Advocating through the Night for Medicaid

 

I was proud to join advocates from DC and around the country yesterday for part of the 24-hour vigil for Medicaid, which is still going on as I write this blog post.  Besides the cuts being considered nationwide, the Energy and Commerce committee of the House of Representatives, where we in DC have no voting representation, is considering shifting the federal funding for Medicaid in DC from 70% to 50%, which would have devastating consequences.  

For now, it appears that the House committee has postponed its voting on the Medicaid cuts, but analysis has shown that in order to cut the government's budget deficit by $880 billion over the next ten years as directed by the House budget resolution, the House will indeed be cutting Medicaid, which is unacceptable.  So when you ask your friends and family living outside DC to write or phone their representatives NOW in opposition to Medicaid cuts, remind them to protect the cuts to DC Medicaid as well.  

They're coming for DC Medicaid too

Well, the celebrating over the past few days has been about Mayor Bowser's tentative deal with the Commanders to return to RFK Stadium (which still needs DC council approval).  At about the same time she was announcing that breakthrough, though, the mayor was also holding a press conference warning of the "dire impacts" of changes in the federal contribution to DC's Medicaid program that are being proposed by some in Congress.  This DC-specific proposal is part of a package of potential Medicaid cuts that I wrote about in my latest blog post.  Even though the mayor understandably focused on the consequences for local hospitals and health care, she mentioned that there would be effects on other programs, and as we know, this could affect our local disability supports as well.

The House of Representatives committee overseeing Medicaid will meet day after tomorrow to finalize these cuts, as described in this article.  While - as usual - we in DC have little ability to affect decisions that affect us directly, one thing you can do is look at this list of members of the House Energy and Commerce committee, and see if you know anyone in the districts they represent that you can ask to write in opposition to this DC-specific change, as well as any Medicaid reductions being considered in their own state.

We'll all been focused on the House's failure to restore its $1.1 billion in cuts to local DC funding in the current fiscal year, which continues to affect the mayor's presentation of next year's budget.  But these looming Medicaid cuts, if they go through, are even more significant because the effects will extend long before this year and hit the most vulnerable people in DC most directly.

So again, look at that list of members of the House Energy and Commerce committee, and generate those calls, letters and emails to them today and tomorrow!  There's no time to waste!

You Can Help Save Disability Protections Nationwide

NORMALLY MY BLOG IS OF MOST INTEREST TO PEOPLE WHO RESIDE IN DC, BUT THIS TIME THERE'S ESSENTIAL INFORMATION - AND A CALL TO ACTION - FOR THOSE OF YOU LIVING IN ONE OF THE FIFTY STATES!  PLEASE READ ON!

I won't lie to you:  this morning's Project ACTION! (https://www.facebook.com/dcprojectaction/) meeting was pretty discouraging.  

That's in part because the House is still on recess and we still don't know where we stand with DC's FY2025 budget.

But it was also discouraging to learn about the impact the Trump administration's FY 2026 budget passback for the US Department of Health and Human Services could have for essential disability supports nationwide, as explained here by the American Association of People with Disabilities.  

And this is where you - in DC but especially in places where you have voting representatives in the US Congress - can make a big difference - go to this page, fill it out, and also send it to your voting representatives.  SAVE ESSENTIAL DISABILITY ORGANIZATIONS THROUGHOUT THE US by making your voice heard NOW.

Here's Where We Stand with our Budget

 

Here I was with my message last Saturday (the other side of my sign said "Hands Off DC and Medicaid").  It was a good turnout, both here and in other cities around the country.

On the subject of our budget - The House of Representatives will go out on recess again today, for the next two weeks, without having passed the Senate bill protecting DC's FY2025 budget, so our relief continues to be postponed.  Hopefully things will look up for us when they reconvene toward the end of the month, but I can't help thinking the timing of this bill just passed by the DC council won't help us much.  This is a time for treading very carefully, not waving a red flag.  Hooray to Janeese Lewis George (who chairs the DDS/ODR committee) and Charles Allen for seeing that clearly!

