The Deficit Reduction Act of 2005

P. L. 109-171

(analysis by The Disability Policy Collaboration,

a collaborative effort of The Arc of the U.S. and United Cerebral Palsy)

President George W. Bush signed the Deficit Reduction Act (DRA) of 2005, also known as the budget reconciliation act, into law on February 8, 2006. Below is a summary and the effective dates of the major provisions affecting people with disabilities, by topic, in the following order: Medicaid (Long Term Services and Supports; Cost Sharing; Health Care; Eliminating Waste, Fraud, and Abuse in Medicaid; Transportation; and Katrina Relief), Supplemental Security Income, and Temporary Assistance for Needy Families.

MEDICAID

Many of the changes to the Medicaid program are established as options for the states. Regardless of the effective dates indicated in the Act, those provisions that create new state options for Medicaid will not be come effective until the state has fulfilled the requirements under state law for changes to its Medicaid state plan. Where possible, some states will likely prepare their state plan amendments in advance, so that new options are in effect on the first possible date under federal law. As we learn details of the Administration’s plans regarding implementation, including rulemaking and issuance of policy guidance, we will update the information below with relevant information.

Long Term Services and Supports

The Deficit Reduction Act includes a number of provisions affecting long term services and supports. The provisions of most interest to people with disabilities include the following:

Section 6086: Expanded Access to Home and Community-Based Services for the Elderly and Disabled

Section 6086 contains the provisions from Title II of S. 1602, the Improving Long-Term Care Choices Act, introduced by Senators Charles Grassley (R-IA), Evan Bayh (D-IN), and Hillary Clinton (D-NY) with the support of the disability community. These provisions of Section 6086 will: establish a new option for states to provide home- and community-based services (HCBS) without states needing to use a waiver process; allow states to provide any of the services now covered under HCBS waivers; and require states to establish stricter eligibility (level of care) criteria for institutional services than for community-based services. In addition, states may continue to provide services through their existing waiver programs.

However, this section is overshadowed by new state flexibility provisions. Section 6086 allows states to cap the number of people to be served under the new home and community services Medicaid option. It allows states to provide these services in limited areas of the state and explicitly allows states to maintain waiting lists for these services. If the state decides to establish new eligibility criteria in the future, HCBS beneficiaries who do not meet new criteria would have grandfathering protection, but for as little as one year from the date the beneficiary first received the service.

Essentially, this combination of new state flexibility provisions maintains the states’ entitlement for federal reimbursement for allowed expenditures while it eliminates the individual’s entitlement to these services. Since the services will be state-plan option services, rather than waiver services, the federal government will no longer have a role in periodically approving these services.

It is unclear whether the states’ new authority to establish cost-sharing for services will also apply to these non-institutional long term services and supports.

Section 6086 will become effective on January 1, 2007.

Section 6071: Money Follows the Person Rebalancing Demonstration

Section 6071 establishes a Money Follows the Person Rebalancing Demonstration to provide incentives for states to move people from institutions to community settings. The states are eligible for two- to five-year competitive grants which will provide an enhanced federal medical assistance percentage (FMAP) for services to an individual for the first year after the individual moves out of an institution to the community. The enhanced FMAP will be equal to the state’s regular FMAP plus half of the difference between the regular FMAP and 100 percent. No state may receive more than 90 percent federal match.

Appropriations are made for grants beginning on January 1, 2007 through September 30, 2011, as follows:

· $250 million for January 1 through September 30, 2007 of fiscal year 2007;

· $300 million for fiscal year 2008;

· $350 million for fiscal year 2009;

· $400 million for fiscal year 2010; and

· $450 million for fiscal year 2011.

Amounts unspent remain available for awarding of grants to states not later than September 30, 2011.

Section 6087: Optional Choice of Self-Directed Personal Assistance Services (Cash and Counseling)

Section 6087 establishes a new state option for self-directed personal assistance services, also known as “cash and counseling.” This provision requires that self-directed personal assistance services be provided based on a written plan of care and budget for people who would otherwise be eligible for personal care services under the State’s Medicaid plan or home- and community-based waiver services. The section prohibits use of self-directed personal services for beneficiaries who live in homes or property owned, operated, or controlled by a service provider. Individuals using this new option are allowed to hire, fire, supervise, and manage the people providing the services and, if the state allows, may use family members to provide the services.

This section will become effective on January 1, 2007.

