cdcan NEWS REPORT The
President's proposed $2.9 trillion spending plan for the federal
budget year 2008 (Note: the California budget year begins July 1 and ends
June 30) unlike in previous years however, faces a Congress controlled
by the Democrats, who are likely to reject many of the proposed
reductions. The proposed federal spending plan received criticism
from Republican Governor Arnold Schwarzenegger in a statement released
Monday afternoon.
Medicare Provider Cuts &
Medicaid Home Equity Proposed Changes Significant
Report
#020-2007 February 6, 2007 - Early Tuesday Morning
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Proposed Federal Budget for 2008
* SIGNIFICANT CUTS TO MEDICARE & MEDICAID PROPOSED
* MEDICARE PROVIDERS & RECIPIENTS BOTH IMPACTED
* VALUE OF HOME WOULD LIMIT MEDICAID ELIGIBILITY
* DEMOCRATIC CONGRESS LIKELY TO RESIST MANY CUTS
* GOVERNOR EXPRESSES CRITICISM OF BUSH BUDGET
SACRAMENTO - The proposed federal spending plan, for the budget
year that begins October 1, 2007 through September 30, 2008, was
released by President George W. Bush on Monday (February 5), and would
make significant long term reductions to Medicare, Medicaid, housing
and other programs impacting people with disabilities, mental health
needs and seniors
* Though the spending reductions represent about 2 or 3% of the total
Medicare and Medicaid budget, disability, mental health, senior and
low income advocates are sounding the alarm to oppose the President's
proposed spending cuts as significant, especially at a time that the
nation and the State is focused on the issue of health care. Proposed
savings or spending reductions impacting Medicare providers and
savings will have a significant impact - if enacted - on Medicare
health facility providers and others who serve people with
disabilities, mental health needs and seniors.
* Likewise, a proposal in the proposed federal budget to eliminate the
option by the states to increase the $500,000 home equity limit for
Medicaid eligibility to $750,000, and instead limit equity to $500,000
would have a major impact on hundreds of thousands of people with
disabilities, seniors and others in California if enacted [note:
though no official legislative language was released, it is presumed
that the house equity limits would apply to people who come up for "redetermination"
or a review of their Medi-Cal eligibility. California has not yet
issued any regulations or change in State law regarding home equity
limits, including upping the limit to $750,000].
[CDCAN Editor's Note: A CDCAN "Advocacy Without Borders" Townhall
Telemeeting is scheduled Tuesday, February 6th at 1 PM to 2:30 PM
featuring the head of the California Medicaid (Medi-Cal) program, Stan
Rosenstein. The townhall is free and open to the public - and is
organized to provide a way for people with disabilities (including
developmental), mental health needs, seniors, their families, workers,
community organizations and other advocates to have direct access to
public policy. Go CDCAN website for free toll free number or dial
toll free number: 1-800-608-4143 Note: there is NO passcode.]
2007 Federal Budget Still Not Yet Final
The US Senate is still finishing up work on making permanent - with
changes made by the Democrats in both houses, the temporary federal
budget for 2007 that was originally passed last December by the then
Republican controlled Congress. Congress in December, unable to agree
on a final budget for 2007, passed a temporary spending plan to keep
the federal government operating at least until February 15, 2007.
The Democratic controlled House of Representatives, joined by 57
Republicans, voted on January 31 to approve HR 20, which included
increases for housing (public housing authorities). [see CDCAN Report
2/1 for more details]
Governor Raises Concern On President Bush's Proposed Budget Cuts
Gov. Arnold Schwarzenegger issued a statement late Monday and saying
that "Over the next several days, we will be analyzing the impact
that the President's budget would have on California. However, several
issues stand out immediately" adding that it was "...encouraging that
the budget recognizes the need to spend more on the Healthy Families
Program to provide health insurance for uninsured children. But what
the budget calls "reforms" in Medicaid reimbursements are straight
transfers of federal costs onto state budgets. I plan to work with our
delegation to make sure these cost shifts aren't enacted."
It is not clear however what increases the Governor was referring to,
given the proposed spending for the State Children's Health Insurance
Program, fell far short, especially when combined with proposed cuts
to Medicare and Medicaid, of what most advocates believe would be
needed to fund the programs in the states.
The Governor - who has been at odds with President Bush over several
policy issues in the past year, said that the President's proposal to
eliminate the program that reimburses states for the costs of
incarcerating undocumented immigrants is "unacceptable"
"This program has bipartisan support in the Congress and with my
fellow governors who have to bear the costs of a failed federal
immigration policy. Working together, I'm confident that these funds
will be restored to the budget, as they have in the past."