From what I can tell, the mayor is still holding up presenting her FY2026 budget until we (hopefully) get House agreement on FY2025, so we really need to keep our eye on that ball.  

HANDS OFF DC APRIL 5!

 

The cherry blossoms were beautiful while they lasted, though most are sadly now gone with our recent rains.  Tomorrow, April 5, is the Petalpalooza celebration, but make sure you detour to the Washington Monument for the Hands Off rally starting at noon, and hold up high those "Hands Off DC Government" and "Hands Off Medicaid" signs!  

For the past couple of weeks, I had thought I would be writing about FY2026 budget hearings before the DC Council, but in light of the refusal by the US House of Representatives to pass the bill "allowing" DC to spend our own local tax dollars in this fiscal year (FY2025), everything about next year's budget has been postponed.  (If the House doesn't take action soon, we may be having to make abrupt cuts in this year's local spending.)

SO - GET OUT THERE TOMORROW AND SAY IT LOUDLY:  HANDS OFF DC GOVERNMENT!

The Upside and the Downside

Last night was a special evening, a time for celebrating community and recognizing the essential work of the Quality Trust in supporting DC residents with disabilities at their annual Better Together reception.  It was wonderful to spend time with Shawn Ullman, Quality Trust's CEO, and so many others involved in protecting and advancing disability rights every day - and it also was great to see Shawn's predecessor, Tina Campanella, who never misses an opportunity to visit us back here in DC when she can!

On a more sobering note, the DDS performance review last week, while examining DDS policies and actions over the past year, couldn't help but also touch on the nerve-wracking proposals, now making their way through the Congress, that could directly affect DC's overall finances as well as reduce federal Medicaid funding across the country.  Judging from today's news, risks to DC's budget may not even wait for next year, since the continuing resolution now under consideration would force DC to cut over $1 billion in spending between now and the end of September.

These risks to DC are the reason why I am so dismayed that different organizations concerned about our lack of national representation don't seem to be pulling together to fight the affronts to home rule that are right on our doorstep.  Each day I receive an email from a different organization, each wanting my support on behalf of DC's political rights.  But frankly it's dizzying - it's time, right now, for a united front among these various groups so I hope they will figure things out quickly, because our opponents are not waiting.  Here's a tip though:  The 51st continues to be a reliable source of information about our besieged future state (it WILL happen!), and it, at least, deserves your support if you're able to subscribe. Maybe they can do some research to help explain why we' have such a fragmented bunch of DC advocacy organizations...

Judy Heumann, Still Building Bridges!

In these trying times, it's a pleasure to get together with friends in a good cause.  So it was huge fun - not to mention informative - to be a part of Monday's event at UDC honoring Judy Heumann, national and local trailblazer for disability rights, who passed away on March 4, 2023.  Besides the inspiring videos and panels, there was an exciting announcement at the event, namely that Councilmember Frumin has introduced a bill to rename the Klingle Valley bridge on Connecticut Avenue in her honor.  Apparently a number of her neighbors at the Kennedy Warren apartment building had championed this idea.  DC's disability advocates, and the community at large, will want to turn out in support of this bill when it receives consideration by the DC council.  

Holding the Line on Home Rule

I promised in my February 11 blog post to give more air time to defending our DC democracy as well, and there are definitely efforts under way to undermine even DC's limited home rule. I'm doing my best to try to educate friends, especially in my home state of Tennessee, about the real DC and its longtime fight for democracy, but in this difficult moment, it helped me to get this encouragement from at-large DC Councilmember Christina Henderson:

Dear Neighbor,

“What have the people of the District done that they should be excluded from the privileges of the ballot box?” - Frederick Douglass, 1895 from his home in Anacostia 

It is not lost on me that at the same time our country is being thrust into a debate about the value of diverse and inclusive communities, and teaching the full scope of American history, that the District’s right to self-governance has also entered the chat. For over 130 years, this conversation about whether DC should have home rule has raged on, and though some are reluctant to admit it, race has always been a main character in the story. 

