Any property that needs to report to HUD and does not register for SfS by Sept. 27 will be out of compliance with HUD requirements. 

Additional data collection information and training on the new reporting tool, which is called inForm, are available on the HUD Exchange website under the Training Material and Resources section on the right side of the page.

Beginning in January, service coordinators working in all HUD-assisted properties and currently filing semi-annual reports must begin submitting Standards for Success (SfS) reports. The new report, which will be filed annually in October, will replace semi-annual reporting. HUD announced the change during the 2018 National Service Coordinator Conference in Austin, Texas.

SfS eliminates sections 8-14 of the semi-annual report that addressed service coordinator allocation of time. While some quality assurance and management companies may still require service coordinators to log that data, it will no longer be reported to HUD. Instead of tracking how service coordinators spend their time, HUD staff say the goal of SfS is to collect resident-level data that paints a more comprehensive picture of how the program is working.

“We know that this is a powerful program, we just don’t have the data to show it,” Alicia Anderson, branch chief of HUD’s Grants and New Funding Office, told conference attendees. She said the improved data from SfS will be used to refine the service coordinator program, improve accountability and highlight its successes.

Currently, HUD collects aggregate information on resident Activities of Daily Living, age, gender, ethnicity and race. With the new reporting tool, that information will be presented at the resident level to allow HUD to better determine the impacts service coordinator programs have on individual residents. Residents will be assigned indicator numbers to protect privacy.

Daily information collection isn’t expected to change drastically, according to HUD staff. Instead, the biggest change is in the way the information sent to the agency is packaged. More than 1,600 AASC Online users were part of the SfS pilot and are presently submitting only the annual report. Those who will be new to SfS in January must submit their final semi-annual reports by Jan. 30, 2019. For the first year of SfS implementation, data submitted by Oct. 30, 2019 will represent a truncated reporting period (Jan. 1 – Sept. 30).

See the chart below for a comparison of the semi-annul report to SfS. AASC will continue to inform and prepare members for the new report in the coming months. If you have questions, contact AASC Government Affairs Manager Melissa Harris at mharris@servicecoordinator.org or 614-848-5958. More information is also available about the report on HUD Exchange. 

Members voted 210-206 for the cuts that would impact several programs, including affordable housing and development programs that have been proven to benefit low-income residents and promote self-sufficiency.

The plan would cut $41 million from public housing, $23 million from the Community Development Financial Institutions Fund, $40 million from USDA’s Rural Rental Assistance program, and $142 million from the Capital Magnet Fund.

The rescission would also impact funding for Resident Opportunities and Self-Sufficiency (ROSS) grants as well as eliminate all Jobs Plus grant funding from Fiscal Year (FY) 2017.

Meanwhile, $7 billion of the proposed reduction in funding was previously approved for the Children’s Health Insurance Program. A portion of those dollars come from the contingency fund, which can be used to cover potential shortfalls because of increased enrollment in the program that currently covers nine million children from low-income families.

Although the Trump administration and those who support the rescission argue that some of the funding has lapsed and can no longer be spent, opponents believe the optimal response would be to reauthorize the money or reallocate it to other programs that benefit the same causes.

The package heads next to the Senate, which must act soon to ensure the funding won’t be frozen for 45 legislative days and cause program disruptions well into the fall.

If approved by both chambers, it would be the largest rescission package in U.S. history. That support, however, will likely spur the introduction of another, even wider-ranging rescission plan that would include cuts from the recently passed FY18 budget, the administration and Congressional leaders have said.

The House on Friday voted 198-213 to defeat the Farm Bill, which included the proposed work requirements that could have jeopardized benefits for an estimated one million low-income, able-bodied adults.

The proposal would have required most unemployed adults between the ages of 18 and 59 to enroll in 20 hours of workforce training to receive assistance. Exceptions were to be made for pregnant women, people with disabilities and parents with children under 12. The Congressional Budget Office (CBO) estimated the changes could have resulted in a more than $17 billion reduction in benefits provided to low-income families over 10 years.

