President's Fiscal Year 2019 Budget: AUCD Analysis of Impact on People with Disabilities

from AUCD:

President Donald Trump on February 12 released his budget proposal to Congress for Fiscal Year 2019, which will cover October 1, 2018-September 30, 2019 (FY19). The entire budget can be found on the White House homepage.  In general, President Trump's budget, titled "Efficient, Effective, Accountable: An American Budget," would dramatically impact Americans with disabilities, with cuts far deeper than any ever enacted. The Association of University Centers on Disabilities (AUCD) examines the budget's cuts to the national network of university-based interdisciplinary programs, key disability programs, research, and a broad set of public services critical to the lives of people with disabilities.

As we did upon the release of the President's budget last year, AUCD will strongly advocate for the network's program funding in an effort to build on the recent expansion of LEND funding in Congressional appropriations and the growing recognition of UCEDDs in implementation of the ABLE Act, the Every Student Succeeds Act and other bipartisan policy priorities. The bipartisan support that LENDs, UCEDDs and IDDRCs enjoy reflects their essential role in meeting public health, education, research, training and service delivery needs, while impacting critical systems in each state and territory. We will also fight for access to services that are critical for the independence and inclusion of people with disabilities.

As a reminder, many of the draconian cuts proposed in the President's FY2018 budget proposal were never acted upon, and were strongly opposed by members of both parties. The passage of The Bipartisan Budget Act of 2018 on February 9^th of this year added an additional dimension to this year's proposal by increasing defense and non-defense spending limits for both Fiscal Year 2018 and FY 2019, setting top-line spending caps well above both current-year levels and those in the president's budget.

University Programs

Funding for 52 Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs in 44 states - which provide long-term, graduate level interdisciplinary training as well as interdisciplinary services and care - is eliminated. This reduces dedicated funding supporting efforts around Autism and related neurodevelopmental disability by more than $31.3 million. The purpose of the LEND training programs is to improve the health of infants, children and adolescents with disabilities. They accomplish this by preparing trainees from diverse professional disciplines to assume leadership roles in their respective fields and by providing high levels of interdisciplinary clinical care. The failure to allocate funding for LENDs reflects a policy shift toward emphasizing direct services, and is part of an overall reduction of $112 million for maternal and child health programs.

Sixty-seven University Centers for Excellence in Developmental Disabilities (UCEDDs) - at least one in each state and territory, who are working with people with disabilities, members of their families, state and local government agencies and community providers in projects that provide training, technical assistance, service, research and information sharing, with a focus on building the capacity of communities to sustain all their citizens - face a cut of $6 million, from $39 to $33 million, or more than 15%.

The 14 Intellectual and Developmental Disabilities Research Centers (IDDRCs) - focused on prevention and treatment of disabilities through biomedical and behavioral research, contributing to the development and implementation of evidence-based practices by evaluating the effectiveness of biological, biochemical and behavioral interventions, developing assistive technologies, and advancing prenatal diagnosis and newborn screening - have a current appropriation of $120.5 million annually. While they do not have a specific funding line item, the agency where they are housed (the National Institute on Child Health and Human Development, or NICHD) would face a budget cut of $31 million. Total proposed funding for NICHD is $1.34 billion, down from $1.37 billion. While there is no detail provided to identify where the targeted savings is coming from, the frame of stretching grant dollars farther and leveraging public-private partnership were included in the budget's narrative.

Key Disability Programs

Projects of National Significance, which focus on the most pressing issues affecting people with developmental disabilities and their families, creating and enhancing opportunities for these individuals to contribute to, and participate in, all facets of community life, would receive just $1 million, down from $10 million.

State Councils on Developmental Disabilities, a nationwide network charged with identifying and addressing the most pressing needs of people with developmental disabilities in their state or territory would be cut $17 million (23%) to $56 million. The budget narrative indicates that cuts would be achieved via improved efficiencies.

Centers for Independent Living, charged with providing people with disabilities with tools, resources and support to promote equal opportunities for independence, including going to school, working, living in the community and making daily decisions about life, would be funded at $96 million, down from $100 million, a 4% cut.  It is also important to note that these centers will be expected to take on the work of Limb Loss and Paralysis Resource Centers, for which funding is proposed to be discontinued.

Assistive Technology, a program which provides states with financial assistance to increase the availability, access, provision and training of assistive technology devices and services, was cut $2 million, from $34 million to $32 million.

The Office of Disability Employment Policy (ODEP), within the U.S. Department of Labor, is charged with addressing the significant employment gap between people with disabilities and the broader population. While the budget narrative does not explore how cuts would be achieved, ODEP would face a cut of nearly 25%, from $37.9 million to $29 million.

