and budget priorities. As a community, we need to try push for the best solutions based on objective facts, and try not to work ourselves into a state of panic. We need to approach the new administration with a clear head and make smart policy arguments. 

Unfortunately, we can't say exactly what will happen. However, in the meantime, consumers, PAs, designated representatives, and all of our family and friends which support people with disabilities should continue to remain vigilant and ready to contact their elected officials at the drop of a hat. Make sure that you know exactly who represents you in Albany and Washington by visiting http://act.commoncause.org/site/PageServer?pagename=sunlight_advocacy_list_page

Below please find probably the most relevant communication about what a Trump administration could potentially mean for consumer directed services and Concepts of Independence in particular. This message is from Molly Murphy of Annkissam, LLC, Applied Self Direction, which is a company which provides policy recommendations, software and consulting to fiscal intermediaries.

T.K. Small

Statement from Molly Murphy

Annkissam, LLC

Applied Self Direction

As you know, last Tuesday Republican nominee Donald Trump was elected as the President of the United States.  Additionally, the Republican Party maintained control of both the House and the Senate.

We are working quickly to try to understand what the recent election will mean for self direction.  Little was shared from the Trump campaign prior to the election about specific plans for Health and Human Services (HHS) and Long-Term Services and Supports (LTSS) policies. We are therefore working to predict possible policy implications from documents released during or prior to the campaign, including Trump’s “Contract with America” (https://assets.donaldjtrump.com/_landings/contract/O-TRU-102316-Contractv02.pdf), and Speaker of the House Paul Ryan’s “A Better Way”, released in June 2016 (https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf).

A possible outcome is that Medicaid will no longer operate with Federal reimbursements based on state expenditures and instead Medicaid block grants will be created.  Speaker Ryan’s plan from June 2016 offers states a choice between a capped Federal allotment and a fixed per capita amount based on cost history and enrollment.  

We believe that self direction has strong fundamentals to thrive even within a Medicaid block grant approach.  When Cash & Counseling was piloted in Arkansas, then-Arkansas Republican Governor Mike Huckabee was a strong proponent for the model because of the individual choice and control, the efficiency, and its emphasis on personal responsibility.  Self direction is a strong model for a myriad of reasons, a majority of which are congruent with the principles set forth in Ryan’s “A Better Way.”

How plans to adjust or eliminate the Affordable Care Act (ACA) affect self direction is more difficult to determine.  First, it is not clear how deeply the new administration plans to cut into the ACA.  At an extreme, parts of the ACA which directly address self direction and Home and Community-Based Services (HCBS) could be eliminated, although Republicans have not thus far explicitly identified these provisions as priorities for repeal.  Repeal of the ACA Medicaid expansion, a measure which Republican lawmakers overwhelmingly favor, could affect individuals’ access to LTSS, but it would probably not affect those whose age and disability would make them eligible for Social Security Income (SSI).  

Advocates who have managed services in self direction programs have a history of promoting their expansion and preventing their erosion.  For example, in Wisconsin the IRIS (Include, Respect, I Self-Direct) program is a robust employer and budget authority self direction program. Since Republican Scott Walker became governor, advocates have worked closely with key Republican state lawmakers to ensure that relevant legislation contains definitions and practices which support self direction. IRIS continues today, growing at double digit rates each year.

In the coming weeks and months, we will lead efforts in the public and private sectors to educate policymakers about the benefits of self direction. In an environment where the political goals are likely to be positive health outcomes at the most affordable cost, coupled with the rights of individuals to make their own choices, we believe self direction has a strong future.  We plan to provide each of you with research, concise arguments and access to experts to help to ensure that at the state and local level self direction flourishes.

Regardless of the party in office, we know that individuals with disabilities and those who are aging rely on and deserve high quality services.  A model that delivers quality services in a cost effective way is important for all.

We look forward to speaking to each of you on our upcoming Membership meeting on November 28, 2016 at 3PM Eastern.  Please do not hesitate to reach out to us with questions, ideas or concerns in the meantime.

Best,

Mollie Murphy

Applied Self Direction