Section 6063: Demonstration Projects Regarding Home and Community-Based Alternatives to Psychiatric Residential Treatment Facilities

Section 6063 establishes a five-year demonstration project for up to 10 states to test the effectiveness in improving or maintaining a child’s functional level and cost-effectiveness of providing home- and community-based alternatives to psychiatric residential treatment for children.

The program is authorized for fiscal years 2007 through 2011.

Section 6011: Lengthening Look-Back Period; Change in Beginning Date for Period of Ineligibility

Section 6011 makes significant changes to the rules affecting transfers of assets for less than fair market value for people applying for Medicaid coverage of long term services and supports. Transfers of money or property for “less than fair market value” often include transfers or cash gifts to other family members, payment for education of grandchildren, and donations to charitable organizations, among other ordinary transactions. The new provisions extend the “look-back” period from three years (previous law) to five years and change the beginning date for the period of Medicaid ineligibility to the date on which the individual would otherwise be eligible for Medicaid.

These changes effectively mean that any transfers made for less than fair market value in the five years before an individual would otherwise be eligible for Medicaid will be treated as if the individual still has the property or funds available to use to pay for their long term support needs. The new provisions require states to establish a hardship waiver process with an appeals process. Undue hardship is defined as when the transfer of assets provisions would deprive the individual of medical care so that health or life would be endangered or would deprive the individual of food, clothing, shelter, or other necessities of life.

These provisions are effective on Feb. 8, 2006.

Section 6014: Disqualification for Long Term Care Assistance for Individuals with Substantial Home Equity

Section 6014 establishes an upper limit for the excluded value of a home when determining the value of an individual’s assets for purposes of Medicaid eligibility. An individual will not be eligible for Medicaid nursing or other long-term care services if the equity interest in his/her home exceeds $500,000. States may increase the equity limit, but may not exceed $750,000.

Beginning in 2011, the dollar limits will be increased yearly consistent with increases in the consumer price index. The equity limits will not apply if the individual’s spouse, child under 21, or disabled adult child lives in the home. The provision does not prevent individuals from using reverse mortgages or home equity loans to reduce equity value. The Secretary of Health and Human Services will establish a hardship waiver process.

The provision applies to individuals who are determined eligible for nursing or other long-term care services based on an application filed on or after January 1, 2006.

Section 6021: Expansion of State Long Term Care Partnership Program

Section 6021 allows all states to develop Long Term Care Partnership programs, beyond the original four states - California, Connecticut, Indiana, and New York. These partnership programs allow individuals who have exhausted benefits of their private long-term care insurance to access Medicaid without the same means-testing requirements as other applicants. To qualify, states and the insurance plans must meet extensive federal requirements outlined in the provisions.

The provisions become effective in a state no earlier than the first day of the calendar quarter in which the state plan amendment was submitted to the Secretary of Health and Human Services.

Cost Sharing

Section 6041: State Option for Alternative Medicaid Premiums and Cost Sharing

Section 6041 creates a new state option allowing states to increase cost sharing for any group of Medicaid beneficiaries subject to certain limitations. States must submit “State Plan Amendments” to the U.S. Department of Health and Human Services seeking approval of such cost sharing increases. Cost sharing can be imposed and/or increased for any item (e.g. prescription drug, durable medical equipment) or service (e.g. hospital stay, doctor’s visit, occupational, physical, or speech therapy session).

Under this option, states can require a premium (defined as “any enrollment fee”) and/or cost sharing (defined as a “deduction, co payment or similar charge”), subject to certain/beneficiary income limitations:

• For beneficiaries with incomes below 100% of the federal poverty level (FPL) ($9,800 – individual/$13,200-couple): the law is not explicit. HHS Secretary Leavitt has indicated that no state plan amendment that requires these beneficiaries to pay more than nominal (currently up to $3.00) co-pays will be approved.
• For those with incomes between 100 – 150% of the FPL ($9,800 – $14,700/individual; $13,200 – $19,800/couple):
• No premium; and
• Cost sharing cannot be more than 10% of an item or service overall (including prescription drug cost sharing).
• For those with incomes over 150 percent FPL:
• No Premiums for: those in hospitals, ICF/MR residents, nursing homes, (i.e. anyone on a personal needs allowance (PNA)); and
• Cost sharing cannot be more than 20 % of cost of item or service.

It is important to note that total cost sharing amounts are capped for all of the above groups at five percent of total family income for a month or quarter (time period to be determined by the state). This means that total cost sharing amounts (for all items, including prescription drugs and services) cannot be more than five percent of the individual or family’s income per month or quarter.