The Governor was also critical of budget reductions in the area of
Homeland Security and Urban Areas Security Program, saying that these
programs "...help our first responders protect our major
cities...These programs are critical to helping California prevent
against and respond to threats against some of the world's most
recognized cities here in California, as well as our ability to
respond quickly and effectively to a disaster."
There was no official comment available from the Legislative
Democratic leadership.
CDCAN SUMMARY: MAJOR FEDERAL BUDGET PROPOSALS FOR 2008
MEDICAID 2008 BUDGET PROPOSALS
* Medicaid (called Medi-Cal in California) provides health coverage
to about 50 million people with disabilities, low income seniors, the
blind and people who meet eligibility requirements under the old "Aid
to Families with Dependent Children or AFDC" (called "CalWORKS"in
California). In 2007, 5 million seniors 65 and over, 8.5 million are
blind or persons with disabilities (including developmental), 11.1
million are needy adults and 23.5 million are needy children.
* In California, about 6.8 million people are on Medi-Cal, with about
1.6 million of that number persons with disabilities, seniors or the
blind. This includes people who receive In-Home Supportive Services,
many regional center funded community-based services, persons in
developmental centers, many persons in skilled nursing and other
health facilities, and also includes thousands who are eligible for
both Medi-Cal and Medicare services.
* President Bush proposes legislative and budget proposals that call
for $1.9 billion in savings (spending reductions) in the budget year
2008, and about $13 billion over 5 years. In addition to that is a
total of -$1.5 billion in Medicaid "administrative" savings (or
spending reductions) for 2008, with -$12.7 billion over 5 years.
Altogether, that spending reductions or savings to Medicaid proposed
by President Bush amount to $3.4 billion for budget year 2008, and
over $25.7 billion covering 5 years. The total Medicaid budget for
2008 will be $204 billion, representing a 6.3% increase overall ($12
billion) in spending from 2007.
* The President's proposed budget would slow the average annual
Medicaid growth rate over the next 5 years from 7.3% a year to 7.1% a
year.
* The proposed federal budget will include legislation that will
continue the efforts of the "Deficit Reduction Act of 2005" (passed
February 2006 by Congress and signed into law by the President)
according to the Bush Administration to "restrain unsustainable growth
rates in this vital program"
MEDICAID PROPOSALS IMPACTING THE STATE, PROVIDERS & OTHERS
* Streamline Administrative Reimbursement Match Rates to the
states at 50% [Savings or spending reduction of -$945 million for
2008, and -$5.315 billion over 5 years]
* TANF - Deducts (recoups) Medicaid administrative costs in the
Temporary Assistance for Needy Families (TANF) block grant to the
states [Savings or spending reduction of -$280 million in 2008 and
-$1.8 billion over 5 years]
* Targeted Case Management - Would put federal reimbursement
for Targeted Case Management (TCM) at the standard administrative
matching rate of 50% federal funds to the states. [Savings or
spending reduction of -$200 million or -$1.2 billion over 5 years]
* Pharmacy Medicaid Reimbursement - would reduce federal upper
reimbursement limit for multiple source drugs to 150% of the average
manufacturer price of the lowest priced drug in the group. [Savings or
reduction in spending of -$160 million and -$1.2 billion over 5 years]
* Optional Managed Drug Formulary - would allow the states to
use private sector management procedures to leverage bigger discounts
through negotiations with drug manufacturers. [Savings or reduction in
spending of -$160 million and -$870 million over 5 years]
* 1915(b) Waiver Period - would extend the renewal period for
1915(b) "freedom of choice" Medicaid waivers from 2 to 3 years.
* Government Provider Payments - would recover Medicaid funds, through
new regulations or sub-regulatory "guidance", that are diverted from
government providers and retained by the state. Would also propose to
cap payments to government providers to no more than the cost of
furnishing services to Medicaid recipients. [Savings or spending
reduction of -$530 million in 2008, and -$5 billion over 5 years]
* School Based Services - planning administrative actions
effective 2008 budget year, to phase out Medicaid reimbursements for
some services provided in schools, including transportation and
administrative claiming. [Savings or spending reductions of -$615
million or -$3.6 billion over 5 years]
* Graduate Medical Education - through administrative action,
would clarify in the 2008 budget year that Medicaid will no longer
fund the Graduate Medical Education program. The Bush Administration
says in its budget plan that "paying for [the Graduate Medical
Education Program] is outside of Medicaid's primary purpose, which is
to provide medical care to low income populations".
