1. Federal Policy and Its Impact on State Policy and Funding
Doria Panvini, Public Policy Committee Chair
Carrie Hobbs Guiden, Executive Director
The Arc Tennessee

2. How decisions in Washington, D.C. impact Tennessee
Many Tennessee programs impacting people with disabilities are a state and federal partnership – the federal government matches the funds that Tennessee puts in their budget
38% of Tennessee’s entire state budget is funded through federal dollars
About 67% of TennCare’s budget is funded through federal dollars
Vocational Rehabilitation is a state and federal partnership
Many public assistance programs (such as SNAP) receive federal funding
To receive federal funding to support these various programs, Tennessee must follow rules put forth by the federal government

3. Common areas impacted by federal policy
Education
Employment
Access to the community
Long term services and supports
Healthcare
Housing

4. Examples of federal laws that impact people with disabilities
Americans with Disabilities Act (ADA)
Elementary and Secondary Education Act (ESSA)
Individuals with Disabilities Education Act (IDEA)
Vocational Rehabilitation Act
Developmental Disabilities Act (DD Act)
Affordable Care Act (ACA)
Workforce Investment and Opportunities Act (WIOA)

5. Federal Impact in Tennessee – Dollars and Cents
Department/Agency
Total in millions
% from STATE
% from FEDERAL
% from OTHER
Bureau of TennCare
$11,583
32%
62% 6%
Dept. of Education (K-12)
$ 6,245
80%
18% 2%
Dept. of Human Services (includes VR)
$2,857
91%
Dept. of Mental Health and Substance Abuse
$355
68%
19%
13%
TN Housing Development Agency
$298 0%
93% 7%
Dept. of Intellectual and Developmental Disabilities
$142
17%
83%

6. Breaking it down – Medicaid (TennCare)
Federal Government:
Sets core requirements
Matches state’s funding
Federal share (FMAP) is 65%.
For every $1 spent by state, the Federal government matches $1.85
Medicaid spending in Tennessee - $9.8 billion
26% of state federal fund spending is for Medicaid
51% of all federal funds received by TN is for Medicaid
States have flexibility regarding:
Eligibility (who qualifies)
Benefits (what services are covered and to what degree)
Delivery system and provider payments
Long term care (whether primarily institutional or community based and what it looks like)
State health priorities

7. Breaking it down – Medicaid (TennCare)
TennCare covers
2 in 5 children
3 in 5 nursing home residents
2 in 5 people with disabilities
48% of long-term care spending is for home and community based care
Nearly 1.6 million people covered by Medicaid
43% of all children covered by Medicaid
60% of nursing home residents
30% of people live in rural areas (People who live in rural areas are more likely to be dependent on Medicaid)
100 % of Medicaid enrollees are in Managed Care

8. Breaking it down – Supplemental Nutrition Assistance Program (SNAP)
Provides nutritional assistance benefits to children and families, the elderly, the disabled, unemployed and working families.
Helps supplement monthly food budgets of families with low-income to buy the food they need to maintain good health and allow them to direct more of their available income toward essential living expenses.
SNAP benefits
1,113,000 Tennessee residents or
17% of population (1 in 7)

9. Breaking it down - SNAP
More than 67% of SNAP participants are in families with children
Almost 30% are in families with members who are elderly or have disabilities
More than 38% are in working families
Most SNAP Participants are Poor
41% have income between % of poverty
49% Income at or below 50% of poverty
10% above 100% of poverty

10. Breaking it down – Americans with Disabilities Act (ADA)
Americans with Disabilities Act – a critical law that created rights for people with disabilities to access public accommodations including:
Businesses such as stores, restaurants, hotels, movie theaters, etc.
Government buildings such as libraries, court houses, bureau of motor vehicles, SSA offices, etc.
Businesses have an obligation to make themselves accessible and there are consequences if they do not