Section 6041’s “enforceability” provision is one of the most problematic for beneficiaries with disabilities. Under this provision, states may allow Medicaid providers to deny any “care, item or service” to a Medicaid beneficiary who fails to pay a co-pay. That means that a pharmacist can refuse to fill a prescription if the beneficiary doesn’t pay the co-pay, the doctor or speech therapist can refuse a beneficiary any item or service (e.g. prescription drug, doctor’s visit, physical therapy session, etc). Providers can apply this provision on a “case by case basis”.

The HHS Secretary must increase nominal cost sharing amounts every year by the annual percentage increase in the medical care component of the consumer price index, beginning in 2006.

The effective date of this provision is March 31, 2006.

Section 6042: Special Rules for Cost Sharing for Prescription Drugs

This section allows states to impose higher cost sharing to non-preferred (typically brand name) medications to encourage the use of preferred (typically generic) drugs, subject to the following limitations. States have the authority to decide which drugs are preferred versus non-preferred. For non-preferred medications, beneficiaries whose income is below 150% FPL cannot be charged more than nominal cost sharing (currently up to $3.00) per medication. States can reduce or waive co-pays for preferred drugs. For beneficiaries whose income is 150% or above FPL, co-pays for non-preferred drugs cannot exceed 20 percent of the drug’s cost.

Section 6042 includes a provision allowing a state to waive these rules if a physician determines that a preferred drug is not effective or causes adverse health effects, the state can charge the preferred (generic) co-pay amount for a non-preferred (brand name) drug.

The effective date for this provision is March 31, 2006.

Section 6043: Emergency Room Co-payments for Non-Emergency Care

This section creates another state option permitting states to submit a state plan amendment allowing hospitals to impose cost sharing for non-emergency services (defined as “any care or services furnished in the emergency department of a hospital that the physician determines do not constitute an appropriate medical screening examination or stabilizing examination and treatment required to be provided by the hospital”) provided in hospital emergency rooms, if they follow strict notice requirements. This provision requires that the beneficiary receive a medical screening (as defined in Medicare law) and a determination by the emergency room that the beneficiary does not have an emergency medical condition. Before non-emergency care is provided, the beneficiary must be told that:

• the hospital can require a co-pay before the non-emergency service is provided;
• the name and location of an alternate non-emergency provider (that is available and accessible) that may charge a lower co-pay;
• the alternate non-emergency provider can provide the services with a lower or no co-pay;
• the hospital will provide a referral to coordinate scheduling of the treatment.

Alternate non-emergency providers include physicians’ offices, health care clinics, community health centers, and hospital outpatient departments. Such providers must be able to diagnose or treat a condition “contemporaneously” - i.e. within the same amount of time as a hospital emergency room would have taken to provide the non-emergency services.

Co-pays for non-emergency services in an emergency room for beneficiaries under 100% FPL cannot be more than twice the nominal amount (i.e. currently $6.00 – twice the nominal $3.00 limit).

Section 6043 becomes effective on January 1, 2007.

Health Care

Section 6044: Use of Benchmark Benefit Packages

This provision gives states the option to provide “benchmark” or “benchmark-equivalent” health care benefits to certain beneficiary groups which may be more limited. Under this option, children must continue to receive Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefits – either directly or through a benchmark or bench-mark equivalent plan.

The benchmarks are the Federal Employee Health Benefits Plan standard Blue Cross/Blue Shield preferred provider option, any state employee plan generally available in a state, the HMO plan that has the largest, commercial non-Medicaid enrollment in the state, or a any plan which the Secretary of the U.S. Department of Health and Human Services deems appropriate.

Children and adults with disabilities who are eligible for Medicaid on the basis of disability are exempt from this provision. On the other hand, children and adults with disabilities who qualify for Medicaid on the basis of income, not disability, are included in this provision. For example, it appears that a person with a disability which is not severe enough to qualify for SSI, but who is eligible for Medicaid on the basis of income, would be covered by this provision.

This provision is effective March 31, 2006.

