Advocates for people with disabilities flooded the Cannon House Office Building in Washington, D.C., Monday to protest the GOP 2012 budget proposal (PDF), authored by Rep. Paul Ryan (R-Wis.), which includes approximately 35 percent in funding cuts to Medicaid and a complete overhaul of the program by turning the states’ federal shares into block grants.

More than 300 members of disability advocacy group ADAPT occupy the rotunda in the Cannon House Office Building to protest GOP-proposed Medicaid cuts in the 2012 budget (photo courtesy of ADAPT).

Mike Ervin, an organizer for the national disability-advocacy group ADAPT and founder of its Chicago branch, is one of about 300 protesters from 25 different states who traveled to Capitol Hill to tell congressional leaders how Ryan’s proposal would impact the disability community.

“The idea of block granting really scares us, because a lot of people with disabilities rely on Medicaid in order to stay out of institutions,” Ervin said. “Block granting … gets rid of the idea that people are entitled to a minimun amount, no matter what their situation is. Now there will be less money available.”

For decades now, members from ADAPT and its state affiliates have made the trip one week every spring to Capitol Hill to lobby for or against legislation and to demand equality for people with disabilities (the group was instrumental in pushing for the passage of the Americans with Disabilities Act).

Of the 300 people circling the rotunda in the Cannon Building, Ervin said about 200 of them are in wheelchairs. One aspect of the proposal to block-grant Medicaid that worries ADAPT, he said, is that there might not be enough money for all recipients to purchase the medical equipment and medicine they need.

In addition to a “health care tax credit,” Rep. Ryan has proposed providing Medicaid beneficiaries with about $11,000 that can be applied to health care costs but has made an exception for states’ “long-term care and disabled populations,” which would not receive the tax credit. Instead, each state would receive a block grant of that portion of Medicaid funds.

“This change allows States maximum flexibility to tailor their Medicaid programs to the specific needs of their populations,” reads Ryan’s Roadmap Plan.

ADAPT does not agree and believes what will happen is that more Medicaid recipients with disabilities — most of whom lack steady jobs or another source of income — will be forced to move out of their communities and into institutions.

“We feel if they are really serious about the cost of Medicaid, they ought to do exactly the opposite of what Ryan is proposing,” said Ervin, who has muscular dystrophy and is mostly paralyzed from the neck down but is able to live at home with his wife because his home state of Illinois chooses to pay for his long-term care services through Medicaid.

Courtesy of ADAPT

Members intend to crowd the House building until they are spoken to by congressional leaders, Ryan or the president or until they are arrested. Their message to leaders will be to reject the idea of block-granting Medicaid and to require all states to make long-term care services (providing people with disabilities the opportunity to get care in their homes rather than in institutions) a mandated rather than optional Medicaid benefit.

UPDATE: At about 6:30 p.m. EST, Capitol police began arresting ADAPT members who refused to leave the rotunda. The organization released a brief statement as the arrests began:

Tonight, Capitol Police have begun arresting ADAPT members from all over the country, who have remained in the Cannon House Office Building since midday. The ADAPTers want Representatives Paul Ryan, John Boehner and Michelle Bachmann to publicly withdraw their support for Medicaid budget cuts and Medicaid state block grants. Without this commitment, ADAPT has decided to make a point that we are willing to do whatever it takes to defend the right of people with disabilities and seniors to live in our homes, not nursing homes and institutions. It is unacceptable for our own government to treat the 60 million Americans who rely on Medicaid like garbage.

Ervin told TAI that  about 100 people have been arrested so far, many of them chanting “I’d rather be in jail than in a nursing home!” He said Ryan sent his chief of staff to speak wit the protesters but that Speaker of the House John Boehner refused to speak to the organization. Representatives who talked to the group and listened to their demands included: John Lewis (D-Ga.), Danny Davis (D-Ill.), Jan Schakowsky (D-Ill.), and Barney Frank (D-Mass.).