CBO also determined that it would take years for states to create work training programs that would then be able to accommodate only about two percent of individuals who would need to take part in them to maintain SNAP eligibility.

The loss of SNAP benefits impacts not only the individuals directly eligible for them, but also children, who rely on the program for regular and healthy meals. Of the estimated 42 million low-income Americans currently using the SNAP program, children and older adults make up the largest groups of beneficiaries. 

U.S. Department of Housing and Urban Development (HUD) Secretary Ben Carson today proposed raising the rent for low-income families and allowing public housing authorities (PHA) and owners to implement work requirements.

As expected, the so-called “Making Affordable Housing Work Act” seeks to increase the current monthly rent contribution for those in HUD programs from 30 percent to 35 percent. It would also triple the rent paid by the lowest-income families, which is currently capped at $50. That change would impact about 175,000 families, according to HUD.

The agency is also looking to eliminate deductions for medical and child care, which are presently considered when setting tenant rents.

PHAs and owners would have the ability under the proposal to impose work requirements – something just 15 authorities in a dozen states are already doing, HUD has indicated. They would also be given greater flexibilities regarding rent payments and calculations.

While older adults and persons with disabilities are entirely exempt from work requirements in the administration’s plan, they’d only be safe from proposed rent increases for six years.

Secretary Carson unveiled the much-anticipated details of the proposal ahead of a House Financial Services Subcommittee hearing were members examined Rep. Dennis Ross’s (R-FL) Promoting Resident Opportunity through Rent Reform Act, which includes similar provisions. Both proposals require full Congressional approval. 

Plans to create new work requirements for the food stamp program, also known as the Supplemental Nutrition Assistance Program (SNAP), were included in the 2018 Farm Bill unveiled by House Republicans on Thursday. The measure will be reviewed in the House Agriculture Committee next week.

The proposal would require most unemployed adults between the ages of 18 and 59  to enroll in 20 hours of workforce training to receive assistance. Exceptions are made for pregnant women, people with disabilities and parents with children under 12. Preliminary data from the Congressional Budget Office estimates the changes to the work requirements would cut food stamp enrollment by as many as one million people over the next decade.

The plan would also impose stricter eligibility guidelines for low-income families who qualify for SNAP through other welfare programs. An estimated 42 million low-income Americans currently use the SNAP program. Children, a fifth of which live in poverty in the U.S., make up the largest group of beneficiaries of SNAP, as well as other public benefit programs, according to federal data. 

Income limits are set by HUD to determine the eligibility of applicants for HUD’s assisted housing programs, such as Section 202, Section 811 and Section 8 Housing Choice and Project-Based Vouchers.

Section 8 Fair Market Rent (FMR) area definitions are used to develop median family income estimates for each metropolitan area and non-metropolitan county. HUD income limits are calculated for every FMR area with adjustments for family size and for areas that have unusually high or low income-to-housing-cost relationships.

Low-income families are defined as families whose incomes do not exceed 80 percent of the median family income for the area. Very low-income families are defined as families whose incomes do not exceed 50 percent of the median family income for the area. Income limits for non-metropolitan areas may not be less than limits based on the state non-metropolitan median family income level.

These income limits are effective as of April 1. The income limits can be found here.

As part of an ongoing effort to reduce prescription drug costs, CMS said it is finalizing a plan to lower the price low-income beneficiaries pay for medicines referred to as biosimilars.

The proposed lower costs, which were among a handful of other initiatives announced Monday, are expected to result in a $10 million program savings in 2019, according to a CMS release. Proposed changes are set to go into effect Jan. 1.

Another finalized policy allows for certain generic drugs to be substituted onto plan formularies at any point in the year, allowing beneficiaries to access lower-cost options sooner. Currently, Medicare beneficiaries must wait until the next open enrollment period before they can use their insurance for newly approved prescription drugs.

CMS said other proposals seek to increase competition among plans and pharmacies by removing a requirement that certain Medicare Part D plans have to “meaningfully differ” from each other and clarifying an “any willing provider” requirement.

The latter update could increase the number of pharmacy options available to beneficiaries, according to administrators.

