 March 6, 2006 Dear Budget Committee Member: The Consortium for Citizens with Disabilities (CCD) urges you to reject proposals in the Administration’s FY 2007 budget that would have an extremely negative impact on the health and long term care of children and adults with disabilities and their families. CCD is a coalition of national disability organizations working together to advocate for national public policy that ensures the self determination, independence, empowerment, integration and inclusion of children and adults with disabilities in all aspects of society. We represent individuals facing a wide range of impairments including mental illness, epilepsy, diabetes, physical disabilities, sensory disabilities, traumatic brain injuries, and mental retardation. Access to health and long term supports that lead to these goals is critical. Medicaid Medicaid programs across the country are facing increasing financial pressures, many of which result from changes in federal policies. These cost pressures threaten the ability of states to provide life-saving health and long-term services to more than 9.4 million people with disabilities. The Deficit Reduction Act of 2005 is projected to reduce federal Medicaid spending by $4.7 billion over the next five years. This represents a significant cost shift to states and low-income Medicaid beneficiaries. In 2006, Congress should not exacerbate the financing pressures on Medicaid by calling for additional Medicaid savings. Key legislative provisions in the President’s FY 2007 budget proposal to save an additional $4.9 billion over the next five years are misguided and would severely harm individuals with disabilities. These include the President’s proposal to reduce federal support for Targeted Case Management Services (TCM). TCM is a critical Medicaid service that is essential to the ability of states to meet key policy goals for Medicaid, such as moving people with disabilities out of costly institutions and into cost-effective and more appropriate community-based alternatives. The loss of these critical services would be particularly harmful to children and adults with mental illness. Further, the proposal to allow states to use more restrictive formularies in their Medicaid programs could not be more counterproductive. Under current law, state Medicaid programs have an appropriate range of tools to safely, appropriately, and effectively manage the Medicaid pharmacy benefit. States can—and do—use prior authorization and other utilization management tools to -manage the pharmacy benefit and promote the prescribing and dispensing of the most cost-effective drugs. At the same time, individual Medicaid beneficiaries retain a right to obtain the full range of FDA-approved drugs when they can demonstrate their clinical need. This is a balanced policy that promotes the interests of both Medicaid beneficiaries and the federal government. Eliminating this essential consumer protection would do nothing to lessen the need for pharmaceuticals, but could only lead to abuses where medically necessary drugs are denied which may lead to increases in other physician and hospital costs paid by Medicaid. Medicare The President proposes significant cuts to Medicare, largely through fee freezes or reductions to hospitals and other providers, as a way of further reducing entitlement spending. With so many major improvements critically needed in the Medicare program, these proposals are misplaced. Putting aside the merits of whether these providers can tolerate these fee reductions, Congress should be focused on fixing the problems with implementation of the Part D drug benefit, extending reasonable treatment of Medicare beneficiaries whose outpatient therapy needs exceed the caps set to apply in full force next year, averting a significant decrease in the physician fee schedule, and modifying the "in the home" restriction under the durable medical equipment benefit so that people requiring wheelchairs are not confined to the four walls of their homes. Without these types of meaningful improvements to the Medicare program, CCD believes that further restrictions in funding to the Medicare program would be ill-advised at this time. Disability Related Health Programs CCD also strongly urges you to reject the significant cuts in the President’s budget for discretionary spending for critical disability-related health programs. If these cuts are accepted, not only would children and adults with disabilities lose access to important services but efforts to prevent and/or ameliorate disability would be set back. The budget proposes to eliminate several important programs located in the Health Resources and Services Administration (HRSA). Among these are the Traumatic Brain Injury (TBI) state grant program and the TBI protection and advocacy program. It is difficult to comprehend eliminating funds for the TBI programs considering that a very large percentage of the almost 17,000 soldiers wounded in the Middle East have TBIs. In addition, critical HRSA child-health programs, such as the Universal Newborn Hearing Screening program, Emergency Medical Services for Children, and Health Professions Training grants have been targeted for elimination. The Administration also proposes to zero out important disability programs at the Centers for Disease Control, including the Epilepsy Public Health program, which is the only federal program solely concerned with documenting the scope of epilepsy as a national health problem and addressing the impact of epilepsy on individuals and their families. Also targeted for elimination is the CDC Preventive Health and Health Services Block Grant, which has been the primary source of flexible funding to states to address the national health objectives in the Healthy People 2010 health improvement plan. Federal funding for important mental health programs is also in jeopardy. The administration is proposing a 4 percent cut to the Center for Mental Health Services -- on the heels of cuts last year to mental health funding. The demand for mental health services and supports has increased due to the many returning veterans facing Post Traumatic Stress Disorder and the many victims of Hurricane Katrina facing a variety of mental health problems. Again, we urge you to reject cuts to important health and health related programs that help make life better for millions of children and adults with disabilities and their families. Thank you for your consideration. Alexander Graham Bell Association for the Deaf and Hard of Hearing For further information please contact CCD’s Health Task Force Co-Chairs:
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