Most people do not remember that for much of the nineteenth century, Congress allowed residents in the District to elect their own local officials. At the time, however, only white, male landowners had the right to vote. Then in 1867, Black men were granted the right to vote in DC elections for the first time – yes, years before the passage of the Fifteenth Amendment. That was too radical for Southern members of Congress and elites in DC who were concerned about the growing political power of Black Washingtonians. And in 1874, they revoked home rule for everyone in the District. It was never about the Constitution. It was never about operations of government. Voting rights is always about power.  

What should you say to your family and friends who are probably asking your thoughts on the latest conversation? Tell them this – Washington, DC is a world-class city, home to 700,000 residents who are doing their best to live out the American dream just like everyone else. We are a beautiful mixed tapestry of cultures and lived experiences. We just had our 28th consecutive clean audit. Violent crime is down 30%. Our pensions are fully-funded. And our schools are award-winning. You’re always steps away from history, arts and culture, and the best libraries and parks in the country. And yes, our sports teams compete on the highest level. We relish in our role as host of national and international events, and fiercely protect the right of our residents and all Americans to exercise their First Amendment right in our town. No city is perfect and we do have some challenges to acknowledge, but this is my home – why shouldn’t I have the right to choose my representation and serve as a check on political power like all other tax paying Americans? 

The challenges that we currently face will not be our last, but we will continue to move forward and fervently hold onto the values and integrity of our city. Representing the District has been a profound honor and I will continue to defend her. I hope you will join me. 

And this from me again:  Don't sit on your hands!  We may not have representation (yet), but we have our voices, so use them to protect home rule right now!

Your Experience with DDS/DBH Coordination

DHCF head Wayne Turnage used his performance review testimony last week to talk about the troubling budget outlook for Medicaid, and there is no doubt that that that will be the big issue once the DC council starts budget hearings for FY 2026 later next month.  However, in the meantime, DDS still has not had its performance review hearing, scheduled for March 3.  As you know, I've been very focused in my blog recently on the kind of treatment people with disabilities receive when they get services from DBH.  Here is what DDS had to say in its pre-hearing questions on the subject of coordination with DBH:

28. Describe DDS’ collaboration with the Department of Behavioral Health. Include any specific partnerships on programs, initiatives, and events that DDS had with DBH in FY 24 and FY 25, to date.

In FY24 DDS and DBH collaborated to transition 147 DDS people to new behavioral health providers following the closure of the DBH Intellectual-Developmental Disability program at 35 K St.

In FY24, upon official notification that the 35 K St IDD clinic would be closing, DBH and DDS collaborated to ensure that patients were provided choice in the selection of new psychiatric service providers by: a. Collaborating on the official notification letters informing of the closing to ensure consistent messaging to CSAs, DDS service coordinators, DDS residential providers, guardians/decision makers, and patients. b. Identifying specific CSAs that had the capacity to take on the patients from 35 K St without delay, including the ability to schedule an intake within 7 days of referral. c. Requiring DDS service coordinators to work with the person and their interdisciplinary teams to choose a new psychiatry service provider.

DBH Provider Relations tracked 30- day, 60 -day, and 90- day follow-up appointments. Biweekly meetings between DBH Provider Relations and DDS Service Coordination were held throughout the transition to ensure patients were successfully placed with new providers. Currently, all DDS-linked patients have been placed with a new provider. DBH-IDD psychiatrist, Dr. Todd Augustus, has been available throughout the transition process to assist with questions/concerns and to consult with the 35 K St. Urgent Care Clinic on people with IDD who presented to UCC during the transition. In FY 25, DDS and DBH will continue this joint initiative to ensure that people with IDD receive high-quality and consistent behavioral health services. Dr. Augustus will provide ongoing consultative services to DDS and participate in interdisciplinary treatment team meetings for complex IDD cases, when requested. Dr. Augustus will also provide educational trainings to DDS and group home providers pertaining to mental health needs of IDD consumers through the DDS Nursing Roundtable. DBH and DDS have a well-established collaborative relationship which will continue to expand and evolve in FY 2025.

a. Does DDS encourage providers to contact DBH’s Community Response Team when an individual is in crisis or to contact 911?