“The steps we are taking will drive more competition among plans and pharmacies to meet the needs of seniors and lower costs,” CMS Administrator Seema Verma said in a statement.

The agency this week also issued 2019 rates and a final rule on Medicare Advantage and Part D updates. It estimates the rule will result in $295 million in annual savings for the Medicare program over the next five years.

CMS said it will also provide Medicare with additional tools to combat opioid addictions and overprescribing. Among them is new authority for Part D sponsors to require beneficiaries at risk of addiction to use only certain prescribers or pharmacies for opioid prescriptions.

Proposals this week didn’t include plans for an overhaul of Medicare rebates, which lawmakers and the administration have questioned in recent months. Benefit managers and Part D insurers presently receive discounts on certain prescription drugs and collect fees. They are not required to pass that money on in the form of consumer savings.

Administrators said CMS has received detailed stakeholder input on the issue and it is being evaluated as the agency considers future policies.

This is a rejection of the cuts previously proposed by the House and Administration, which included plans to eliminate many core HUD programs. The bill funds HUD $4.7 billion above FY 2017 and provides the most significant funding increase for the Older Americans Act and other aging programs since 2010.

Details of the bill include:

• The Section 202 Service Coordinator program was funded $15 million above FY 2017, for a total of $90 million.
• The Section 202 Supportive Housing Program for the Elderly received $678 million, up from $502 million in FY 2017.
• The Public Housing Capital Fund, which administers ROSS Grants, received $2.75 billion, an increase of 42% from last year.
• The ROSS program received $35 million (level funding from 2017).
• The FSS program received $75 million (level funding from 2017).

These increases are a testament to the advocacy of aging organizations across the country, including your advocacy in response to our Action Alert on March 13.

For a breakdown of the bill’s affects on key programs, view the National Association of Area Agencies on Aging’s (n4a) initial analysis.

HUD’s mission is to ensure Americans have access to fair, affordable housing and opportunities to achieve self-sufficiency, thereby strengthening our communities and nation.

The current mission statement, which was last updated in 2010, is:

HUD’s mission is to create strong, sustainable, inclusive communities and quality affordable homes for all. HUD is working to strengthen the housing market to bolster the economy and protect consumers; meet the need for quality affordable rental homes; utilize housing as a platform for improving quality of life; build inclusive and sustainable communities free from discrimination, and transform the way HUD does business.

The proposed statement would shorten the mission from 63 words to 23. Housing and civil rights groups have pushed back against the changes, stating their concerns that inclusive, anti-discrimination language would be removed. 

Dr. Ben Carson, secretary of HUD, sent a letter to HUD employees stating the department is considering a change to the mission statement and is seeking comments and ideas from HUD senior staff. 

In a public statement, HUD said, "You can be sure of one thing—any mission statement for this Department will embody the principle of fairness as a central element of everything that we do. HUD has been, is now, and will always be committed to ensuring inclusive housing, free from discrimination for all Americans.”

Recently we learned that the Department of Housing and Urban Development (HUD) has prepared language for “rent reform” legislation that could have a devastating impact on those that depend on assisted housing. The draft bill includes several of the provisions that have circulated for years regarding work requirements, eliminating deductions and raising the minimum rent for tenants. While these changes have always been proposed in by members of Congress and successfully been beaten back, they may have a better chance under an administration proposal by HUD Secretary Ben Carson.

Households receiving HUD rental assistance are now required to pay 30 percent of the adjusted household income towards their rent. HUD’s adjusted income allows deductions for dependents, childcare, medical and disability related expenses, and deductions for seniors and persons with disabilities. Under the draft bill, all of these deductions would be eliminated, increasing the rent burden for most households served by HUD. These changes would hit families with high medical costs and children the hardest, putting vulnerable residents at risk for homelessness.

Under this draft bill, families would be required to pay the higher of 35 percent of the household’s gross income—not adjusted—or 35 percent of what they earn from working 15 hours a week for four weeks at the federal minimum wage. The document notes that the estimated amount for the latter would be $152.25. This amount would basically become HUD’s new minimum rent.

