Category Archives: Disabilities

Bill would allow motorized wheelchairs in bike lanes – Las Vegas Sun News

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WheelchairBicyclists might have to start sharing the road with motorized wheelchair users under a proposed Nevada law.

The bill would allow motorized wheelchairs to enter bike lanes if a sidewalk isn’t available or passable by wheelchair. Wheelchair users would be required to yield the right-of-way to bikers.

via Bill would allow motorized wheelchairs in bike lanes – Las Vegas Sun News.

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High court considers if providers can sue states for higher Medicaid pay

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Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

By Phil Galewitz
KHN

The U.S. Supreme Court heard arguments Tuesday in a case that could block hospitals, doctors — or anyone else — from suing states over inadequate payment rates for providers who participate in the Medicaid program for low-income Americans.

Many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

Federal law requires Medicaid, which covers 70 million people, to provide the same access to care as that given to people with private insurance. But many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

In Armstrong vs. Exceptional Child Center, several providers for developmentally disabled Medicaid patients sued the state of Idaho after officials failed to increase Medicaid payments as required under a formula approved by the federal government.

An appellate court upheld a judgment in favor of the providers last year, noting that Idaho had conceded that it held rates flat since 2006 for “purely budgetary reasons.”

The issue before the high court is whether the U.S. Constitution gives providers the right to sue the state to increase their pay. And the court appeared split on that issue based on their remarks Tuesday. Continue reading

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Wellness programs at work are popular – but do they work?

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yoga-office-570By Julie Rovner
KHN

If you get health insurance at work, chances are you have some sort of wellness plan, too.

But so far there’s no real evidence as to whether these plans work.

One thing we do know is that wellness is particularly popular with employers right now, as they seek ways to slow the rise of health spending. These initiatives can range from urging workers to use the stairs all the way to requiring comprehensive health screenings.

The 2014 survey of employers by the Kaiser Family Foundation found that 98 percent of large employers and 73 percent of smaller employers offer at least one wellness program. (Kaiser Health News is an editorially independent program of KFF.)

What makes wellness plans so popular?

It really is part of their strategy to help employees be healthy, productive, and engaged,” says Maria Ghazal, vice president and counsel at the Business Roundtable, whose members are CEOs of large firms. “And it’s really part of their strategy to be successful companies.”

And there’s another reason wellness has gotten so pervasive, said health consultant Al Lewis. It’s a big industry. Continue reading

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US takes aim at company ‘wellness’ programs

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ScaleBy Michelle Andrews
KHN

Do it or else. Increasingly, that’s the approach taken by employers who are offering financial incentives for workers to take part in wellness programs that incorporate screenings that measure blood pressure, cholesterol and body mass index, among other things.

The controversial programs are under fire from the Equal Employment Opportunity Commission, which filed suit against Honeywell International in October charging, among other things, that the company’s wellness program isn’t voluntary.

In the wellness program, employees and their spouses are asked to get blood drawn to test their cholesterol, glucose and nicotine use, as well as have their body mass index and blood pressure measured.

It’s the third lawsuit filed by the EEOC in 2014 that takes aim at wellness programs and it highlights a lack of clarity in the standards these programs must meet in order to comply with both the 2010 health law and the landmark Americans with Disabilities Act.

Honeywell, based in Morristown, N.J., recently got a reprieve when a federal district court judge declined to issue a temporary restraining order preventing the company from proceeding with its wellness program incentives next year.

But the issue is far from resolved, and the EEOC is continuing its investigations. Meanwhile, business leaders are criticizing the EEOC action, including a recent letter from the Business Roundtable to administration officials expressing “strong disappointment” in the agency’s actions.

In the Honeywell wellness program, employees and their spouses are asked to get blood drawn to test their cholesterol, glucose and nicotine use, as well as have their body mass index and blood pressure measured.

If an employee refuses, he’s subject to a $500 surcharge on health insurance and could lose up to $1,500 in Honeywell contributions to his health savings account.

He and his spouse are also each subject to a $1,000 tobacco surcharge. That means the worker and his spouse could face a combined $4,000 in potential financial penalties. Continue reading

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Nearly half of Americans over 65 need help with daily tasks

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Clinic elderly doctor nurse office couchBy Millie Dawson
Health Behavior News Service

Nearly half of Americans age 65 and older, totaling about 18 million people, require help with routine daily activities like bathing, handling medications or meals.

A new study in Milbank Quarterly reveals a growing need for improved services and support for older Americans, their spouses, their children and other “informal caregivers.”