The Idaho House Wednesday voted down a bill that amends an existing law related to early childhood and early intervention services.

What’s telling is that the bill flew through the Senate 27-8 three weeks earlier, when it was sponsored by Republican Sen. Tim Corder. But in the House, where the bill was sponsored by Democratic Rep. Phylis King, the bill lost 52-12.

The Associated Press account of the story characterizes the failed bill as a measure that would “help children with special needs get access to early intervention services.”

Actually, the measure in question just updates existing code related to the Early Childhood Coordinating Council previously created by an executive order from former Gov. Dirk Kempthorne.

Corder said the bill created some controversy in terms of language changes, for example, swapping out “children with disabilities” to “special needs,” and making the age restrictions broader (“infants and toddlers” to “young children”), making some members in both chambers believe the definition as to who would have access to these services was being expanded. However, Corder said he had heard, as AP reported, that the reason for slamming down on the measure was retaliation.

According to the AP, Rep. Mark Shirley has openly stated that the Republican intent was to punish Democrats for delays in the House. Corder said that he’s heard from his Republican colleagues in the House that Democrats have been forcing full readings of bills on the floor and extending debates, which delay their passage.

House Rep. Eric R. Anderson, a Republican, said “it appeared” that the bill failed because of retaliation, but it is not why he voted no.

The Equal Employment Opportunity Commission last week published the guidelines as to how to define a disability under the latest version of the Americans with Disabilities Act of 1990, which was amended in 2008 as the ADA Amendments Act.

The document published in the Federal Register includes the final revised ADA act and interpretative guidelines, which, according to an EEOC release, are ”designed to simplify the determination of who has a ‘disability’ and make it easier for people to establish that they are protected by the Americans with Disabilities Act.” The regulations go into effect May 24.

In the most current version of the act, “disability” is defined as a “physical or mental impairment that substantially limits one or more life activities of such individual.” In other words, a disability was always considered to be constantly “debilitating.” The new regulations maintain the ADA’s definition of disability, but major changes come from how the terms “impairment” and “life activities” are interpreted. With the new language, “impairment need not prevent or severely or significantly restrict performance of a major life activity to be considered a disability. Additionally, whether an impairment is a disability should be construed broadly, to the maximum extent allowable under the law.”

Impairments that are in remission or are episodic, such as cancer or epilepsy, can now be interpreted as “substantially restricting the performance of a life activity”  when the condition is active.

Under the regulations, “major life activities” include “major bodily functions,” such as functions of the immune system, normal cell growth, and brain, neurological, and endocrine functions. The rules document clarifies that not every impairment will be considered a disability and gives clear examples, such as HIV infection, diabetes, epilepsy and bipolar disorder.

Formerly, the burden of proof was on the worker to prove he or she suffered from a condition that required certain accommodations; now it will be up to individual employers to make certain they have not overlooked any condition or disability that could be covered under the law.

A census estimate (PDF) from 2005 found that of all Americans, 16.5 percent of people aged 21 to 64 had some level of disability; 45.6 percent of this group was employed.

In its preliminary estimation of the effects of the amended ADA, the EEOC, predicted that the new regulations would increase the pool of those considered to be workers with disabilities by 160,000 people; but further analysis and input from academics and experts raised that estimation to between 12 million and 38.4 million new disabled workers.

The EEOC further estimates that the broadened definitions will lead to between 400,000 and 1.2 million new accommodations employers will be required to provide, which is estimated to cost between $60 million and $183 million annually. The commission notes that many of these accommodations will be low-cost, such as allowing breaks or making small modifications to office equipment.

“Just as the ADAAA [ADA Amendments Act]  was the result of a considerable bipartisan effort by Congress, the final rule represents a concerted effort of EEOC Commissioners representing both parties to arrive at regulations that hold true to that bipartisan Congressional intent,” said EEOC Commissioner Constance S. Barker in a press statement. “I was pleased to have been able to vote in favor of the final rule.”

Read the full analysis and implications of the regulations here.

