Tag: Alabama

Candidate Giuliani Visits My City

Guess who showed up in my city today ?

Rudy Giuliani.


I live in Mobile, AL, Alabama’s second largest city. The Port City.

Today Candidate Giuliani showed up here. As far as I know he didn’t meet with any real people, any disability or elderly groups, nor did he visit the parts of the county that were devastated by Hurricane Katrina.

What he did do was speak at a $1,000 per plate fundraising dinner in Theodore, a nearby wealthy exurb. He also spoke at the State Capitol.

Not that other candidates are much better. Most of the candidates, both Republicans and Democrats, are only talking to the uber rich who are contributing to them (*cough* bribing). It’s no wonder most young people feel apathetic and disengaged from politics. It really IS depressing, and the current legalized bribery makes everyday (read: poor) people feel they can’t possibly be heard. I don’t blame people for being cynical.

The system is huuuuuuuuuuurting us.

It’s past time for democracy funding, to publicly-fund our elections so that corporations don’t own the system lock-stock-and-barrel. It is way cheaper than the current system of corruption.


Undo The Alabamization Of America!

Undo The Alabamization Of America!

Why I’m A Liberal

The Democrats have now won both houses of Congress.

Let me go back to the basics and explain. I’m far from a “proud Democrat,” but let’s be real here; it’s an unavoidable truth that what the GOP has done is incredibly damaging to our future. When President Clinton was writing and sending budgets to the Congress, we had surpluses; in contrast, THIS is what Republican presidents have done with the budget.

Bush spent the surplus on tax cuts before 9/11 hit; in April 2001 gigantic rebate checks were going out to billionaires.

In Alabama, there are nearly no taxes, lowest taxation in the 50 states, and in 2003 the citizens voted down a ballot amendment to bring sanity to tax policy. And the GOP keeps cutting taxes further, which has led to roads in third-world condition, schools falling apart, and teachers, police officers and many college graduates leaving the state in droves for a living wage. The cuts to law enforcement mean we only have three Alabama state troopers on the roads at night, for the entire state, which is a clear and present danger to the public safety. The mean-spirited slashing of social programs here, that devastated the most vulnerable people — we had a whole group of disabled people here cut off of Medicaid, and I witnessed the death of my oldest friend as a result — is just unconscionable. I encourage everyone to click here and watch the 40-minute documentary “323,000,” about what happened when Tennessee cut 323,000 people off their Medicaid program. Your soul will be revolted at how dire these consequences are.

These kind of extremely conservative policy choices are morally unjustifiable, and Alabama shows what this means to real people. Alabama proves beyond a shadow of a doubt that the underpinning mythology of the conservative movement, that low taxes on the rich means wealth trickling down to the working poor, is false, because if that were true, the state with the lowest taxes in the union, Alabama, would be a very wealthy state. In fact, it’s the poorest. The story is similar in Latin America, where there’s little government and massive wealth by a few noblemen at the top not trickling down to a country of peasants. This is what happens when the government does not have a safety net and furthers a policy tilted entirely toward the wealthy. Republicans have been headed this way for years, voting for policies that ignore the human nature toward consolidation of wealth (huge tax rebates to billionaires, repealing the estate tax) and I want to shriek out “NO!!” The great trust-buster, Teddy Roosevelt would be furious. Thomas Jefferson, who was very angry about the British companies, wanted a ban on monopolies put in the Constitution, and explicitly favored an estate tax. A Sixteenth Article to the Pennsylvania Bill of Rights (that was only “narrowly defeated”) declared: “an enormous proportion of property vested in a few individuals is dangerous to the rights, and destructive of the common happiness of mankind, and, therefore, every free state hath a right by its laws to discourage the possession of such property.” Where Jesus stands on this is clear. In Matthew 19, he tells a guy that in order to be perfect, he has to sell all his stuff, give the money to the poor and follow him. In Matthew 25, Jesus goes as far as to say people will go to Hell because they did not feed him when he was hungry, give him drink when he was thirsty, welcome him when he was a stranger, visit him when he was sick, etc. and that “as you did it not to one of the least of these (the poor), you did it not to me.” So the Christians leading the charge for the extreme consolidation of wealth are hypocritical.