In addition, HUD’s draft language would permit state and local housing agencies to establish work requirements of up to 32 hours per week. The implementation of such a requirement would be difficult for agencies, which are struggling to operate with severely limited funding.

Housing advocates have been particularly concerned about the administration and Secretary Carson’s vision for federal housing programs. President Trump’s FY18 budget proposed a 13 percent cut to HUD, including the elimination of the National Housing Trust Fund, a key resource for new affordable housing development. Congress pushed back in FY18, protecting owners and residents, but the anticipated cost of the recent tax reform legislation has many wondering if cuts are seen as necessary and are gaining support.

AASC continues to educate members of Congress and the administration about the value of HUD’s affordable housing and service coordination programs. We urge Congress to provide the funding necessary to expand service coordination programming to better serve residents with job training, education and on-site supportive services. 

Healthy Housing Rewards offered pricing breaks to borrowers who included features that improved air quality, encouraged physical activities and incorporated common spaces into affordable rental properties.

Now, Fannie Mae is rolling out a new feature of Healthy Housing Rewards called Enhanced Resident Services^TM to encourage developers to focus on the health and wellbeing of residents.

Enhanced Resident Services offers developers a lower borrowing rate in exchange for providing residents with health and wellness programs, food access, youth and education programming, day care and job training.

The program will be implemented with help from Stewards for Affordable Housing for the Future (SAHF), a group of affordable housing providers that offers compliance certifications for borrowers and affordable housing properties providing the services.

The bill was introduced by Representatives Sean Duffy (R-WI) and Emanuel Cleaver (D-MO). It permanently reauthorizes the Family Self-Sufficiency (FSS) program, combines the FSS programs for Housing Choice Vouchers and public housing (which are currently run separately), and expands eligibility to include families in privately owned properties subsidized with HUD project-based rental assistance. The program would also offer new services for financial literacy and educational attainment.

The bill will now move to the Senate.

View the full report

The report also highlights challenges and effective strategies for overcoming barriers and identifies technical assistance needs. Finally, it includes four “Spotlights,” which focus on different ways providers can integrate multi-generational activities into senior housing.

The study's key findings include the following:

• Many housing providers have integrated a range of intergenerational activities into their overall programming and see positive benefits for residents and youth.
• Most intergenerational efforts identified are short-term or one-time events and do not require a major commitment of time.
• Most providers have not identified clear outcomes for older adults or youth, nor have they conducted formal program evaluations.
• There is limited training of staff and volunteers.

Learn more about Standards for Success

In FY 2017, HUD partnered with the Pangea Foundation—AASC’s partner in the development and maintenance of the web-based AASC Online data and case management system—to begin piloting SfS with service coordinators who use AASC Online. If you are a current AASC Online subscriber, you participated in and reported your work in the SfS system this past October and are still included in the pilot unless you have specifically requested not to participate.

For FY 2018, HUD seeks to expand participation. SfS requires only one annual report submission, and pilot participants do not have to complete the Semi-Annual Performance Reports. Furthermore, pilot participation provides the advantage of learning and becoming accustomed to the new reporting requirements before they become mandatory across HUD discretionary programs.

Service coordinators that want to participate in the SfS pilot may subscribe to AASC Online or use their own existing electronic case management system. For those who do not have an electronic file/data management system, HUD provides complimentary access to the GrantSolution online data collection and reporting tool called inForm. inForm allows participants to record their data throughout the reporting period and submit the data when ready.

If you do not use AASC Online but would like to participate in the SfS Pilot for FY 2018, you will need to email the GrantSolutions Help Desk at help@grantsolutions.gov and provide the following information:

• Organization name
• Organization authorized representative
• Organization point of contact
• Organization DUNS number
• Organization EIN/TIN number
• HUD program
• HUD grant number or contract number
• Statement confirming your participation in Standards for Success for FY 2018

• 92456 Semi-Annual Performance Report – Due 7/30 and 1/30
• 50080 Expense Report – Due 7/30 and 1/30
• Annual Quality Assurance Reports (if applicable) – Due 1/30

 CHSP Grants

•  SF 425 Financial Report – Due 7/30 and 1/30
•  90006 Annual Reporting Form – Due 1/30

If your service coordinator program is participating in the SfS pilot*:

• Your 50080 Expense Report will still need to be uploaded to GrantSolutions in grants notes by the required submission dates indicated above.
• You do not have to submit a Semi-Annual Performance Report. 
• In October, you should submit your SfS pilot report and the Annual Quality Assurance Report, if applicable.