* 1915(b) Services - budget proposal announces proposed
regulation that would clarify which services provided under 1915(b)(3)
of the Social Security Act will be allowed. [no savings or spending
reductions in budget]
* "Pay and Chase" Pharmacy Claims - would issue through
administrative process, requirement that the states uphold the "cost
avoidance" standard for pharmacy claims, and eliminates waivers that
permit "pay and chase". [no savings or spending reductions in budget]
* Provider Tax Clarification - would issue through
administrative process, a clarification of how Congress originally
intended the "provider tax" limitations to operate. [Note: the Tax
Relief and Health Care Act of 2006 set the maximum rate at which a
state can tax its health care providers at 6%, in effect on November
1, 2006. Beginning January 1, 2008 though federal budget year 2011,
the rate will be temporarily reduced to 5.5%. [no savings or spending
reductions in budget]
MEDICAID PROPOSALS IMPACTING PEOPLE WITH DISABILITIES, SENIORS
* Home Equity (Value of Home Impacting Eligibility) - would remove
the option by the states to increase the $500,000 home equity limit
for Medicaid eligibility to $750,000, by proposing to codify the
substantial home equity definition at $500,000. [Savings or spending
reduction of -$70 million in 2008, and -$430 million over 5 years]
* Asset Verification - would expand the Social Security
Administration pilot using electronic financial records for verifying
a Medicaid (Medi-Cal) applicant's assets to appropriate US Health and
Human Services programs. State Medicaid programs (Medi-Cal in
California), would be required to establish pilots in locations where
the Social Security Administration is operating such pilots.
[Savings or spending reduction of -$65 million or -$640 million over 5
years]
* Third Party Liability - Would make changes to current federal
law by allowing the States to avoid Medicaid costs for prenatal and
preventive pediatric claims where a third party (such as insurance) is
responsible; would allow the states to collect for medical child
support where health insurance is "derived" from a non custodial
parent's obligation to provide coverage, and to authorize the states
to recover Medicaid (Medi-Cal) costs from Medicaid (Medi-Cal)
recipient liability settlements. [Savings or spending reduction of
-$10 million in 2008 and -$85 million over 5 years]
* Transitional Medical Assistance (TMA) - would extend his
program to September 30, 2008. The program allows families to remain
eligible for Medicaid for up to 12 months after they lose welfare (CalWORKS
in California) cash benefits due to increased earnings. The Tax
Relief and Health Care Act of 2006 passed and enacted last year
extended the TMA program to June 30, 2007, and the budget proposal
extends it to September 2008. [Increase in spending $460 million in
2008 and $665 million 2008-2012]
* Qualified Individuals Program (QI) - would extend through
September 30, 2008, assistance for Qualified Individuals who are
Medicare recipients with incomes at least 120% (and less than 130%) of
the federal poverty level and who have limited financial resources.
This extension will continue federal coverage of Medicare Part B
premiums.
* Refugee Exemption - would extend the Social Security
Administration budget proposal (impacts Medicaid), from 7 to 8 years
the exemption for refugees and those who have been granted asylum in
the US, time to complete their citizenship application process without
penalty.
* Rehabilitation Services - would propose federal regulation
that "clearly define" allowable services that may be claimed as
rehabilitation services, which are optional Medicaid (Medi-Cal)
services that persons with special needs or disabilities are typically
offered. [Savings or spending reduction of -$230 million or -$2.3
billion over 5 years]
STATE CHILDRENS HEALTH INSURANCE PROGRAM 2008 BUDGET PROPOSAL
Created by the federal Balanced Budget Act of 1997, under Title XXI
of the Social Security Act. Is a partnership between the federal and
state governments that helps provide health care coverage for children
under 19 years old.
* SCHIP, called "Healthy Families" in California, can cover children
whose families have incomes too high to qualify for Medi-Cal
(Medicaid) but too low to afford their own health insurance.