In Deut. 15:7-8 Jews are told they must give to the poor; a commandment, not optional. If I was in Israel, I’d have no problem voting for the United Torah Judaism party, because I know their purpose is to give halacha a strong voice at the table, the same halacha that would never allow reducing aid and harming the poor and disabled. In America, I have no choice but to vote liberal for the rest of my life. Because of my life experiences, seeing what ultra-conservative policies have done to Alabama, I could never in good conscience support their authors.

The Republicans want to (and to a large degree, have) spread these Alabama policies (low taxes starving funding to a crumbling infrastructure, health care and school system) nationwide, Alabamized the country. We can’t close our eyes to the consequences of voting for Alabamization anymore.

I hope with all my heart the new Democratic Congress can reverse the policies of inhumanity and begin to undo the Alabamization of America. But with Alabamizer in chief, George W., holding the veto pen, I don’t expect much.

One can only hope in the long-run, the humanity of the American public will win out.

Never give up,


Nick Gets Lifetime Advocacy Award

Nick Gets Lifetime Advocacy Award

I Received Lifetime Advocacy Award At ADAP’s 30th Anniversary Event

Friday, we made the 175-mile journey to Montgomery to attend the 30th anniversary of ADAP (Alabama Disabilities Advocacy Program), the state P&A (protection and advocacy) agency (every state has one), and receive their first-ever “Lifetime Advocacy Award” at the Alabama state capitol building.

It was awesome.

Me in front of the Alabama state capitol building.

ADAP Executive Director Ellen Gillespie gave a speech praising my accomplishments in “Nick’s Crusade,” saying I’ve done more for disability rights in Alabama than most do in a lifetime, and then awarded me the Ricky Wyatt Lifetime Advocacy Award.

I loved this.

Never missing an opportunity like this to advocate, I had some one-on-one time with the executive director to stress the importance of opening an ADAP office in Mobile (we are Alabama’s second biggest city) and offer to work on issues.

I also talked to the National Director of P&As, Curt Decker, who was down from D.C. for the event, and asked him if I could contribute.

This is me brainstorming with head lawyer for ADAP, James Tucker, who famously won the 33-year long Wyatt case that set in place basic constitutional standards for humane treatment at mental institutions, and the Nick vs. Medicaid case, which capped off “Nick’s Crusade” by reaffirming the right to home care for people on ventilators. Both of these made for ripples of positive changes and headlines across the nation. Because Alabama is notorious for its consistent, actionable human rights abuses, it is the greatest frontier for positive change through activism.

James Tucker, Governor’s Office On Disability director Barbara Crozier and I had hours of brainstorming. It was great. We are looking to foster change. James said the abuse, intimidation and other difficult situations faced by Alabamians with disabilities are so great, he’s not finding anyone willing to step up and be a part of litigation to change the systematic segregation of people with disabilities in institutions. I want to find stories and cultivate actionable cases.

Bruce Mildwurf, seen here in the first story about Nick’s Crusade in 2001, was there in Montgomery filming the award ceremony and interviewing people because I’ve turned him on to doing a story about Alabama refusing Money Follows the Person. Had I not found him through his wife on Mobile’s tiny Jewish welfare committee, had he not led the charge with stories on Nick’s Crusade (which he won an Edward R. Murrow award for), the campaign would’ve gone nowhere (if a tree falls, and there’s no news media there, did it make a sound?) and wouldn’t have found lawyers, etc., so I give him huge credit for that and non-stop gratitude and love.

With his help, hopefully there will be another campaign.

May the year 5767 be a year for social justice.


What Is Medicaid? What Are Waivers?

What Is Medicaid? What Are Waivers?

A Medicaid Policy Wonk Explains

Medicaid stuff is my specialty. While I’m a political junkie who tries to glean deep knowledge of American political ideas on all sides on nearly every issue and the philosophies that underpin them, and, while in a year of intense study, I’ve gained a great deal of Judaic knowledge, my area of expertise is still disability rights and Medicaid, and I have more study and hands-on experience in this area than in any other. A solid case could be made that, though it’s hard to resist diving into the issue-of-the-day, I should shut up on other issues and focus on what I really am: a Medicaid policy wonk. 🙂

I want to explain to my readers what Medicaid is, and what Medicaid waivers are, because these are complex issues most legislators don’t even understand, much less the media, but are very critical to our most vunerable citizens.