Section 6062: Family Opportunity Act

Inclusion of the Family Opportunity Act (FOA) in the Deficit Reduction Act ends the disability community’s seven year battle to enact this bi-partisan bill, which Senate Finance Committee Chairman Charles Grassley (R-IA) and Sen. Edward M. Kennedy (D-MA) have championed. Under Section 6062 of the DRA, states are allowed to provide a phased-in option, giving parents of children with severe disabilities whose income is at or below 300 percent of the federal poverty level (approximately $60,000 for a family of four) the ability to buy into Medicaid. Under this provision, states can require cost-sharing (premiums and co-pays) but cannot exceed five percent of family income up to 200 percent of the federal poverty level, and 7.5 percent of family income from 200-300 percent of federal poverty.

This section becomes effective for items and services provided on or after January 1, 2007. The section applies to children under age 19 and is to be phased in, beginning with the youngest children, as follows:

· Beginning on Jan. 1, 2007 through Sept. 30, 2007 (the last three quarters of fiscal year 2007) – children born on or after Jan. 1, 2001;

· Fiscal year 2008 – children born on or after Oct. 1, 1995; and

· Fiscal year 2009 – children born after Oct. 1, 1989.

The state may choose to phase in coverage more quickly in fiscal years 2007 and 2008.

Section 6064: Development and Support of Family-to-Family Health Information Centers

This provision requires the HHS Secretary to develop these centers, through grants, contracts, or otherwise, in at least 25 states in FY 2007, 40 states in FY 2008, and all states, including the District of Columbia, in FY 2009. Such centers will provide information to parents of children with disabilities and special health needs so that they can make informed decisions about health care (e.g. treatment decisions, cost effectiveness, and improved health care for their children including available resources, identify successful health care delivery models, develop a model for collaboration between health care professionals and these families, and provide outreach and training to health care professionals and other appropriate entities).

Funds available for the Centers are as follows:

• $3 million for fiscal year 2007;
• $4 million for fiscal year 2008; and
• $5 million for fiscal year 2009.

The funds remain available until expended.

Section 6065: Restoration of Medicaid Eligibility for Certain SSI Beneficiaries

Section 6065 establishes that Medicaid eligibility for children (under age 21) will occur on the latter of the date of application or the date SSI eligibility is granted. This eliminates requirements that the child wait until the beginning of the following month.

This section becomes effective on February 8, 2007.

Eliminating Waste, Fraud, and Abuse in Medicaid

Of interest to people with disabilities, their families, and their service providers are a number of provisions that were added to the Medicaid program to help prevent or detect waste, fraud, and abuse, including:

Section 6032: Encouraging the Enactment of State False Claims Acts

Section 6032 provides financial encouragement to states to have in effect a law dealing with false or fraudulent claims that meets certain federal requirements. If states have such a law in place, when recoveries are made for Medicaid funds improperly paid, the share owed to the federal government will be decreased by 10 percentage points.

This provision will be effective on January 1, 2007.

Section 6033: Employee Education About False Claims Recovery

Section 6033 requires states to ensure that any entity receiving Medicaid payments of at least $5 million per year must establish written policies with information about the federal False Claims Act; state laws regarding civil or criminal penalties for false claims and statements; and whistleblower protections with respect to preventing and detecting fraud, waste, and abuse in federal health care programs.

This provision is effective on January 1, 2007. The exception is for states requiring state legislation to comply with this provision. These states will not be found non-compliant before the first quarter after the next regular session of the state legislature after enactment.

Section 6035: Medicaid Integrity Program

Section 6035 would establish a Medicaid Integrity Program in which the Secretary of the Department of Health and Human Services contracts with eligible entities to: review actions of individuals or organizations providing items and services reimbursed by Medicaid; audit payment claims; identify Medicaid overpayments to individuals or organizations; and educate service providers, managed care organizations, beneficiaries, and other individuals regarding payment integrity and benefit quality assurance issues.

Eligible entities must: have demonstrated capability to carry out the activities; agree to cooperate with the Inspector General of HHS, the Attorney General, and other law enforcement agencies in investigation and deterrence of fraud and abuse; comply with federal acquisition and procurement conflict of interest standards; and meet other requirements specified by the Secretary.

Funds are appropriated as follows:

• $5 million for fiscal year 2006;
• $50 million each for fiscal years 2007 and 2008; and
• $75 million for each fiscal year thereafter.

Amounts are available until expended.

The Secretary of HHS must increase by 100 the number of full-time equivalent employees whose duties consist solely of protecting the integrity of the Medicaid program by providing support and assistance to states.

The HHS Office of Inspector General is to receive an additional $25 million for each of fiscal years 2006 through 2010 for Medicaid integrity work and such amounts remain available until expended.