The decision whether to call 911, the Community Response Team, or the Department of Behavioral Health (“DBH”) Assertive Community Treatment (“ACT”) team is made by the service provider, who acts based on the specific situation (i.e., whether there is a life-threatening emergency, or particular services are needed to ensure the safety of the person and staff). When 911 is called, a Crisis Intervention Officer (“CIO”) can be dispatched, meaning that a police officer with 40 hours of training in working with people who have mental illness and/or developmental disabilities will respond. Their training includes recognizing indicators that a person may have I/DD, communication procedures for people who have I/DD, and procedures for interacting with people who have disabilities. Two goals of the CIO program are to promote safe interactions between the police and citizens with mental health challenges and/or disabilities along with diversion of nonviolent mentally ill individuals, including people with dual diagnosis, from the criminal justice system to appropriate behavioral health services. Since June 2021, District 911 operators have been trained to identify situations involving mental health crises and to assess whether a police response is appropriate or whether they should redirect the call to the Community Response Team. Providers can also contact the Community Response Team directly or request DBH ACT services for people who receive those services as part of their mental
health treatment.

b. If someone receiving supports from both DBH and DDS needs housing and
supports, how do DBH and DDS work together to meet their needs?

DDS considers the suitability of the person’s current housing situation for meeting the person’s needs and, if necessary, explores the housing resources offered by DBH, DDS or other agencies. When a person requires individualized housing to promote their mental health recovery, DBH and DDS collaborate with the person’s ACT Team and the core service agency to identify housing options, rental subsidies, and community based behavioral health treatment services. If necessary, DDS will contact the Director of the DBH Housing Development Division or the Director of Residential Services and Supports to identify rental subsidies for the person. If the person receives housing supports from DBH and requires supports in the home and in the community, the DDS service coordinator works with the person and their circle of support to identify the appropriate waiver services based on the person’s assessed needs. The person selects a DDA provider for the service.

If you've had direct experience with DDS/DBH coordination, how has that worked out?  The DDS performance review hearing is an opportunity to testify and let the committee know what you've experienced - even if you can only send written testimony.

And if this isn't your topic but you plan to testify about some other aspect of DDS performance over the past year, you can take a look at all the committee questions, with DDS answers, here.by clicking here.

DC DBH Hearing and Follow-up

In my January 28 entry, I encouraged readers to participate in Georgetown's survey about the interactions of people with disabilities with DC DBH (what's that? check here: Terms) and to participate in the then-upcoming performance review hearing for DBH.  I was happy to testify at the hearing - here's my testimony - and proud to be joined by two members of Project ACTION! as well as a concerned family member, who described direct interactions with DBH.  (Others were, I know, submitting written testimony as well.)  

What struck me in the hearing was that not only people with developmental disabilities, but quite a few others who testified about their direct experiences with CRTs, CPEP (Terms) or one of DBH's community service providers, had encountered insensitive or poorly trained staff who made them feel misunderstood or dismissed.  There was substantial discussion throughout the performance review, during testimony by public witnesses on February 3 and also in questions to DBH director Bazron on February 5, about inadequate staffing, as well as difficulties in reaching the Access Helpline and poor CRT response times.

Despite the evident need for improvement in DBH services, budget challenges are going to loom large in the upcoming fiscal year in all the DC government programs overseen by Deputy Mayor Wayne Turnage, who will address some of these funding concerns in his February 20 testimony this coming week.  These concerns will continue to be a prominent feature of budget hearings throughout the spring.