Law firm Seyfarth Shaw LLP provides a list of implications for employers, essentially suggesting new tactics for fighting lawsuits. These include:

• “Defendants are far less likely to prevail in court by arguing that an individual is not disabled and therefore is not covered under the ADA and/or does not require accommodation. “
• Now more than ever, employers must focus on reasonable accommodation, and on whether an individual with a physical or mental condition is otherwise qualified to perform essential job functions, with or without reasonable accommodation.”
• “Lawyers defending ADA cases in court must, in most cases, wean themselves off arguing that the plaintiff is not disabled … the employer must typically focus its arguments on accommodation – it made accommodation, the plaintiff failed to request accommodation, the plaintiff declined accommodation, the plaintiff failed to participate meaningfully in the accommodation process, etc.”
• “The class action epidemic that continues in most parts of the country will now likely expand further to encompass mass actions under ADAAA. Some such actions will be brought by the EEOC under pattern and practice theory. Others will be filed by plaintiffs seeking class certification under Rule 23. … The EEOC’s repudiation of that approach could well mean a rise in class cases, e.g., by numerous individuals with a particular impairment, or numerous individuals having various impairments – all of them now protected.”

Seniors and people with disabilities who receive health care through Medicare* might have an additional service covered in the near future: testing for sexually transmitted diseases such syphilis, gonorrhea and hepatitis B, according to a Reuters report. Centers for Medicare and Medicaid Services (CMS) is due to decide on the measure within the next nine to 12 months.

Government-funded health insurance already covers HIV testing, but now CMS is looking into paying for additional STD exams, in an effort to promote preventative care and reduce the amount spent on costly treatments for people who do become infected.

CMS spokesperson Don McLeod said that under the Affordable Care Act, Medicare has to cover what other private insurers cover if the government deems these procedures appropriate and necessary. Cost of the increased coverage is never factored into CMS’ determination, he said.

“Somebody else has to worry about how to pay for it.”

The tests up for consideration -– chlamydia, gonorrhea, hepatitis B and syphilis -– target people considered to be high risk for these diseases: women, pregnant women and people with disabilities.

The Centers for Disease Control and Prevention estimates:

• Approximately 1.2 million chlamydial infections were reported in 2008, though the disease is frequently under-reported because many people don’t know they have chlamydia and do not seek testing. In women, untreated infections can increase the risk of HIV, cause pelvic inflammatory disease, and lead to infertility or pregnancies outside the uterus.
• More than 700,000 Americans contract new gonorrheal infections each year, but only about half of these infections are reported to the CDC. A pregnant women with gonorrhea can give birth to a baby who is blind or has a life-threatening blood infection.
• In 2007, there were an estimated 43,000 new hepatitis B virus infections in the U.S., and an estimated 800,000 to 1.4 million Americans have chronic hepatitis B.
• More than 36,000 cases of syphilis were reported in 2006. Reported cases of congenital syphilis in newborns increased from 339 in 2005 to 349 in 2006. Pregnant women with syphilis are at greater risk at giving birth to stillborns. Rates have increased in men every year between 2000 and 2006 from 2.6 to 5.7 percent. In 2006, 64 percent of reported syphilis cases were among men who have sex with men.

According to Reuters, since 2009 CMS has had the power to add coverage for preventive services; currently Medicare covers pap smears and pelvic exams and tests for colorectal cancer and diabetes.

Furthering preventative care, the Department of Health and Human Services announced Thursday that it will allocate $100 million to states that offer incentives to Medicaid beneficiaries who adopt healthy habits, as part of the Affordable Care Act. For instance, a state could establish a set of goals -– such as quitting smoking or losing weight -– and people who meet those goals could be offered direct cash incentives, gift cards, reduced Medicaid program fees or even services not normally available through Medicaid.

“With the right incentives, we believe that people can change their behaviors and stop smoking or lose weight,” said CMS Administrator Dr. Donald Berwick, in a press release. “Not only can preventive programs help to improve individuals’ health, by keeping people healthy we can also lower the nation’s overall health care costs.”