While 51 percent of older Americans in the study reported no difficulty with routine tasks, “29 percent reported receiving help with taking care of themselves or getting around in the previous month,” said co-author Vicki A. Freedman, Ph.D., a research professor with the Institute for Social Research at the University of Michigan.

“Another 20 percent reported that they had difficulty carrying out these activities on their own,” she said.

KEY POINTS

  • Nearly half of Americans age 65 and older require help with routine daily activities such as bathing, meals or taking medications.
  • Substantial numbers of older adults living outside of nursing homes experience adverse consequences from unmet care needs.
  • There is a growing need for improved community-based services and support for older Americans and their caregivers.

Continue reading

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Does selling your home affect eligibility for assisted living?

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Q. I’m a realtor who’s listing a client’s home. She is on Social Security and is moving into assisted-living housing. Will the proceeds from the sale of her home affect her eligibility for housing, which is based on her income?

A. This is an unusual question because assisted-living facilities typically do not have special eligibility criteria for low-income residents, experts say. Continue reading

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Inactivity linked to chronic disease in adults with disabilities – CDC

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CDC – Vital Signs

Icon of a visually impaired person with a service dog  3x

Adults with disabilities are 3 times more likely to have heart disease, stroke, diabetes, or cancer than adults without disabilities.

Icon of man and woman1 in 2

Nearly half of all adults with disabilities get no aerobic physical activity, an important health behavior to help avoid these chronic diseases.

Icon of a doctor and a person in wheel chair82%

Adults with disabilities were 82% more likely to be physically active if their doctor recommended it. Continue reading

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Jails house 10 times more mentally ill than state hospitals, report

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Screen Shot 2014-04-08 at 7.26.27 AMBy Jenny Gold
KHN

April 8, 2014 – In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association. Continue reading

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Health law helps states move elderly and disabled from nursing homes to home care

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01_17_Chart_Health_Funding_thumbnailBy Christine Vestal
Stateline Staff Writer

In New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes.

To remedy this imbalance, New Hampshire is taking advantage of Affordable Care Act funding for a program aimed at removing existing barriers to providing long-term care in people’s homes and communities.

Known as the Balancing Incentive Payments Program, it is one of several ACA provisions designed to keep as many people as possible out of costly institutions. Continue reading

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Health law adds coverage needed by people with developmental disabilities

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PrintBy Michelle Andrews
KHN

January 14, 2014 — A little remarked upon requirement in the health law expands treatments for people with cerebral palsy, autism and other developmental disabilities. But some advocates and policy experts are concerned that insurers may find ways to sidestep the new requirement.

The health law requires that individual and small group plans sold on or off the health insurance marketplaces cover 10 essential health benefits, including “rehabilitative and habilitative services and devices.” Continue reading

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tacuin women

Women’s Health – Week 14: Dementia

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From the Office of Research on Women’s Health

Dementia is the loss of thinking, memory, and reasoning skills to the extent that it seriously affects a person’s ability to carry out daily activities. Dementia is not a disease itself but a group of symptoms caused by certain diseases or conditions.

The most common form of dementia is Alzheimer’s disease. People with dementia lose their mental abilities at different rates and may eventually need total care.

Symptoms of dementia
  • Being unable to remember things.
  • Asking the same question or repeating the same story over and over.
  • Becoming lost in familiar places.
  • Being unable to follow directions.
  • Getting disoriented about time, people, and places.
  • Neglecting personal safety, hygiene, and nutrition.
  • Changing clarity in memory, language, and reasoning.
  • Changing moods and personality.
  • Losing the ability to perform daily activities like driving a car or handling money.

A person with dementia should be under the care of a health care provider. The health care provider might prescribe medications that may help maintain thinking, memory, and speaking skills, and that may lessen certain behavioral problems for a few months to a few years.

Family members and friends can help people in the early stages of dementia to continue their daily routines, physical activities, and social contacts. If you are concerned that you or someone you know has a serious memory problem, talk with your health care provider.

Note
There are now drugs to treat diseases such as Alzheimer’s disease. Although these drugs do not stop the disease or reverse existing brain damage, they may be able to lessen symptoms of the disease for a time. This may improve a person’s quality of life, ease the burden on caregivers, or delay admission to a nursing home.
 
For more information: www.nia.nih.gov
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‘Habilitation’ is among new Obamacare benefits

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ACA health reform logoBy Michael Ollove
Stateline Staff Writer

“To rehabilitate,” according to the Merriam-Webster dictionary, means “to restore to a former capacity.”

But what if that capacity — be it walking or talking or brushing one’s teeth — was never there in the first place? In that case, you aren’t talking about “rehabilitation” but “habilitation.”