* In 2006 about 6.6 million children across the nation were enrolled
in the various SCHIP programs, including about 750,000 to 800,000
children in California. In California, the income limit for families
is 250% of the federal poverty level ($42,925 for a family of three)
* Authorization for the federal program expires at the end of the 2007
federal budget year (September 30, 2007) unless renewed (reauthorized)
* Reauthorization of SCHIP - The President's proposed budget
calls for reauthorizing SCHIP every 5 years and provides for about $5
billion over five years for additional allotment funds, "consistent
with submission of a five-year Budget to the Congress, and focuses
each of the program elements on SCHIP's original objectives to provide
health insurance coverage for uninsured, low income children at or
below 200%. of the federal poverty level." (200% of the federal
poverty level is $34,340 for a family of three). [President proposed
$1.2 billion for 2008 and $5.9 billion over 5 years]
* Advocates have raised concerns that the funding levels in the
proposed budget for 2008 fall far short of what is needed by the
states to fund their children's health programs and could result, they
fear, in hundreds of thousands of children being forced off the
program.
MEDICARE 2008 BUDGET PROPOSALS
* Medicare is a federal program that provides
health insurance to 44.6 million persons who are either 65 years or
older, or have disabilities or suffered from ESRD
(End-Stage-Renal-Disease).
* President Bush's proposed budget for 2008 includes a package of
legislative proposals that include savings (or reductions) that total
- if approved, $4.3 billion for the budget year 2008 and $65.6 billion
over five years. The proposed budget reduces beneficiary plans
premiums by $5.6 billion over five years.
The total Medicare budget for 2008 will total $454 billion.
* The Medicare spending reductions increase further by including
further cuts in Medicare administrative savings, estimated at $1
billion for the budget year 2008, and $10.2 billion in savings (or a
reduction in spending) over 5 years. Medicare administrative savings
(or reduction in spending) will result, according to the President's
proposal, from "new efforts to strengthen program integrity in
Medicare payment systems, correct for inappropriate provider payments,
and adjust payments to encourage efficiency and productivity." These
administrative savings include implementation of the "Tax Relief and
Health Care Act of 2006" passed by Congress and signed by the
President last year.
* Total savings in Medicare (administrative and those new savings or
reductions proposed for 2008) total $5.3 billion for the budget year
2008, and $75.9 billion over five years. This includes reductions for
oxygen rentals payments of $110 million in 2008 (reduction of $2.4
billion over 5 years), reductions for power wheelchair rentals ($70
million in 2008, $530 million over 5 years), reduction in skilled
nursing facility payments (updates) $1 billion in 2008 and $9.2
billion over 5 years, reduction in home health agencies updates or
payment totaling $410 million in 2008 and $9.7 billion over 5 years.
See "Medicare Providers" for more information.
* The proposed federal budget would reduce Medicare average annual
growth rate over 5 years from 6.5% to 5.6%.
MEDICARE PROPOSALS IMPACTING MEDICARE PROVIDERS
* Hospitals - would reduce update or payment increase by
-0.65% every year beginning in the 2008 budget year (that begins
October 1, 2007) [Savings or reduction of -$720 million in 2008 and
-$13.8 billion over 5 years.]
* Hospices - would reduce update (payment increase) to hospices
by -0.65% every year beginning 2008 [Savings or reduction of -$60
million in 2008 and $1.1 billion over 5 years]
* Outpatient Hospital - would reduce update to outpatient
hospitals by -0.65% every year beginning 2008 [Savings or reduction of
-$120 million in 2008 and -$3.4 billion over 5 years]
* Ambulance Services - would reduce ambulance fee schedule
payment increase or update by -0.65% beginning 2008 [Savings or
reduction of -$10 million in 2008 and -$360 million over 5 years]
* Skilled Nursing - Proposes zero percent or no increases in
updates (rates) for skilled nursing facilities in the 2008 budget
year, and a reduction of -0.65% to the update each year after that.
[Savings or reduction of -$1 billion in 2008 and -$9.2 billion over 5
years]
* Inpatient Rehab Facilities - Proposes zero percent or no
increases in updates (rates) inpatient rehabilitation facilities in
the 2008 budget year, and a reduction of -0.65% to the update each
year after that. [savings or reduction of -$230 million in 2008, and a
total of -$1.9 billion over 5 years]
* Home Health Agencies - Proposes zero
percent or no increases in updates (rates) for home health agencies in
the 2008 budget year through 2012, and a reduction of -0.65% to the
update every year after that. [Reduction or savings of -$410 million
in 2008 and -$9.7 billion over 5 years]
* Ambulatory Surgical Centers - Proposes reducing the annual
update (increase in rate payment) for ambulatory surgical centers by
-0.65% beginning in budget year 2010. [Totals savings or reduction of
-$90 million over 5 years]
* Competitive Bidding - would introduce competitive bidding for
clinical laboratory services [reduction or savings of -$110 million in
2008 and -$2.4 billion over 5 years]
* Bad Debt Payments - would eliminate bad debt reimbursements
for unpaid Medicare beneficiary cost sharing over 4 years for all
providers. Currently, Medicare pays 70% of unpaid co-pays and
deductibles to hospitals and skilled nursing facilities. [Savings or
reduction of -180 million in 2008, and -$7.1 billion over 5 years]
* Provider Sequester Order - proposes a provider "sequester
order" of - 0.4% to all Medicare provider payments when general fund
contributions exceed 45%. The sequester order would increase each year
by 0.4% until general revenue funding is brought back to 45%.