The Centers for Medicare & Medicaid Services is now inviting proposals from states to compete for grant awards for this legislatively mandated Medicaid Incentives for Prevention of Chronic Diseases Program. The program will target behaviors that cause some of the most critical chronic conditions Americans face: smoking (kills 430,000 people a year, according to HHS), obesity, heart disease, and diabetes. States’ notices of intent are due April 4; applications are due May 2.

Seniors and people with disabilities who receive health care through Medicare* might have an additional service covered in the near future: testing for sexually transmitted diseases such syphilis, gonorrhea and hepatitis B, according to a Reuters report. Centers for Medicare and Medicaid Services (CMS) is due to decide on the measure within the next nine to 12 months.

*Earlier we stated that additional STD coverage could be extended to Medicare and Medicaid beneficiaries, but only Medicare beneficiaries would be affected.

On Tuesday, the U.S. Health and Human Services Department announced the 13 states that will be collectively receiving $45 million in grants for implementing the Money Follows the Person demonstration program this year. Recipients are: Colorado, Florida, Minnesota, New Mexico, Idaho, Maine, Massachusetts, Mississippi, Nevada, Rhode Island, Tennessee, Vermont, West Virginia. An additional $621 million is committed to these states through 2016. These are the newest states to join this program, established by the Obama administration in 2005; currently 29 other states and the District of Columbia participate.

“Our country recognized in the Americans with Disabilities Act that everyone who can live at home or community-based setting should be allowed to do so,” said HHS Secretary Kathleen Sebelius in press statement. “The Affordable Care Act provides states critical new dollars toward achieving that goal.”

All states will have access to a pool of $3.7 billion if they follow HHS rules to provide long-term services through the Community First Choice Option program. The goal of this program is to encourage states to make community living a “first choice” for Medicaid beneficiaries who need long-term care, rather than just placing people in the first available institution. Starting in October, states that comply with the rules (PDF) will get a 6 percent increase in federal matching funds through 2014. (To qualify for the matching increase, states must develop “person-centered plans” that outline how services will be provided to maintain the independence of each individual. Additionally, states must develop a council to implement these plans that must comprise people with disabilities, elderly individuals, and their representatives.) The idea of both programs is to help people with physical and/or mental disabilities live more independently, but with services and support.

Obama’s ambitious Money Follows the Person program (MFP) has thus far served fewer than originally anticipated. The 29 original states were given their grants in 2007, and many began their programs a year later with a combined goal of moving out approximately 38,000 residents by 2013. But by 2010, less than 5,800 residents had been moved nationally, according to Kaiser Health News. The Kaiser Commission on Medicaid and the Uninsured has been evaluating the program since it was implemented. The commission found that as of 2010, about a dozen states moved fewer than 60 people; Louisiana only moved 10. And Texas had the most success, moving 2,029 out of nursing homes and other facilities.

But according to the HHS, to date MFP has helped 12,000 individuals move out of institutions and back into their communities. The grants issued Tuesday are expected to help another 13,000 people.

The program was supposed to expire in 2011, but through the passage of the Affordable Care Act, it was extended through 2016. The act also loosened some of the program’s eligibility rules that were making it harder to transition people. MFP grants are distributed to states by the Centers for Medicare & Medicaid Services (CMS), which has to approve each state’s plan.

Some of the details:

• Minnesota received the most: $13.4 million for the first year and $187.4 million through 2016.
• Florida received $4.2 million and $35.7 million through 2016.
• Colorado  was awarded $2 million; $22.2 million through 2016.
• New Mexico was at the bottom of the 13-state stack,  getting $595,839 for the first year and $23.7 million through 2016.

Laura traces Palin’s history of opposition to abortion and ties it to what has become one of her central messages on the stump: her understanding of children with disabilities, embodied at many of her rallies by her infant son, Trig, who has Down syndrome.

It’s a strong piece on an under-reported topic. Get the rundown here.