People need habilitation when they have a congenital defect or disease that impairs the development of basic life skills. For example, autism may leave a child unable to speak. Cerebral palsy may result in language deficits and severe physical limitations. Birth defects may leave a child deaf.

Thanks to the Affordable Care Act (ACA), habilitation services will now be widely covered for the first time in private insurance plans.

Rehabilitative and habilitative services are among the 10 “essential benefits” that must be provided by all plans sold on all the state and federally run health insurance exchanges. Starting in 2014, all individual and small group health policies sold outside the exchanges also will have to cover habilitative services.

But as is the case with some of the other “essential benefits,” the federal health law mandates coverage of habilitation services without spelling out exactly what that means. The states, together with insurers and advocacy groups, will have a big say in what, and how much, is covered.

The computer deficiencies that have plagued the exchanges since they opened on Oct. 1 have further muddied the picture, since few people have read what insurers on the exchanges are offering. “How this all plays out very much remains to be seen,” said Daniel Brown, senior state policy analyst for the American Occupational Therapy Association.

The number of people who might benefit from such services also is uncertain, Brown said. However, 15 percent of children between the ages of 3 and 17 have one or more developmental disabilities, according to the Centers for Disease Control and Prevention.

The cost of habilitative therapy varies widely, but can be quite expensive. One form of therapy used to treat those with autism, “applied behavioral analysis,” can cost $50,000 or more a year.

A Popular Addition

Before the ACA, habilitative services were inconsistently covered in health insurance plans. Most insurers took the view that teaching skills to the developmentally disabled was an educational matter rather than a health care concern. But as the disabled movement has gained influence over the last 50 years, that view has become far less than universal, even among insurers.

For one thing, it has become clear that financially strapped school systems do not have the resources or expertise to meet the habilitation needs of their students. In response, Medicaid in 1989 added habilitative services to its benefits menu, and dozens of states began to require insurers operating in their states to offer habiliative benefits. However, the coverage requirement varies widely from state to state, and many states have limited it to children with autism.

That was the situation when the ACA was being crafted in 2009 and 2010. For part of that time, people with disabilities had a formidable ally on Capitol Hill in Sen. Edward Kennedy of Massachusetts, who died in August 2009. Kennedy, whose sister Eunice Shriver founded the Special Olympics, was a longtime champion of services for the developmentally disabled.

Though the ACA as a whole remains controversial, opponents of the law have not criticized coverage of habilitative services. But advocates are concerned that the federal law leaves it to the states to determine just how robust habilitative services have to be.

Fear of Limitations

When the details of the insurance plans sold on the exchanges finally emerge, advocates will scrutinize the limitations imposed on the habilitative services offered.

For example, they would oppose a lifetime cap on the number of therapeutic visits patients are entitled to under habilitative services. They also are wary of combining rehabilitative and habilitative visits under one cap, because a person could exhaust all visits for habilitation and have nothing left for rehabilitation. Brown said children with congenital problems sometimes suffer falls or other accidents that require rehabilitation.

“We wouldn’t want (insurers) to say, if you get rehab you don’t need hab,” said Laurie Alban Havens, who advocates for insurance policy changes for the American Speech-Language-Hearing Association (ASHA), a professional organization representing various types of therapists.

Advocates also will be surveying plans to make sure “maintenance” services are included. After reaching a certain level of ability, a person typically needs help to keep that ability. ASHA and similar organization argue that maintenance often requires skilled therapy rather than the custodial level of care that insurers prefer to provide.

Many states, including Arkansas, require insurers to provide the same level of habilitative benefits as they do rehabilitative benefits.

“We wanted parity but the question was, ‘what does that mean?’” said Cynthia Crone, a deputy insurance commissioner in Arkansas. For example, an insurance plan might provide 60 days of in-patient rehabilitation without specifying whether habilitation, which doesn’t usually require in-patient care, is covered.

However the states interpret habilitative services, it will certainly be subject to challenge by consumers, regulators and the courts. Jan. 1, when the ACA officially takes effect, will mark only the start of that process.

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Think all caregivers are unhappy? They’re really not

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A younger man holds an elderly man's handBy Nancy Shute, NPR News

This story comes from our partner ‘s Shots blog.

The stereotype of caring for a family member is that it’s so stressful it harms the caregiver’s health. But that’s not necessarily so.

Studies are conflicted, finding that caregiving can harm or help the caregiver. Here’s one on the plus side: A study finds that people who care for a family member live longer than similar people who aren’t caregiving.

The scientists didn’t ask the caregivers why they might be healthier and presumably happier than similar people who weren’t caring for someone. But the 3,503 people who participated represented a broad swath of the American public and may be a better representation of the caregiving experience overall.