Do not hesitate to contact your HUD Grants Specialist with any questions or concerns.

*If you use AASC Online as your documentation software, you were automatically enrolled in the SfS pilot program unless you chose to opt out.

On Thursday, the Federal Communications Commission (FCC) reversed net neutrality regulations that had been implemented in 2015 during the Obama administration.

Net neutrality regulations prohibited internet service providers (ISPs) such as Comcast or AT&T from throttling internet speeds or prohibiting access to websites or services. They also restricted the use of internet “fast lanes” by reclassifying ISPs as common carriers, which meant that since 2015 the internet has been regulated like utilities such as gas, telephone and water. Under the rules, internet service providers are required to treat all online content the same. They cannot deliberately speed up or slow down traffic from specific websites or apps, nor can they put their own content at an advantage over rivals.

With the internet being increasingly central to our lives, changes to how it will be regulated has far-reaching implications in terms of potentially widening the “digital divide” (the technology gap between the rich and poor) and limiting access to remote health monitoring and other services. Affordable housing for low- and moderate-income older adults and families may also be impacted by slow connection speeds at their ISP's discretion, or they may have to pay more for faster internet speeds.

The repeal could change how customers are billed for services, both for good and bad. Cell phone and other tech providers could make it cheaper for their customers to stream the cell phone provider’s specific content, while possibly charging more for accessing competitors’ content. Without net neutrality, internet providers may pursue these types of offers more aggressively. This could be viewed as a positive by consumers looking to save money on their streaming media but also a negative if consumers want freedom of choice in accessing their internet content.

This repeal could also negatively impact rural areas. Many rural broadband customers have few options when it comes to choosing an ISP, and with the end of net neutrality, it will further harm competition in rural areas. Already, broadband prices are higher where monopolies exist, and without net neutrality, those ISP providers already in place would have yet another tool with which to leverage their advantage without fear of losing customers.

While the repeal of these regulations appears to be a done deal, technology advocates and states’ attorneys general are already gearing up to challenge the action in the courts. Some have speculated that the issue could also be decided by legislation in Congress.

Special Offer!
Register by January 19, 2018, to get the courses for $550. After January 19, the cost of each course will increase by $75, so act fast! Find more program details here.

Register for one course, or successfully complete the three-course series and earn a Certificate of Completion in Gerontology from The Ohio State University Office of Geriatrics and Interprofessional Aging Studies.

S.A.G.E. courses in 2018: 

• Introduction to Applied Gerontology — Spring Semester, starting January 2018
• Case Studies in Clinical Gerontology — Summer Semester, starting May 2018
• Issues and Trends in Aging — Autumn Semester, starting August 2018

Register now! With questions, email aging@osu.edu.

Do you have several employees from the same organization who would like to complete courses at the same time? Email Ohio State to ask about organizational discounts.

*Students will be granted seven hours of continuing education credit (or 21 hours for the series) from the Office of Geriatrics and Interprofessional Aging Studies at The Ohio State University College of Medicine, which may be presented to professional credentialing organizations for possible continuing education credit. Each course in the OSU S.A.G.E. Program is approved for seven (7) hours of continuing education credit by the State of Ohio Board of Executives of Long Term Services and Supports (BELTSS). The BELTSS approval number is 004-SS-17.

HUD has released information regarding the CY 2018 Annual Extension Funding Renewals that will again be processed through GrantSolutions as was for the CY 2017 process. The processing of the renewals will be accomplished through a streamlined process which applies to all grants that were submitted and awarded in GrantSolutions under the CY 2017 cycle.