"Sequester" , according to the US Department of Health and Human
Services, means the reduction of funds to be used for benefits or
administrative costs from a federal account based on the requirements
specified in the Gramm-Rudman-Hollings Act (also known as the
Balanced Budget and Emergency Deficit Control Act of 1985). [No budget
savings or reductions in the budget regarding this. proposal]
* "Never Events" - would prohibit Medicare payment for "never
events" (preventable events that include surgery on a wrong body part)
and would require hospitals to report occurrences of these events or
receive a reduced annual update (rate increase). Savings or reduction
of -$30 million in 2008 and -$190 million over 5 years]
* "Tax Relief and Health Care Act of 2006" calls for
increasing payment rates for End-Stage Renal Disease or ESRD
facilities by 1.6% beginning April 1, 2007, and that is included in
the President's proposed budget. That Act also eliminated the
previous -5% reduction in Medicare physician payments scheduled for
2007, and replaced it with a zero percent (no increase) update
instead. In addition, a 1.5% bonus payment is established for doctors
who report quality measures in 2007. The Act in 2007 extends the
floor for the labor costs of doctors in certain rural areas, and
establishes a "Physician Assistance and Quality Initiative Fund"
totaling $1.35 billion in 2008 to promote doctor payment and quality
improvement initiatives in 2008.
* "Deficit Reduction Act of 2005" passed and signed by the
President in February 2006, requires hospitals to report an expanded
set of 21 quality measures required by the Centers on Medicare and
Medicaid Services (CMS) or see their payment updates (increases)
reduced by 2% and is part of the President's budget proposal for 2008.
MEDICARE PROPOSALS IMPACTING MEDICARE RECIPIENTS
* Post Acute Care - proposes to move to site neutral post
hospital payments to limit what the Bush Administration calls
"inappropriate incentives" for five post-acute conditions commonly
treated at both skilled nursing facilities and inpatient
rehabilitation facilities. [Savings or reductions of -$470 million
and -$2.9 billion over 5 years]
* Power Wheelchair Rentals - would establish a 13 month rental
period for power wheelchairs that the Bush Administration says is
being done to "...ensure that Medicare and its beneficiaries no longer
pay excessively for the purchase of equipment that could have been
rented". [Savings or reduction of -$70 million in 2008 and -$530
million over 5 years]
* Oxygen Rentals: would reduce the rental period for most
oxygen equipment from 36 months to 13 months, which the Bush
Administration says will "lower Medicare and beneficiary spending".
[Savings or reductions of -$110 million in 2008 and -$2.4 billion over
5 years]
* Medicare Part B Premium Indexing - would eliminate annual
indexing of income thresholds for reduced Part B premium subsidies
beginning January 1, 2008. Medicare Part B helps pay for doctors
services, outpatient hospital care, durable medical equipment, and
some medical services that aren't covered by Medicare Part A.
[Savings or reductions of -$543 million in 2008 and $7.1 billion over
5 years]
* Medicare Part D Premium Subsidies - would eliminate annual
indexing and reduce Part D premium subsidies based on the same income
limits (thresholds) that apply to reduced Part B premium subsidies.
[Savings or reductions of -$357 billion in 2008 and -$3.2 billion over
5 years]
* Kidney Dialysis or Transplant Medicare Recipients - Would
extend Medicare as Secondary Payer status for Medicare recipients
(beneficiaries) with ESRD or permanent kidney failure requiring
dialysis or transplant, from 30 months to 5 years for large
employers. ESRD (End-Stage Renal Disease) means permanent kidney
failure requiring dialysis or a kidney transplant. [Savings or
reductions of -$160 million in 2008 and -$1.1 billion over 5 years.