Just 17 percent of the people surveyed said they had high levels of caregiving strain, and the majority put in fewer than 14 hours of care a week.

“The burden of caregiving certainly can be overwhelming and negative to health,” says David Roth, director of the Center on Aging and Health at Johns Hopkins University and lead author of the study, which was published in the American Journal of Epidemiology. “But those are not necessarily the typical experience.”

The study data was originally gathered for a big multiyear study on stroke risk, but the people being cared for in this study had a broad range of health problems. The caregivers themselves were age 64 on average, more likely to be female and either white or African-American.

Family caregivers were 18 percent less likely to die than non-caregivers over six years, the researchers found.

Something must have made life better for the caregivers. But what? To help find out, we called up Leah Eskinazi, director of operations for the Family Caregiver Alliance in San Francisco.

“There are people who find caregiving very rewarding,” Eskinazi told Shots. “They feel really good that they can give back to Mom, for example, because Mom was really there for them when they were growing up. Maybe they weren’t the best kid, but as they’ve aged they can have a more balanced healthier relationship and heal some of those wounds.”

Context is everything, Eskinazi says. Caring for someone with dementia can be more stressful and depressing because the person is facing a long inevitable decline. “You’re caring for someone who can’t voice their preferences,” she says. “You’re making decisions for another person and for yourself, and that can last for a long time. It’s tough.”

But only about 10 percent of family caregivers are tending someone with dementia, other studies have found.

Caring for someone after a stroke, by contrast, can be very positive. “There’s a lot of energy going into helping that person recover,” Eskinazi says.

And in many cases the person being cared for is in a position to be grateful. “To have someone stick by you, or a group of people stick by you, that’s pretty cool,” Eskinazi says. “It gives you an opportunity to say thank you.”

Spouses typically expect to be taking care of their mate in old age, but adult children don’t always prepare for that possibility — or try not to think about it.

People tend to avoid the Family Caregiver Alliance’s booth at health fairs, Eskinazi admits. “People don’t really want to think about it. It’s time, it’s emotion and it takes energy.”

But this latest study points out that caregiving isn’t all a big minus for the caregiver — something to prepare for, perhaps, but a normal, often rewarding part of life.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Sequester hits special education like ‘Ton of Bricks’

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Photo of Vierdrie

Photo of Vierdrie

By Adrienne Lu
Staff Writer

Since the first day of class for most schools in Michigan last week, Marcie Lipsitt’s phone has been ringing nonstop with parents distraught about cuts to their children’s special education services.

A new round of special education cuts were taking hold, prompted by a 5 percent reduction in federal funding of the Individuals with Disabilities Education Act (IDEA), said Lipsitt, a longtime advocate for disabled children and co-chair of the Michigan Alliance for Special Education.

Lipsitt said it means that many schools have eliminated resource rooms where children can go to get help in areas such as math, reading, writing and organizational skills.

Many schools will have fewer speech, occupational or physical therapists, along with social workers and school psychologists, which means students who previously received speech therapy twice a week might only receive it once week, for example.

And in some general education classrooms that had two teachers – one for the whole class and one specifically to support students with special needs – the special education teacher has been eliminated.

Estimated reductions in dollars in federal funding to the states in fiscal year 2013 for Individuals with Disabilities Education Act Part B Grants, following 5 percent sequestration cuts.

US

$578,892,762

AL

8,915,770

AK

1,919,022

AZ 

10,040,553

AR

5,633,069

CA

62,855,318

CO

8,108,108

CT

6,314,489

DE

1,839,638

FL

31,092,117

GA

17,458,448 

HI

2,035,593

ID

2,865,332

IL

24,657,563

IN

12,376,969

IA

5,770,827

KS

5,251,785

KY

7,688,909

LA

9,752,289

ME

2,586,535

MD

9,719,363

MA

13,418,282

MI

20,279,289

MN

9,199,308

MS

6,123,987

MO

10,762,593

MT

1,919,022

NE

3,529,607

NV

3,775,945

NH

2,247,666

NJ

17,085,902

NM

4,354,823

NY

36,378,359

NC

16,776,161

ND

1,493,764

OH

22,008,413

OK

7,300,677

OR

6,372,225

PA

21,381,079

RI

2,067,098

SC

8,583,510

SD

1,779,462

TN

11,706,600

TX

51,026,919

UT

5,672,990

VT

1,440,274

VA

13,878,260

WA

11,251,352

WV

3,589,871

WI

10,097,151

WY

  1,510,990

DC

924,976

Source: U.S. Department of Education

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“For Michigan, it hit like a ton of bricks,” Lipsitt said. “Conditions are eroding and children are not being allowed to become taxpayers. They’re not being given access to independence, being productive, being ready for a global workforce.”