Click to view the Application and Submission Instructions and the GrantSolutions QuickSheet for adding documents to Grant Notes in GrantSolutions. Also see the two-page GrantSolutions Grantee User Account Request Form if you do not currently have access to your Service Coordinator grant in GrantSolutions and need this.

The deadline for submitting the CY 2018 Service Coordinator Grant extension renewal in GrantSolutions is November 20 December 8, 2017. There will be no extensions to this deadline, and the process as outlined in the instructions must be followed in order to not jeopardize the receipt of 2018 extension funding. The required information is to be submitted on the same grant application record that was established in GrantSolutions for 2017.

Changes in West Region Grants communications

The West Region of HUD that oversees the grant-funded service coordinator programs for that region has communicated a change in where West Region grantees are to send their grant-related correspondence beginning November 1, 2017:

• West.Grants1@hud.gov – for Arizona, California, Hawaii, Guam, Nevada and Utah – monitored by Rhonda Horn, Grant Specialist, 303-675-1608
• West.Grants2@hud.gov – for Colorado, Montana, Oregon, North Dakota, South Dakota, Washington and Wyoming – monitored by Darlene S. Matushefske, Grant Specialist, 303-672-5474

The West Region has also setup a mailing list for grantees to receive pertinent grant related information, guidance and updates starting November 1, 2017. To receive these mailings, you must subscribe to the ListServ at the following link. This will be the primary avenue of communication out to grantees from West Grants, so it is important that you sign up in order to receive information you will need throughout the year. 

https://www.hud.gov/subscribe/signup?listname=West%20Region%20Grants&list=WEST-REGION-GRANTS-MF-L

After November 1, the West Region Grants Specialists will no longer be sending out email blasts. Please do not rely on receiving information via email from West.Grants or email blasts from the West Region Grant Specialists after November 1 which is why signing up for the West Region Grants ListServ is imperative.

Service Coordinator in Multifamily Housing Program Resource Guide (Draft) Is Available for Review and Public Comment

At long last, a more comprehensive guide for service coordinators in Multifamily Housing for the Elderly and Disabled and Quality Assurance professionals has been developed by HUD. HUD contracted with Abt Associates to develop the guidebook. The Director of Housing and Community Initiatives at Abt, a former member of AASC’s Board of Directors, contacted AASC to subcontract in the development and writing of the Guide.

On October 26, 2017, HUD posted a draft of the Service Coordinator in Multifamily Housing Program Resource Guide for public comment. This resource guide focuses on how to operate an effective service coordination program in HUD Assisted Multifamily Housing for the Elderly and Disabled programs.

Comments should be submitted to mfservicecoordinator@hudgov.onmicrosoft.com by November 27, 2017.

With over 60,000 low- and very low-income residents, HHA is the largest provider of affordable housing in Houston. Many of these residents suffered crippling losses from Hurricane Harvey.

If you are looking to directly help these residents, HHA's nonprofit affiliate Houston Housing Resource is accepting charitable contributions that will go directly toward helping HHA residents rebuild their lives.

Donations may be made via PayPal or by check to Houston Housing Resource, Attn: Donna Dixon, 2640 Fountain View, Houston, TX 77057.

For more information, read a letter from Donna Dixon.

Additionally, AASC is monitoring the situation as Hurricane Irma continues to affect Florida, other southern states and the Caribbean. In the coming days, we will share organizations that will assist with Irma recovery.

While these measures account for most of the bill’s $756 billion reduction in federal Medicaid spending over the next decade, there are other big changes in the bill that would reshape the federal health insurance program that covers 74 million low-income Americans.

A new issue brief from the Kaiser Family Foundation highlights several less-discussed Medicaid provisions in the bill, including:

• Phase out of the enhanced federal financing for the ACA Medicaid expansion. To date, 32 states have implemented the Medicaid expansion.
• An option for states to require work as a condition of Medicaid eligibility for the first time in the program’s history
• Changes in eligibility and enrollment processes that would make it more difficult for eligible individuals to obtain and maintain Medicaid coverage.

The issue brief goes into more detail regarding the provisions in the Senate bill. However, given the impact the provisions identified above could have on low-income residents in affordable housing, it is imperative that AASC members and their residents inform their Members of Congress (MoCs) what the potential adverse impact would be if these changes to the Medicaid program become law.