In addition, the Secretary shall ensure that, beginning in 2006, the Medicare-Medicaid Data Match Program (commonly known as the Medi-Medi Program) is conducted to identify program vulnerabilities, coordinate activities to protect the federal and state share of expenditures; and increase the effectiveness and efficiency of both programs through cost avoidance, savings, and recoupments of fraudulent, wasteful, or abusive expenditures. Funds are appropriated for expansion of the Medi-Medi Program as follows:

• $12 million for fiscal year 2006;
• $24 million for fiscal year 2007;
• $36 million for fiscal year 2008;
• $48 million for fiscal year 2009; and
• $60 million for fiscal year 2010 and each fiscal year thereafter.

Where the Secretary determines that a state requires legislative action to comply with requirements of the new fraud and abuse provisions, the state will not be found non-compliant before the first quarter after the next regular session of the state legislature that begins after enactment. (Where a state has a two-year legislative session, each year will be considered a separate regular session of the state legislature.)

Section 6036: Enhancing Third Party Identification and Payment

Section 6036 would require states to determine if third party liability exists (in order to avoid the use of Medicaid funds) for additional entities: self-insured health plans; pharmacy benefit managers; and other parties legally liable by statute, contract, or agreement for payment of a health care claim or services. These organizations would be prohibited from taking an individual’s Medicaid status into account in enrollment or making payments.

This provision is effective on January 1, 2007. The exception is for states requiring state legislation to comply with this provision. These states will not be found non-compliant before the first quarter after the next regular session of the state legislature after enactment.

Section 6037: Improved Enforcement of Documentation Requirements

This section requires individuals to present documentation of citizenship or nationality when they apply for Medicaid benefits. Failure to present such documentation will make them ineligible for Medicaid services. Documentation includes: a U.S. passport, Certificate of Naturalization (or other document specified in Immigration and Nationality Act), a birth certificate, valid driver’s license, or other documentation which the U.S. Secretary of Health and Human Services specifies is proof of U.S. citizenship or naturalization.

Section 6037 becomes effective for eligibility determinations made on or after July 1, 2006. It requires the HHS Secretary to develop an outreach plan to educate individuals who are likely to be affected by these provisions.

Transportation

Section 6083: State Option to Establish Non-Emergency Medical Transportation Program

The States are given the option of establishing a non-emergency medical transportation brokerage program for individuals eligible for medical assistance who have no other means of transportation.

This option became effective on Feb. 8, 2006.

Katrina Relief

Section 6201-6203: Katrina Relief

Sections 6201-6203 provide $2.9 billion in funds for Hurricane Katrina-related Medicaid waivers for use by the Secretary of Health and Human Services. These funds are to pay eligible States for the non-Federal share of expenditures for health care for Katrina evacuees. Funding is also provided for high-risk pools that States operate for Katrina evacuees who cannot otherwise obtain health insurance.

Eligible states are defined as those that have provided care to affected individuals or evacuees under a Section 1115 waiver. Funds are designated to cover the non-federal share of expenditures for health care provided to affected individuals (those who reside in a major disaster area declared as a result of Hurricane Katrina and continue to reside in the same state) and evacuees (affected individuals who have been displaced to another state) under approved multi-state Section 1115 demonstration projects. Funds may also be used for administrative costs related to such projects, as well as the non-federal share of expenditures for medical care provided to individuals under existing Medicaid and SCHIP state plans. They may be used for other purposes, if approved by the Secretary, to restore access to health care in affected communities. The non-federal share paid to eligible states will not be considered federal funds for purposes of Medicaid matching requirements.

No payment obligations may be incurred under these provisions for regular health care provided as Medicaid or SCHIP medical assistance after June 30, 2006, or for uncompensated care after January 31, 2006.

The Katrina demonstration programs build upon existing Medicaid/State Children’s Health Insurance Program (SCHIP) eligibility and other program rules. Approved waivers allow for Host States to provide the Medicaid/SCHIP benefit package within their own State and provide comprehensive State Plan services to evacuees.

The Centers for Medicare and Medicaid Services (CMS) has approved Hurricane Katrina Multi-State Section 1115 Demonstrations for Alabama, Arkansas, District of Columbia, Florida, Georgia, Idaho, Mississippi, Puerto Rico, Tennessee, Texas, Indiana, South Carolina, Louisiana, Maryland, Nevada, Ohio, and California.