Across the country, advocates for children with disabilities are grappling with the impact of sequestration, the automatic budget cuts that kicked in when Congress failed to reach an agreement to reduce the federal budget. Although the cuts took effect March 1, the impact did not reach schools until the start of the current school year because of the way many education programs are funded.

Experts agree there is little hard data on the impact of the budget cuts on special education. The U.S. Department of Education estimates the sequester cut about $579 million in federal funding for IDEA Part B, which supports students age 3-21 with specific learning disabilities, speech or language impairments, intellectual disabilities, autism or emotional disturbances.

The National Education Association estimates that if states and local school systems did not replace any of the funds lost through sequestration, nearly 300,000 students receiving special education services would be affected. The union estimated up to 7,800 jobs could be lost as a result of the federal budget cuts.

All told, 6.5 million disabled children from ages 3-21 received services funded by the IDEA in the fall of 2011, the most recent number available.

Tricky Funding Formulas

It is unknown how many states or schools districts will replace some or all of that money from other sources, such as new tax revenues or cuts to other programs. But they may hesitate to replace federal funding even if they have the resources.

That’s because by law, states and school districts that raise their funding for special education and then later reduce it, after adjusting for enrollment and other factors, can see their funding from the federal government cut.

That requirement, known as maintenance of effort, means that even if the federal government eventually replaces the money cut through the sequester, school districts will be on the hook to spend more than they did before the automatic federal budget cuts.

Because of the maintenance of effort requirement many school districts have worked hard even through several years of state budget cuts to preserve special education funding to avoid risking their federal special education funding.

Noelle Ellerson, associate executive director of public policy and advocacy for AASA, the School Superintendents Association, said that as a result, “Over the course of the recession, the cuts in a school district’s budget have disproportionately been on general education students,” although disabled students are often affected along with everybody else by reductions in services to general education students, such as larger class size.

But in a survey by AASA earlier this year on the impact of the recession on schools, more superintendents indicated that special education spending would decline for the first time in the nearly five years the survey has been conducted.

Ellerson said that in previous years, school systems were able to cover the cuts in federal funding, but superintendents indicated this year they can no longer do so because of continuing recessionary pressures and the depth of the sequestration cuts.

Those cuts further exacerbate the federal government’s chronic underfunding of its contribution toward the education of students with disabilities.

Under the IDEA, the federal government committed to giving states funding for up to 40 percent of the difference between the cost of educating a disabled student and a general student.

The most the federal government has ever given the states is 18.5 percent in 2005 (aside from a one-time infusion of economic stimulus funding in fiscal year 2009), and the figure has been declining since, according to Joel Packer, executive director of the Committee for Education Funding, a coalition of education organizations. Under the sequester, the federal share fell to 14.9 percent, the lowest federal contribution by percent dating to 2001.

Federal funding aside, local school systems are obligated by law to provide children with disabilities with a free appropriate education.

“It doesn’t matter what the feds send down to the locals and the states in federal support, the law requires that states and local school districts identify and serve every student that they deem to be eligible and in need of special education,” said Candace Cortiella, director of The Advocacy Institute. The institute is a nonprofit that provides training for special education advocates and runs the web site IDEA Money Watch, which tracks federal funding for special education.

“There can be no consideration given to how much money there is to spend. That really puts the states and the local districts in quite a precarious situation,” Cortiella said.

What States Are Doing

The impact of the sequester on special education varies from state to state and even district to district.

In Virginia, most school districts have been able to weather the special education funding cuts so far by not replacing teachers who leave, according to John Eisenberg, assistant superintendent for special education and student services. Many school systems have also reduced or eliminated staff development, which is critical in special education.

“There’s constant change in the field in terms of making sure folks are up to speed and are using research-based practices for students,” Eisenberg said. “As we have learned more and more about things like autism, the field has changed. Getting teachers trained in the most recent research-based practices is critical.”

Virginia schools have also reported big cuts in budgets for materials and technologies to support students with disabilities, which can include electronic devices to help nonverbal students communicate, technology to help students who are hearing-impaired and computers to enlarge text, for example.

In Florida, Miami-Dade and Palm Beach counties found the money to keep their special education programming intact. But nearby Broward County this year eliminated five of 11 behavior specialists, 10 program specialists and an assistive technology position, according to Mark Halpert, director of the Florida Advocacy Coalition for Learning Disabilities.

Halpert worries about the damage a second year of sequestration could inflict.

“These kids are smart – they learn differently, have challenges and can be enormously successful,” Halpert said. “We owe it as a society to help them succeed.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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