The Cost of Education

Few would question the value of education.  It is the bedrock of our democracy and at the very heart of our economic systems. “Educate and inform the whole mass of the people. They are the only sure reliance for the preservation of our liberty,” opined Thomas Jefferson, more than 250 years ago. Education is a fundamental right, one that is afforded to all children under federal law and our United States Constitution.

For children with disabilities, the right to an education has been evolving slowly.  Now fully guaranteed by laws such as Section 504 of the Rehabilitation Act, the Individuals with Disabilities Education Act, and Supreme Court decisions like Bd. of Ed. v. Rowley and Endrew F. v. Douglas County, it has not always been so.

Last month, the Richmond Times Dispatch ran a disturbing editorial that suggested that the cost of educating children with autism was out of control.  The author of the editorial, newly-hired James Bacon, wistfully recalled the good old days when children with disabilities could be institutionalized.  Educating children with autism, Mr. Bacon argued, detracted from the education of other students.  That view struck terror in the hearts of all families, friends and advocates for children with disabilities, as it understandably should have.

After decades of struggle, it is now well established law that students with disabilities are entitled to a meaningful education.  Beyond the basic right to education that all students are afforded, the Individuals with Disabilities Education Act requires that students with disabilities be educated in the least restrictive environment. In short, students with disabilities must be educated alongside their non-disabled peers to the extent possible. Congress saw such value in the concept of inclusive education that they created a specific mandate requiring it.

Mr. Bacon and the Times Dispatch seemed to suggest that this mandate is an act of charity, and one that we can no longer afford.  That view misunderstands the value of inclusive education for all children.  Clearly, there is little value in educating children surrounded by only those who are exactly like them.  To do so would poorly equip them to live in an increasingly diverse world.   As adults, we interact daily with others who have various strengths and needs. Inclusive education prepares all students for the diverse interactions they will have throughout their lives.

Students with autism or other disabilities can and do disrupt classrooms at times, as do children who are experiencing trauma, or who face language barriers, or who are simply going through hormonal changes, or countless other situations.  The key to quality education is not to segregate out everyone who is different, but rather to invest in our schools to ensure that teachers and counselors have the tools and skills to redirect disruptive behavior in the classroom — and to respond to behaviors in a manner that improves the quality of education for all students.

Demonstrating skills and techniques to respond to distressed children, to diffuse potential conflicts, and to redirect disruptive behaviors does not detract from valuable education.  Indeed, those skills may be some of the most valuable education a child can acquire. That valuable education begins with the skills and resources we invest in our teachers and schools.

It is important to know that, under Federal law, cost is not a factor when determining appropriate supports and services to ensure a student’s individual educational needs are met.   This makes sense.  The cost of public education ought not be determined by establishing a baseline for educating only the most docile or the smartest children.  Public education is for all children, regardless of their starting point.   Special education spending, as all educational spending, is an investment, not an expenditure.  There is ample evidence that students who receive early intervention and special education services are better able to support themselves and give back to their community as they enter adulthood.  Investing in inclusion prevents the need for more costly supports in later years.

At the disAbility Law Center of Virginia, we have seen countless examples of this.  Children with disabilities –  yes, even those with autism! – who, with proper supports in public education, become productive and interesting adults, excelling at sports, law, social work, business and politics.  Once considered disruptive, our brothers and sisters with challenging disabilities often grow into trusted neighbors, colleagues and friends.

The response from the community to the misguided editorial was swift and strong.   We were pleased to see that the Times Dispatch printed an apology within a few days of that editorial.  We were likewise pleased to learn that Mr. Bacon’s short tenure on the editorial board came to an abrupt end.  The newspaper promised further dialogue with the disability community, which we welcome.  For the good of the Commonwealth, we should not be looking for ways to cut costs in education, and certainly should not be doing so at the expense of children with disabilities.  Rather, we must ensure that valuable and useful education for all children is fully supported throughout the state.

 

 

 

 

Charlottesville: Let us never forget our true history

The nazi chants and fascist symbols on display in Charlottesville last weekend were terrifying to many people.  Among those feeling especially threatened — people with disabilities.  The ideology on display evoked a time when the extermination of people with disabilities was a key element of the fascist movement in America.

The 1920s saw the rise of fascism in America and all over the world.  With fascism came the eugenics movement.  Together, they sought the establishment of  a “superior” race, absent any “defects.”  In Virginia,  eugenics — forced sterilization of “defectives” — was legally and social acceptable.  Just down the road from Charlottesville, at what is now known as the Central Virginia Training Center, superintendent A.S. Priddy carried out thousands of sterilization operations, with the intent to eliminate future generations of people with intellectual and other disabilities.

Perhaps most famously, Priddy involuntarily sterilized  a young woman named Carrie Buck, claiming that Buck had diminished intellectual capacity. The United States Supreme Court endorsed this action, stating, “It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.”

That was 1927.  Those shameful days are long past now. Or so we hoped. The Eugenics law in Virginia was repealed, but it took 50 years to do that.  Virginia’s legislature issued a statement of “regret” for the Eugenics movement, but even that did not occur until 2001.