Medicaid, along with Medicare, was amended to the Social Security system in 1965 as part of President Lyndon Johnson’s “Great Society” program, which sought to complete FDR’s “New Deal,” and finish something that had been sorely needed, and on the table forever: publicly-funded health care for “the indigent.” Medicare provides some limited hospital, nursing home, doctor, and now prescription drug coverage, among other things, for the elderly and disabled adults. Medicaid covers children and any other citizen who can’t afford medical bills, and it, unlike the purely federal Medicare, is administered by the states, so it varies widely from state to state. The federal judge who heard my case back in 2003 said Medicaid is the most confusing law he’s ever read in his long career in law. He’s right. I’ve read it, and it is an incredible labyrinth of half measures, carrots and sticks to compel states to provide coverage for nearly everything while in the next section providing microscopic loopholes so that the law doesn’t iron-clad force states to. Medicaid law painfully tip-toes a tightrope between federal mandates and violating states’ rights.

But what I want to address here is one of the most important roles that falls to state Medicaids, long-term care, especially what I’ve mentioned before, home care vs. nursing home and the institutional bias in Medicaid.

When Medicaid was established in it only allowed those with incredibly low incomes to participate, and few states provided home care at all. In the 80s the case of a young girl with a trach named Katie Beckett who was stuck in the hospital because Medicaid wouldn’t pay for home care was brought to the attention of Ronald Reagan. Everyone knew the situation was wrong. She was trapped in ICU, which was incredibly expensive, and it didn’t allow her to be with her family and thrive in the community. Her parents made too much money to even qualify for Medicaid. The Reagan administration recognized this and created a framework for home care waivers under Medicaid. The Katie Beckett waivers allow states who didn’t already provide home care to make exceptions (or “waive” typical rules) and provide home care by looking at the child’s income (nothing) not the parent’s income. Thus, a generation of severely disabled children got to qualify to live with their parents and get proper care. If Katie’s parents, and later Katie, hadn’t raised holy hell all the way up to the oval office, we wouldn’t have had ANY home care in most states for a lonnnnng time.

Katie Beckett herself emailed me once to congratulate me on my Crusade. She was a college student then in Iowa, walking around and fully included, when, as a baby, the establishment wanted to let her rot in the hospital forever. She was pretty cool. But she is busy now and doesn’t do tons of advocacy.

Anyhow, this is what waivers are, states “waiving” normal Medicaid rules (often waiving the rule that you must provide a given service to everyone) so they can provide additional services (like home care) to a specific population; in the program that I won in Alabama, the waiver provides home care only to those on ventilators, restricted to about 6 people. There’s another waiver only for those with HIV, implemented right after mine, possibly with my momentum. Every state has waiver programs for people with mental disabilities. Some states have waivers for diabetics, or only for a geographic area. I heard South Dakota created a waiver for only one dude. With the waiver system, state Medicaids can waive rules and provide as many or as little services as they want, to whomever they want, and get federal matching funds for it. And though they love to pass the buck to the feds, the feds have never denied a state’s request for a waiver. In the case of “Katie Beckett waiver” it means either a state’s home care waiver that allows children to be eligible under their income, or the underpinning federal law set up by the Reagan administration that allows states to look at the child’s income for eligibility. Every state, even Alabama with its third-world conditions, has a home care waiver or “Katie Beckett waiver” of some sort. Because of this federal mandate, children under 21 from middle class income brackets can qualify for EPSDT, (Medicaid’s federally mandated Early, Periodic, Screening, Diagnosis and Treatment program). But once the Medicaid recepient is an adult, there is zero mandate to provide them home care, and countless Americans have been given no choice but a nursing home. This is what spurred my successful campaign to force Alabama Medicaid to extend care past age 21 for a few people on ventilators.

But segregating people in institutions is a mandatory service the feds make state Medicaids provide, home care is still not mandatory for states. Though all states do provide home care on different levels, this “instutional bias” continues to limit home care options and create MASSIVE injustice.

As John F. Kennedy said in West Berlin, “freedom is indivisible, and when one man is enslaved, all are not free.” This echoes the classic Jewish idea of the oneness of humanity and our collective responsibility for social justice, which most Christians are exposed to through Jesus’ teachings, especially Catholics.

Of course the way Alabama and most states currently have it set up, most people don’t have the home care they need. Alabama’s policies have resulted in deaths, but also the policies of many other states. Alabama is definitely not alone. You’ve got states from Texas to Virginia lining up in the hall of shame. I don’t have any numbers, but I have plenty of stomach-rending personal stories. I lost my oldest childhood friend because his care got cut off at age 21 (story).