Note: the "Tax Relief and Health Care Act of 2006" calls for
increasing payment rates for End-Stage Renal Disease or ESRD
facilities by 1.6% beginning April 1, 2007, and that is included in
the President's proposed budget.]
* Federal Clearinghouse of Data - Would require group health
plans (and other 3rd party payers) to report Medicare as Secondary
Payer information and create a federal clearinghouse for data sharing
with other federal health insurance programs (including the Federal
Employees Health Benefits, Veterans Affairs) to identify health care
situations where Medicare may not be responsible as the primary
payer. [Savings or reductions of -$50 million in 2008 and -$640
million over five years]
* Mandamus Jurisdiction Limit - Proposes to mandamus
jurisdiction as a basis for obtaining judicial review, and clarify the
Secretary of the Department Health and Human Services authority to
resolve appeals of Medicare determinations (eligibility). "Mandamus
jurisdiction" is an order (writ) issued by a superior court ordering a
public official or body or a lower court to perform a specified duty.
For instance, "Mandamus" may be used to compel the directors of a
corporation to produce the books for inspection in the manner provided
by law or to compel a lower court to accept a suit it has illegally
refused. "Mandamus" is an extraordinary remedy and will not be issued
if the usual remedies are available. No savings or reductions in
2008, but -$80 million over a 5 year period (2008-2012).
OTHER PROPOSED REDUCTIONS - PROPOSED BUDGET 2008
Note: more federal budget updates, especially on housing, will be
released in a CDCAN Report, as details become available.
COMMODITY SUPPLEMENTAL FOOD PROGRAM
Provides additional food packages valued less than $20 per month
for over 440,000 very low income seniors.
* What President proposes for 2008: Terminate program
LIHEAP (LOW INCOME ENERGY ASSISTANCE PROGRAM)
Provides to several million low income families, seniors and people
with disabilities assistance to afford to heat their homes in the
winter. In California this program implemented by community-based
organizations (including Community Action Agencies), overseen by the
Department of Community Services and Development (CSD) under the
California Health and Human Services Agency.
* What President Proposes for 2008: Would cut LIHEAP program by $420
million (19%) below the level of funding that Congress is expected to
approve this month (the House already approved last week the 2007
level of funding), adjusted for inflation.
COMMUNITY BASED SERVICES, HOUSING
* Public housing (no details) would be reduced by $377 million
(5.9%) below the 2007 spending level (the spending level as passed by
the House last week), before adjusting for inflation. [Note: the
House of Representatives approved HR 20, on January 31, 2007, which
increases funding for public housing under Housing and Urban
Development Department (HUD) for the federal budget year 2007. The
President's proposal is for the 2008 budget year that begins October
1, 2007]
* Supportive Housing for the Elderly and People with Disabilities
proposed reduction of $269 million (28%) below 2007 level.
* Social Services Block Grant - proposed reduction of this
block grant of $4.4 billion over 10 years. The grant provides
critical funding for the states for services for people with
disabilities (including developmental), low income children and
families, seniors.
* Head Start - funding for this early child education program
would be cut by $100 million from the (expected) 2007 funding level.
* Preventive Health Services Block Grant is proposed for
elimination in the 2008 budget. The block grant helps fund state and
local agencies with addressing or prevention various health issues
including obesity and lead poisoning.
Help Continue CDCAN News Reports, Alerts and Townhall Telemeeting
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The California Disability Community Action Network is a non-partisan network connecting tens of thousands of Californians in every community, including people of color, people of every type of disability, including people with physical disabilities, people with developmental and other disabilities, people with traumatic brain and other injuries, people with mental health needs, seniors, people with MS, Alzheimer's and others, and families, community organizations and providers, in-home, direct care and other workers, and other advocates.
MANY THANKS to Training Toward Self Reliance, UCP, California NAELA, Californians for Disability Rights, Inc (CDR), Parents Helping Parents, Arriba, Strategies To Empower People, Parents Helping Parents, Asian American parents groups, Resources for Independent Living and many other Independent Living Centers, several regional centers, People First chapters, IHSS workers, other self advocacy and family support groups, developmental center families, and hundreds of individuals. Thanks also to partnerships and the good people with the State Council on Developmental Disabilities, and also the Department of Health Services, the Department of Developmental Services, Department of Social Services and the CA Health and Human Services Agency and other agencies, and the State Legislature and staff, the Legislative Analyst Office.