Examples of coverage that could be provided include mental health services, prescription drugs or any other medically necessary services needed by evacuees. For example, diabetics in need of insulin and neither insured nor covered by Medicaid could go to the pharmacy and the pharmacist would then bill the Host State’s Medicaid program.

SUPPLEMENTAL SECURITY INCOME (SSI)

Two provisions affecting the SSI program were included in the Deficit Reduction Act. They are:

Section 7501: Review of State Agency Blindness and Disability Determinations

Section 7501 requires the Social Security Administration (SSA), before payments begin, to review eligibility decisions for people age 18 or older made by the state disability determination agencies in order to ensure that the individuals are, in fact, eligible for SSI benefits. Known as “pre-effectuation reviews,” these reviews are already conducted for people in the Old Age, Survivors, and Disability Insurance Program (OASDI) and for SSI beneficiaries who also receive OASDI benefits.

The provision establishes that the SSA Commissioner will review 20 percent of all disability decisions in fiscal year 2006, 40 percent of decisions in fiscal year 2007 and at least 50 percent of all decisions in fiscal year 2008 or later.

Section 7502: Payment of Certain Lump Sum Benefits in Installments Under the Supplemental Security Income Program

Section 7502 changes the law regarding payment of retroactive benefits owed to SSI beneficiaries by the Social Security Administration. The provision requires that, when more than three months of benefits (formerly 12 months of benefits) are due, the payment must be made in installments. The first payment will be for no more than three months of the maximum federal SSI benefit. Six months later, the second payment will be for no more than three months of the maximum federal SSI benefit. Six months after the second payment, the final payment would include all remaining amounts due.

This section becomes effective May 8, 2006.

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)

Reauthorization of the TANF program was included in the Deficit Reduction Act of 2005. TANF was originally enacted in 1996 to provide low-income families with assistance to move from welfare to work. TANF recipients are required, with few exceptions, to find employment or lose their TANF benefits and generally may receive benefits for only five years.

A large number of families across the country have moved from welfare to work. However, the Government Accountability Office has determined that approximately 44 percent of TANF recipients’ still receiving benefits have a disability or are caring for a child or adult relative with a disability. Thus, a large proportion of TANF recipients with disabilities have major barriers to employment and are struggling to obtain employment before their TANF benefits run out.

TANF reauthorization provisions included in the Act make the following changes to current law:

• Extends the block grant through 2010.
• Provides $200 million in new child care funding, subject to a state match, which is far less than the estimated need or what was proposed in previous TANF legislation. No new TANF funding is provided.
• Revises the caseload reduction credit so that the credit is applied to caseload decline after 2005. In 2007, a state will have to have 50 percent of all families participating in prescribed work activities. According to the Congressional Research Service, 47 states fall short of meeting a 50 percent participation rate, and 16 of those states have rates below 25 percent. (The current credit has been helpful in providing states flexibility in assisting people with disabilities – this will disappear.)
• Work participation rates would apply to separate state programs. Separate state programs are often used to assist two-parent families, some families with disabilities, and some families in which the parent is in college.
• While the provisions in the budget reconciliation act do not change the work hours requirements and other key aspects of current law, they direct the Secretary of HHS to issue regulations (for the first time) that address the following:
• When an activity can count as one of the federally listed work activities;
• Uniform methods for reporting participation hours;
• Documentation needed to verify reported hours; and
• Circumstances under which a parent who resides with a child receiving assistance should be included in the work participation rates.
• HHS can impose significant penalties on states that do not develop state procedures to ensure consistency with the new regulations.

The TANF provisions jeopardize progress some states have made in ensuring these families are accessing the services and supports they require to achieve greater self-sufficiency. Increased work participation rates, subjecting state maintenance of effort dollars to federal TANF work requirements, and developing a standardized set of approved work activities, without ensuring states have the flexibility to meet the needs of families that include a person with a disability, all increase the risk that these vulnerable families will lose the services and supports they need.

Unless HHS regulations spell out that states continue to have this much-needed flexibility and will receive credit for their efforts to assist parents with disabilities and parents caring for a child with a disability, many people with disabilities will be unable to meet the ascribed number of work hours nor will they benefit from a standardized set of work participation activities. In all likelihood, as happened in the past, these families will face sanctions for failing to comply with requirements they cannot meet.

The Act establishes a June 30, 2006 deadline for the Secretary of Health and Human Services (HHS) to release regulations. HHS is expected to have the draft regulations completed this spring. The disability community will be working to positively influence these regulations.

3-23-06