There’s a movement now to make home care mandatory under Medicaid, not only waivered, and that’s what MiCASSA, the legislation disability rights activists have been championing for a decade, does.

To say community works is like saying AIR WORKS! We all use it! We should not have to have a freaking special waiver just to have care in our community. It’s backwards. You should need a special waiver to be segregated in an institution, not just to live at home with the help you need. Community must be available to all. The civil right to live, work and play in the community among family and friends regardless of color, religion or disability, should be provided by states no matter what.


Free Our People

Support MiCASSA!!!


Filed Under:
Health care and Disability Rights

Money Following The Person Out Of Institutions "Not Feasible," Says Alabama Medicaid

Money Following The Person Out Of Institutions “Not Feasible,” Says Alabama Medicaid

They Still Won’t Give An Inch To Free Citizens From Nursing Homes

I just watched the Alabama Medicaid commissioner Carol Herrmann spinning and tap-dancing around the Money Follows the Person grant issue on the For The Record show. Alabama Medicaid continues to stick by its decision to refuse to accept federal money for home care. On the show debating Herrmann, Montgomery Independent Living Center director Scott Renner pointed out that CMS surveys have 3,000 Alabamians on record as wanting out of nursing homes. He said if they were to move 1% of current residents out, they would save around $7 million.

But Alabama Medicaid will do anything to avoid slighting the nursing home lobby, do anything to avoid changing their long-term care budget (about 2/3 of which goes to institutional care), do anything to avoid additional expenditures, regardless of what kind of care their consumers want.
It was so disheartening to see Commissioner Herrmann spinning that she is really on the same page with the disability community while on the other hand quietly make ridiculous excuses for refusing this money, like, “our patients will be getting very old and just have to go back into the nursing home,” and “yes, we have a general fund surplus, but other departments need the money more.” AGH!!!

The fact is, Alabama Medicaid does not want to change their antiquated and oppressive system. We have so many already on waiting lists to get out of institutions and into community services, yet Alabama is refusing more funding to meet their needs! The outcry will only grow as our elderly population doubles in the coming years. But Alabama Medicaid won’t give an inch!

The deadline for applying for this grant is November 1st. Alabama Medicaid has dug in their heels. They won’t be applying.

The fact is, we have lost again. It’s only status quo or downhill from here for services in this state, folks.

I feel so much hopelessness and despair.


Filed Under:
Health care and Disability Rights

Amid Protests, Alabama Medicaid Still Refuses Federal Grant

Amid Protests, Alabama Medicaid Still Refuses Federal Grant

Officials Won’t Budge On Anything Affecting Nursing Home Industry

As I reported in my recent editorial on the subject, our government is circling the wagons to protect their nursing home boondoggle while those who want to receive care at home are left out in the cold. This is a justice issue, and everyone should be paying attention as freedom of choice is denied and our most vunerable citizens are deprived of full lives in the community. Here’s the latest update from the Birmingham News:

Medicaid funding decision jeered
State agency declines to seek federal funds to send elderly home

Friday, September 22, 2006
News staff writer

About 100 activists held a rally at the Capitol on Thursday to protest the state’s decision not to apply for a federal grant that would help the elderly and disabled leave nursing homes and get care in their homes. The federal Centers for Medicare & Medicaid Services this summer announced a Nov. 1 deadline for state Medicaid agencies to apply for their share of $1.75 billion over five years. To qualify for the “Money Follows the Person” program, states must allow Medicaid recipients more access to home and community-based services for long-term care.

But Alabama’s Medicaid commissioner said the program requires too dramatic an overhaul of the state’s long-term care system to be accomplished by the January 2007 start date. The state agency would first have to make sure the
infrastructure is in place to provide enough housing, trained personnel and support systems to care for patients leaving nursing homes, said Commissioner Carol Herrmann-Steckel.

“Taking someone out of the nursing home and putting the person in the community is not easy,” she said.

The new federal initiative also requires state matching money, when the state agency has no money to spare, Herrmann-Steckel said.

Groups such as AARP, Alabama Arise and the Center for Independent Living on Thursday decried the state’s decision not to jump at a chance to get more federal money to give people choices besides a nursing home. The new program offers 85 percent federal money to the state’s 15 percent the first year a person is able to leave a nursing home. That compares to the usual formula of almost 70 percent federal money to fund the health program for the poor.