Here are some basic facts about the 52-year-old Medicaid program.

What is Medicaid?

Medicaid is a public health insurance program largely for low-income people, though some middle-class people with disabilities and older adults also qualify. States and the federal government share the cost.

Whom does Medicaid cover?

• Nearly one in five Americans, 74 million people, are covered by Medicaid.
  
• Federal law guarantees Medicaid coverage to pregnant women, children, elderly and peple with disabilities under certain income levels.
• It covers more than a third of the nation’s children and pays for half of all births.
• It also covers almost two-thirds of nursing home residents, including many who are middle class and spent of all their savings on care before becoming eligible.
• States also have the option of covering other groups, like children and pregnant women whose household incomes are higher than the federal thresholds, or young adults up to age 26 who were once in foster care.
• The Affordable Care Act allowed a new optional group: any adults with income up to 138% of the poverty level, which would be $16,643 for an individual this year. Thirty-one states now offer Medicaid to this group.

When was it created?

Medicaid was created in 1965 as part of President Lyndon B. Johnson’s “Great Society.” There was little political debate; the bigger fight was over creating Medicare, the program to cover the elderly, which Medicaid is often confused with.

Is Medicaid an entitlement program?

Yes. Anyone who meets the eligibility rules has a right to Medicaid coverage. For the present, states are guaranteed open-ended financial support from the federal government.

How much does it cost?

• Medicaid cost $553 billion in federal fiscal year 2016 (October 1, 2015 – September 30, 2016). Of that amount, $348.9 billion came from the federal government. The states paid $204.5 billion.
  
• Medicaid accounts for 9% of federal domestic spending. For states, it is the biggest source of federal funding and the second-largest budget item behind education.
• The biggest costs in Medicaid are for older adults and people with disabilities, often because of long-term care in nursing homes.
• Washington pays 50 to 75% of Medicaid costs for most eligible groups, with poor states receiving more money.
• Under the Affordable Care Act, the federal government initially covered all of the costs for the roughly 11 million people insured under the law’s expansion of Medicaid, who are largely adults without disabilities.
• Under the Affordable Care Act, Washington picks up 95% of state costs for the expansion of Medicaid this year, whittling down to 90% in 2020.

What changes are in store?

• Both the House and Senate repeal bills would fundamentally change the way the federal government pays its share of Medicaid costs, setting a per-person limit on spending that would adjust annually for inflation.
  
• The bills would also effectively end the Medicaid expansion by sharply reducing how much the federal government pays for that population starting in 2020.
• The result of these changes, according to independent analyses, would be major reductions in federal Medicaid spending over time.
• Enrollment would drop, too, according to the nonpartisan Congressional Budget Office, with states making it more difficult to qualify for the program and eliminating certain benefits to make up for tightened federal spending.

AASC will keep members informed as the legislative process unfolds in the Senate regarding this bill. In the meantime, you may want to begin collecting personal stories from your residents (and yourself if affected by the bill) regarding how they will be impacted by this bill for advocacy and education efforts in the very near future.

Here are some of the preliminary effects of the draft bill:

• Subsidy to reduce the cost of premiums: You could lose all or some of your subsidy, which is now available to people earning up to $84,650 for a family of three. That income limit would be lowered slightly and would become less generous. The changes amount to about a 15% cut for those who would qualify.
  
  
• Subsidies for purchasing health insurance on the exchanges: The bill would sunset in two years subsidies for people who purchase insurance on an exchange. Most of the more than six million Americans benefiting from the help may not be aware they’re getting it, since the subsidy goes directly to the insurer who then lowers the cost-sharing requirements for a plan. Without the subsidies, insurers would need to raise rates an estimated 20% to make up for the loss, experts have estimated. But the bill also includes funding for states to reduce insurance costs in other ways.
   
  
• Prohibition on charging older people more: The bill would eliminate the ACA's requirement that insurers can't charge older customers more than three times what younger customers pay for the same coverage. Instead, those in their 60s could be charged five times as much, or more.
  