A year later, Virginia erected a historical marker near the site of Carrie Buck’s home, and issued a statement concluding, “the eugenics movement was a shameful effort in which state government never should have been involved.”   The legislation calling for the historical marker argued that eugenics and the supremacist movement underlying eugenics is “an embodiment of bigotry against the disabled and an example of using faulty science in support of public policy.”  The marker stands as a reminder to us all of  those very dark days in our history.

That historical marker is in Charlottesville.

note to hospitals: just tell them!

Medicare patients may be in the hospital for several days without actually being admitted as an inpatient. Instead, they are considered to be in for “observation” only. Observation outpatient status can result in greater out-of-pocket expenses for the hospital stay and can result in denial of Medicare coverage of a subsequent skilled nursing facility stay because the patient lacks the prerequisite of a 3-day hospital stay.

Patients may not even know, until it is too late, that they have not actually been admitted to the hospital!

The Virginia legislature could require hospitals to give patients notice if they are on “observation” status. There is a proposal before the General Assembly to do just that. SB 750 and HB 1509 (identical bills) would make sure that hospitals provide notice, within 24 hours, and that the notice lets patients know that serious financial repercussions can result from their observation status. The proposals require hospitals to recommend to the individual on observation status that they contact their treating physician or others to advocate for their admission as an inpatient and to obtain further information about their rights and potential liabilities.

This sounds like a good idea to us. It seems like simple fair play. What do you think?

Does Virginia Need Training Centers? — Continuing Discussion

In the 2014 session of the Virginia General Assembly, the legislature passed Senate Bill 627, which instructed the Department of Behavioral Health to convene a work group to consider options for expanding the number of training centers that remain open in Virginia.

That work group has now met twice. It is clear that the Commonwealth remains committed to supporting a community based service system. There are many advocates on the workgroup who support that commitment, especially in light of the growing numbers of people who are on the waiting list for services. It is equally clear that a small group of parents are resistant to that service system shift.

Read more about the information being considered by the workgroup at this link: http://www.dbhds.virginia.gov/ODS (Scroll down about half way to the section called “announcements.”)

If you want to comment on the Commonwealth’s commitment to community based services for people with intellectual disabilities and the prospect of keeping more training centers open, you can email to sb627@dbhds.virginia.gov

or send your comments by hard copy to

SB627 Work Group
DBHDS
1220 Bank Street, Room 1323
Richmond, VA 23219

The next meeting of the work group will be on September 5, 2014 at 10 am. The group meets in the capital building in downtown Richmond.

how’s the weather out there?

Some years ago, after a heavy snow storm, the church that I was attending had the parking lot plowed. The contractor dutifully plowed the whole parking area … and pushed the snow pile into the “handicap” designated parking spaces and on top of the access ramp. When I asked what was going on, the minister told me, “frankly, wheelchair users don’t come out in this kind of weather.”

What? People who use wheelchairs don’t have to go to work after a snow storm? Don’t need groceries anymore? Don’t want to go to church? Says who?

Well, I guess all the people who pile snow on the access routes are the ones who “says who.” (This was in a part of the country where snow piles hang around for awhile, too, so there would be no welcome at this church for weeks.)

So, as we are digging out of this recent snow storm, look around you. Are the accessible parking spaces filled with snow? Are the ramps and curb cuts still covered? If so, say something to the owner or manager about it. Speak up on behalf of people who use mobility devices, because, you know, they may not be able to speak up for themselves. They don’t come out in this kind of weather.

Do you have privacy when you vote?

When we go to the polling place on election day, most of us feel comfortable knowing that we get to vote in private. But if you are someone with a disability, you may have to give up some of your privacy rights in order to vote.

Many people with disabilities vote using an absentee ballot. Virginia law allows you to request an absentee ballot, and then vote by mail or vote early, if your have a disability that will make it difficult to vote on election day or if you are caring for someone with a disability and that care makes it difficult to get away to vote. But under current law, when you request that ballot, you have to describe your disability in some detail. In some years, VOPA was told by voters that their application was rejected because they did not provide enough detail about their disability.

That is alarming to us, but what is more alarming is something most voters do not know: applications for absentee ballots are public information. The details that you might be forced to give about your disability are open to anyone in the public who asks to see that information.

People with disabilities will soon regain some measure of privacy in voting, thanks to the dedicated work of state Senator Adam Ebbin. His proposed bill, SB967, eliminates the requirement that people with disabilities or their caretakers need to provide proof of a disability. That bill passed the Senate last month and was approved by a subcommittee of the House Committee on Privileges and Elections this morning. We will track the bill on its way to adoption by the full House, and celebrate the day when privacy rights in voting are granted to Virginians with disabilities

Voting Rights in Virginia

Change comes slowly in Virginia.  Although many states have adopted early voting procedures and made it easy for people to vote absentee, Virginia continues to resist advances in voting rights.  Early voting and absentee voting would especially benefit people with disabilities and the elderly.  The slow-moving lines on election day can be a deterrent to anyone who has difficulty standing for a long period of time.   Moreover, many people with disabilities are employed at lower-paying, hourly wage jobs, so standing in line for hours on a Tuesday can actually be costly.