11. ADA at risk
H.R. 620 the ADA Education and Reform Act of 2017 was passed by the House of Representatives on February 15, 2018
Places the heaviest burden on individuals with disabilities.
Requires the person with a disability who encounters a barrier to send a written notice with the exact provisions of the ADA that are being violated
Gives the business owner 60 days to acknowledge that there is a violation and another 120 days to begin to fix it.
Creates additional requirements for filing lawsuits under ADA
H.R. 620 does not fix business concerns about monetary damages
The ADA does not allow monetary damages
Monetary damages are only available under a handful of state laws (not Tennessee)

12. Breaking it down – Education laws
IDEA is the Individuals with Disabilities Education Act and it requires public schools to
Provide a free and appropriate public education (FAPE) to all eligible students with disabilities
Students must be educated in the least restrictive environment appropriate for that student
Every student receiving special education services must have na individualized education plan (IEP)
IDEA has never been fully funded at the federal level – this impacts a state’s ability to implement IDEA to its fullest extent, especially states like Tennessee that are heavily dependent upon federal funds
ESSA is the Every Student Succeeds Act and it requires State Departments of Education to address
Post-school outcomes for EVERY student – including students with disabilities
Graduation rates for EVERY student – including students with disabilities
Providing supports to students that need them the most – regardless of race, ethnicity, socio-economic status or disability

13. Breaking it down – Employment laws
Vocational Rehabilitation Act of 1973
Asserted that VR programs must provide employment services to people with the most severe disabilities
Prohibited discrimination on the basis of physical or mental disabilities for businesses with federal contracts
First to address the notion of equal access through the removal of architectural, employment and transportation barriers
Workforce Investment and Innovation Act (WIOA)
Requires Vocational Rehabilitation to set aside 15% of their budget to provide Pre-Employment Transition Services (Pre-ETS)
Establishes new rules around the use of sub-minimum wage certificates
Reinforces that even people with the most severe disabilities are capable of competitive, integrated employment

14. Breaking it down - Housing
The US Department of Housing and Urban Development (HUD) oversees the Section 8 Voucher program
Assists very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments.
The participant is free to choose any housing that meets the requirements of the program and is not limited to units located in subsidized housing projects.
Housing choice vouchers are administered locally by public housing agencies (PHAs). The PHAs receive federal funds from HUD to administer the voucher program.

15. Other important federal policies and their impact on state funding and policy
Affordable Care Act (ACA)
Prevented insurance companies from denying coverage of pre-existing conditions
Prevented insurance companies from putting lifetime caps on benefits
Developmental Disabilities Act
Created the DD Network (Councils on Developmental Disabilities, Protection and Advocacy Agencies, University Centers for Excellence in Developmental Disabilities, Statewide Independent Living Councils (recent)
The purpose of the law was to assure that individuals with developmental disabilities and their families participate in the design of and have access to needed community services, individualized supports, and other forms of assistance that promote self-determination, independence, productivity, and integration and inclusion in all facets of community life

16. Other important federal policies and their impact on state funding and policy
Higher Education Act
Provides funding for post-secondary programs for students with developmental disabilities
Provides oversight of financial aid for students – including those attending accredited post-secondary programs for students with developmental disabilities

17. What’s at risk
Many pieces of proposed legislation and budget cuts at the federal level threaten significant funding cuts to programs of importance to people with disabilities:
Medicaid
SSI and SSDI
Post-secondary education VR
Councils on Developmental Disabilities, P&As, UCEDDs, etc.

18. Takeaways Advocacy must occur at the state AND federal level
Decisions made in Washington, D.C. impact Tennessee programs for people with disabilities
We must always be vigilant about tracking decisions made in Washington, D.C.
Keep in contact with your federal Congressmen and Senators

19. Resources The Arc US Action Alerts and Disability Advocacy Network:
Association on University Centers on Disability (AUCD)
Consortium for Citizens with Disabilities (CCD) d.org/

20. Questions?
Doria Panvini Carrie Hobbs Guiden