  
• Expanded Medicaid: If you are among the more than 14 million Americans who gained eligibility through the Affordable Care Act, you could lose it, but not for a few years. Enhanced federal funding for the low-income adults who became newly qualified under the ACA would be phased out, ending after 2024. Federal support for traditional Medicaid would also be scaled back. States, which pay a portion of the cost of Medicaid, would have to find new funding or cut the program through restricting enrollment, curbing benefits, reducing payments to health care providers or finding efficiencies. The Medicaid per capita caps in the House-passed “American Health Care Act” bill already required large state cuts. Now those will be much bigger.
  
  
• Tax penalties for not purchasing health insurance: The bill effectively removes the ACA’s requirement that most people buy insurance by eliminating the tax penalties for failing to do so. For 2015, 6.5 million taxpayers owed the IRS a penalty for not having insurance. While unpopular, the coverage mandate was included in the ACA to encourage healthy people to buy insurance, which spreads the risk to insurers and reduces the cost of plans. Actuaries expect premiums to rise without the mandate.
  
  
• Mandate for employers to offer health insurance: The bill would end the ACA’s penalties for larger employers who don't offer insurance to workers. The nonpartisan Congressional Budget Office has said fewer employers will offer coverage if that change is made.
  
  
• Substance abuse/addiction treatment services: The bill includes $2 billion for grants to states for addiction services, a response to concerns that cutting spending for Medicaid would curtail access to treatment programs. Critics say that’s not nearly enough.
  
  
• What federal subsidies will let your pay for: If you receive federal help to buy insurance on an exchange, you could not use the subsidy to pay for a plan that covers abortion services. There’s an exception for abortions performed to save the life of the mother, or to end a pregnancy that resulted from rape or incest.
  
  
• Planned Parenthood: The bill would block Planned Parenthood from receiving Medicaid funding for a year. The federal government already prevents Medicaid patients from receiving abortion services. But the bill would also block them from using Planned Parenthood for contraception, testing for and treatment of sexually transmitted diseases, and other services.
  
  
• State requirements: The bill would make it easier for states to waive requirements that insurance plans cover specific benefits. Before the ACA, many plans did not cover mental health or maternity care, and some did not cover pharmaceuticals. Some other services were available only at an extra cost. While the ACA already allows states to seek permission from the federal government to waive insurance rules, the Senate bill would remove the requirement that any changes not result in a reduction in coverage or more expensive plans. The bill would also end the ACA's requirement that insurers spend a specific amount of the premiums they collect on benefits, instead of on profits, administration and other expenses.

IMPORTANT NOTE: If you use the AASC Online service coordinator documentation/case management system, you are participating in the Standards for Success (SfS) pilot and DO NOT HAVE TO SUBMIT the Semi-Annual Performance Report. However, if you have requested to OPT OUT of the SfS pilot, you WILL HAVE TO SUBMIT a Semi-Annual report for this time period.

Semi-Annual Performance Reports are to be submitted no later than 30 days after the end of each reporting period, meaning your report will be due July 30, 2017. You should submit your report to your HUD grants specialist or the account executive for your property if your service coordinator position is funded through your property’s operations budget.

As a reminder, service coordinators in Multifamily Housing for the Elderly and Disabled whose positions are paid by the following funding sources are required to submit the HUD-92456, Semi-Annual Performance Report.

• Service Coordinator in Multifamily Housing Grant Program funds
• Section 8 funds
• Project Rental Assistance Contract (PRAC) funds
• Section 236 Excess Income
• Debt service savings
• Residual receipts

If one property has multiple service coordinators,  each service coordinator should submit his/her own report.

If  one service coordinator serves multiple properties, you are to submit one report per property.

If a service coordinator leaves his/her job during a reporting period, he or she must, to the extent possible, complete a performance report for the time worked during that reporting period. If a new service coordinator starts during the same reporting period, he or she should similarly complete a report for the time worked during that reporting period.

The service coordinator who finishes out the reporting period must send both reports to HUD to provide data for the entire reporting period.