Nonetheless, the Commonwealth favors voting on election day only, and this is not likely to change any time soon.  Our legislature, currently meeting in Richmond, has declined several opportunities to make it easier for people with disabilities, and others, to vote.

Tuesday morning, a House subcommittee of the Privileges and Election Committee killed a series of bills that would have made it easier for people to vote absentee or vote early.  The House also killed a bill that would restore voting rights to certain convicted felons after they serve their sentence, even though that particular bill was supported by Governor McDonnell.   Likewise, Tuesday afternoon, the Senate Committee on Privileges and Elections killed a number of bills that might have made it easier for people with disabilities and others to vote.

However, there is one bill still alive and under consideration – SB 967 – that would eliminate the requirement that people with disabilities provide details about their disability in order to get an absentee ballot. The bill, sponsored by Senator Adam Ebbin, eliminates the requirement that people with disabilities provide information about their disability in order to qualify for an absentee ballot.  This bill was considered by the full Senate Committee on Privileges and Elections committee on Tuesday and was referred to subcommittee for further work.

Change comes slowly in Virginia, but perhaps this year, this tiny change will come.

Encourage Virginia to get on board

One of the farthest reaching protections of the Affordable Care Act is the expansion of the Medicaid program.   Under the ACA, in 2014, almost everyone with income under 138% of the federal poverty level (FPL) will become eligible for Medicaid coverage. Most of the expense of this expansion will be borne by the federal government, at least until 2020.

Not everyone will be covered by the expansion.  For example, undocumented immigrants are not eligible for Medicaid now and won’t be eligible under the expansion that begins in 2014. In addition, most adult immigrants who are lawful residents are barred from Medicaid coverage for their first five years in the United States, and that “five-year bar” will continue.

On the other hand, under the expansion, some people who are slightly above the standard of 138% FPL may be eligible.  This is an especially important point for people with disabilities.  Individuals who are in nursing facilities or receiving services through a home- and community- based services waiver like the Intellectual Disabilities Waiver or the Elderly and Disabled Consumer Directed (EDCD) waiver will continue to be eligible up to three times the Supplemental Security Income (SSI) level, which is about 225% FPL.

However, the “maintenance of effort” requirement that prevents states from making changes in Medicaid eligibility through the end of 2013 will expire, and states will be allowed to end Medicaid coverage for some people with incomes above 138% FPL.   This could be problematic for people with disabilities in Virginia, as the state could choose to reduce the kinds of services available under the state plan.

Of greater concern, of course, is the very real possibility that Virginia may choose to opt out of the expansion altogether.  That would mean that the coverage so desperately needed by so many individual with and without disabilities would remain out of reach.

Medicaid expansion under the Affordable Care At

In Virginia, there are countless people living well under the poverty line who, nonetheless, do not qualify for Medicaid. Being poor, by itself, isn’t enough to qualify for Medicaid.  You have to be both “poor and something else” – such as a child, a parent with minor children in the home, or a person with a disability. If you don’t fall into a category of people who are eligible, you can be extremely poor and still not qualify for coverage.

That will change in 2014, when almost everyone with income under 138% of the federal poverty level (FPL) could become  eligible for Medicaid coverage as a result of the Affordable Care Act. (Today,  138% FPL is about $1,284 a month for a single person and $2,651 a month for a family of four.) This expansion will make coverage available to many people who are too poor to buy health insurance but haven’t qualified for Medicaid in the past because they aren’t in one of the recognized eligibility categories.

This is great news for the vast number of uninsured Virginians, but it is also good news for the state itself. That is because the federal government, not the state, will pay almost all the cost of covering the newly eligible enrollees.  For the first three years (2014-16), the federal government will pick up the entire cost of covering people who become eligible for Medicaid as a result of the 2014 eligibility expansion. From 2017 to 2020, the federal share will phase down from 95% to 90%, and stay at that level in years after 2020. That means the state will pay nothing for these enrollees for three years and then only 5% to 10% of the cost after that.

There are some caveats to that good news, however.  For example, people who become “newly eligible” for Medicaid through the 2014 expansion may not get the same benefits as people who are currently eligible.  Virginia could  choose to give newly eligible enrollees the full package of benefits that current Medicaid recipients get, but the Affordable Care Act also authorizes giving states to provide a somewhat reduced package called “benchmark” benefits.  What all will be included in the “benchmark” benefits, we do not yet know.

Of greater concern, however, is that states are not required to participate in this expansion.  Even though the cost to the state is minimal, and the savings potentially tremendous, states may decide to opt out of this portion of the law.    It remains to be seen whether Virginia, as a part of its overall resistance to the law, will opt out — making a political point, but hurting our citizenry dearly.