The National Center on Birth Defects and Developmental Disabilities (NCBDD) focuses on saving babies by studying and addressing the causes of birth defects, helping children reach their potential by understanding developmental disabilities, reducing complications of blood disorders and improving the health of people living with disabilities. Its funding would be cut by $27 million, funded at $110 million, down from $137 million. This funding level includes $10 million in new resources to support and improve ongoing surveillance efforts to address emerging threats to mothers and babies, including the Zika virus and opioids-related neonatal abstinence syndrome, which means a functional cut of $37 million to existing work.

While the budget proposes a five-percent cut to the U.S. Department of Education's budget for Special Education, funds for IDEA formula grants to states to support special education and early intervention services would go up slightly to $12.8 billion. The budget also calls for an additional $222 million for discretionary grants to states, institutions of higher education and other nonprofit organizations to support research, demonstrations, technical assistance and dissemination, and personnel preparation and development. (See here for more on the DOE budget.)

Also of concern is the proposed removal of the National Institute on Disability, Independent Living, and Rehabilitation Research(NIDILRR) from Administration for Community Living (ACL). The program, currently funded at $103 million, would receive $95 million, or an $8 million cut, while being moved to NIH as an independent entity.

A few important programs were level funded:

• The model Transition Program for Students with Intellectual Disabilities into higher education (TPSID) is funded at $11.8 million.
•  The Protection and Advocacy Network is funded at $39 million.

Civil Rights Enforcement

The Department of Justice Civil Rights Division, which includes the Disability Rights Section, works to achieve equal opportunity for people with disabilities in the United States by implementing the Americans with Disabilities Act (ADA), and enforces the federal laws that prohibit discrimination and uphold the civil and constitutional rights of all who live in America. Its budget proposal shows an increase of $893,000 but include plans to reduce 27 positions (including 11 attorneys).

The Department of Justice Community Relations Service provides assistance to state agencies and local communities in the prevention and resolution of tension, violence and civil disorders relating to actual or perceived discrimination on the basis of race, color, national origin, gender, gender identity, sexual orientation, religion, or disability. Its budget ($15.4 million) is cut entirely, eliminating 54 positions (including two attorneys), with the efforts assumed by the Civil Right Division.

The Department of Education Office for Civil Rights (OCR) investigates discrimination complaints, conducts compliance reviews, monitors corrective action plans and provides technical assistance on civil rights issues, and faces a decrease of $300,000 (~3.5%).

Health and Human Services Office for Civil Rights, charged with enforcement and regulation of civil rights, conscience and religious freedom, and health information privacy and security, faces a proposed cut of $8 million. Also within HHS, the  Voting Access for People With Disabilities Help America Vote Act aims to improve participation in the election process for individuals with the full range of disabilities, and is cut to zero from $5 million.

The Equal Employment Opportunity Commission (EEOC), charged with enforcing the Americans with Disabilities Act protections against discrimination by employers against qualified individuals with disabilities, would see a $1.83 million increase in funding that will allow the EEOC to maintain staffing levels.

Broader Public Programs

Medicaid and the Affordable Care Act - The budget endorses the Graham-Cassidy plan for repealing and replacing the ACA, which entails cutting $1.1 trillion over 10 years in Medicaid spending and devolving much of this health care program to the states.

Medicare - The budget proposes cutting a net $266 billion under the category "Medicare: Eliminate wasteful federal spending." Among other things, President Trump's budget proposal changes the way patients are reimbursed for post-acute care, making it harder for physicians to refer patients to other providers, and "limits hospital payments associated with early discharge to hospices."

The budget narrative around "Reform Disability Programs" includes a $72 billion decrease over the 10-year budget window. This includes explicit cuts to Supplemental Security Income programs and Social Security Disability Insurance programs, both managed by the Social Security Administration.  Proposed savings are achieved by program changes including cutting in half the retroactive benefits that disabled workers may receive. These are benefits provided to new SSDI recipients to reflect the loss of earnings when they became disabled. Additional savings would come from new approaches to increase the labor force participation of people with disabilities. The budget cuts nearly $7 billion over ten years from benefits for children and parents if another family member also receives SSI.

In 2019 the budget cuts Department of Housing and Urban Development (HUD) programs by $6.8 billion and includes a 20.1 percent cut to Section 8 housing assistance by 2028.

The budget proposes a 27.4 percent cut to Supplemental Nutrition Assistance Program (SNAP), largely achieved through policy changes, including a shift to aide via distribution of boxes of non-perishable foods, requiring states to terminate food assistance to unemployed adults who aren't raising children after three months, and extends this three-month time limit to adults ages 50 to 62.

Next Steps

The next step following the release of the President's Budget is for the Congress to enact 12 annual appropriations bills within the limits of the Budget Act passed on February 9^th by the October 1 start of the new fiscal year. While many Members of Congress have expressed concern about the deep cuts in the President's request, Congress has already taken steps to repeal the Affordable Care Act and to cut and cap Medicaid. Therefore, advocates must work hard to educate members of Congress about the importance of many of these programs.