“We believe it’s a civil right that everyone should have the choice where they want to live if they have the support in the community,” said Scott Renner, executive director of the nonprofit group Montgomery Center for Independent Living.

Differing opinions:

The groups said moving people out of nursing homes will save the state money in the long run.

Herrmann-Steckel said that’s not necessarily true. First, the enhanced
federal match for the new program is only for one year. Secondly, if you move someone out of the nursing home and start paying for that patient to be at home, another person could move into the vacated nursing home bed, adding yet another person to Medicaid’s rolls.

Renner didn’t buy that argument.

“There is no waiting list to get into nursing homes,” he said.

The Medicaid commissioner said the state does have a number of home-care and community-based programs already, although funding for them is capped while state law does not allow the agency to cap the number of nursing home beds
for which it will pay. Herrmann-Steckel also said the state’s Department of Senior Services applied for a pilot program in the Black Belt under the “Money Follows the Person” initiative, but was recently turned down for funding.

“We’re not just sitting back saying `No,'” Herrmann-Steckel said. “We would very much like to see a system where people are allowed to make their own health care choices.”

The advocacy groups plan to push a bill in the Legislature again next year that would require the state to pay for more long-term care options for Medicaid patients. A similar bill died this year. In the meantime, they hope to change state officials minds on applying for the federal grant.

“We’re not giving up,” Renner said

© 2006 The Birmingham News
© 2006 al.com All Rights Reserved.

Filed Under:
Health care and Disability Rights

Governor Riley Refuses New Fed. Funding For Disabled, Advocates To Rally

A Mobile Register Letter to the Editor

I’m Nick Dupree. Some of you may remember me from my public battle to stop Alabama Medicaid from ending nursing care for people on life support when they turned 21, a battle I won and received a flurry of media attention for three years ago, in the Register and across the nation. My “victory” has extended coverage for approximately six Alabamians.

Any other disabled adult who needs care has little to no options if they want to remain in the community. Even if they could get on one of Alabama’s home care programs in this age of decade-long waiting lists and enrollment caps, they could, at most, get only several hours of care per day. Everyone else is given no other choice but a costly nursing home. Alabama, like many states, spends over 3/4 of their long-term care budget on institutions even though it is more expense than home care. And despite the fact that every survey and study on the subject has shown that institutions are the last place people with disabilities want to live vs. remaining in their homes, it remains the preferred option for a government heavily influenced by nursing home owners’ campaign contributions.

Advocates like myself have been speaking out in response to the institutional bias so entrenched in our system, and we’ve gotten some results in Washington. In July, the federal Center for Medicaid Services (CMS) announced a new “Money Follows the Person” rebalancing project. The Feds are prepared to pay states an enhanced 12-month 84.76% funding match to give citizens the option of freedom in their community instead of the walls of a nursing home. “With new federal funding,” CMS Director McClellan said, “there is no longer any excuse for the status quo.”

In his recent letter to the disability community, Governor Bob Riley does give an excuse for the status quo: it may cost the state more money later. While 38 other states so far have lined up for the new federal money, Riley and Alabama Medicaid have remained steadfast in their refusal to apply for this new grant. See, in Alabama’s current system, big institutions get Medicaid dollars per bed, whether they’re occupied or not. So if Alabamians leave nursing homes for new services in the community, the explicit goal of the CMS rebalancing grant, Alabama will still be giving the nursing homes their cut anyway.

Not accepting federal funding to begin to correct this, and circling the wagons to protect the current inequitable boondoogle is simply inexcusable. Home care instead of institutional care would not make government bigger; the opposite is true. Community-based services allow people to thrive at home at less cost, and it makes them the responsibility of family, friends and neighbors instead of big government nursing homes notorious for abuse and neglect.

Thursday, advocates will be rallying at the Capitol steps in Montgomery to demand Governor Riley do the right thing and accept the new federal funds. It would be especially henious for the Governor to shirk his responsibility for Alabamians with disabilities during this time of record budget surplus. Even the Pharaoh of Genesis 41 did not refuse those in need in the times of Joseph’s planned surplus. We can do the right thing. I urge all readers to speak out and implore the Governor; life in Alabama does not need to remain difficult and inhumane for most of our disabled citizens.

Nick Dupree

Filed Under: Health care and Disability Rights