Indian Health Care Improvement Act Amendments of 2007

Floor Speech

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Ms. MIKULSKI. Mr. President, I wish to speak on amendment No. 4023, a very important amendment that affects over 200,000 people in my State. I am not calling up the amendment right this moment, pending some other parliamentary action, but I do wish to speak on the amendment.

This is a bipartisan amendment sponsored by Senator Klobuchar, who has taken a very impressive lead, as well as Senator Coleman. This bipartisan amendment is to stand up for constituents all over the United States of America who are severely disabled and who are about to lose their case managers.

Thousands and thousands and thousands of people--severely handicapped or disabled, both children and adults--are about to lose either their social workers or their nurses because of a new, harsh, punitive rule put out by the Centers for Medicaid and Medicare. The amendment does the same thing as Senate Bill 2578 that is sponsored by the Senators from Minnesota and myself and 17 others and would simply do this: It would stop the CMS from implementing the new rule by delaying its implementation until April 2009, when we have a new President and a new attitude.

Now, let me give the background. In December, CMS proposed this rule that would cut Medicaid funding to something called ``targeted case management'' services. The rule will go into effect March 3. That is why we are offering it on this very important bill of Indian health, and we thank the managers of the bill for their courtesy.

We hear all these government words, but I am going to talk today not only as the Senator from Maryland standing up for my constituents, but also as a professionally trained social worker. What is this? Well, a Medicaid case manager is either a social worker or a nurse who helps adults and children with very complicated problems. Children in foster care and children with disabilities get the medical and social services they need to be able to have a quality of life to be independent. But what does that mean in real terms? Well, let me give you an example.

I have a constituent in Baltimore, a 2-year-old, who was diagnosed with a genetic disorder that leads to significant feeding problems. This disease causes very severe problems and without help in early life. So what does the case manager do? If the case is a very complicated medical situation, often the case manager is a nurse. If it requires lots of complicated social intervention, it will be a social worker. First of all, the case manager gets in there and does a family assessment and works with the doctors, such as Johns Hopkins or the University of Maryland, so we know what medical plan is in order for this little child to have the ability to thrive. Then the case manager works with the family, who is in acute distress, to make sure they know someone is on their side and helps them comply with the treatment plan.

Now, what might that be? Well, in the genetic disorder case, it will be very specialized nutrition services. That is a lot of coordination to get the right people there to help that family. It will be also speech and language and occupational therapy, so a lot of compliance to make sure that child will be able to get what they need. Then, very important, psychosocial help because when a child has this type of disorder, there are other very severe psychosocial problems that emerge. Then the case manager is working with the family to get the child in the appropriate very specialized daycare. You can imagine the kind of supervision this is. This is tough, hands-on, gritty work.

Let's also take a look at when there is a child born with cerebral palsy. Again, you have a biomedical plan and the need to get the right education for the child and also assistance for the family on how to do it, then a lot of nitty-gritty work. In this case, the child would be evaluated, say, at the fantastic Kennedy-Krieger Institute, where some of the best neurosurgeons and neuroscientists will be working with them. But the case manager helps get the family a wheelchair, a ramp for the home, special education services, and counseling for the parents because this is going to be a significant responsibility for a long time.

Without case management, the whole thing falls apart. If you don't get the right services for the family in the home and the educational programs, you will not have the follow through on the biomedical plan that helps them remain independent or able to grow up.

Now, CMS says they do not want to pay for that. They say they have the authority from the Deficit Reduction Act and they can just slash these services from Medicaid funding. Well, in my State, this affects 200,000 people. It means that over 1,400 social workers and nurses who have devoted their life to helping these families will be impacted, and it means a Governor will have to pick up the bill. In my State, these services cost $150 million, with 50 percent paid by the feds and the other 50 percent paid by the State.

CMS wants to eliminate the 50 percent, which means Maryland will lose $75 million. I know Senator Klobuchar will tell us equally horrific stories. Senator Coleman has spoken about this. We object to CMS. We object to this rule. We want to delay the rule until sensible heads prevail.

We have 20 Senators who have cosponsored the bill that is the same as this Amendment. They have names such as Cardin, Corker, Domenici, Bingaman, Alexander, Voinovich, Brown, Snowe, Wyden, Sanders, Kennedy--the list goes on. Thirty States would be so affected they have taken it upon themselves to write directly to CSM.

I must say to the distinguished chairman of the Indian Affairs Committee, this also affects his State of North Dakota. It affects severely handicapped Native American children.

This is not about who is your favorite bean counter at OMB or how can we control runaway Medicaid costs; it is how do we in this country make sure our constituents and our people get the services they need to be able to have an independent life. I believe we can give help to those who are practicing self-help. For those families who are out there struggling to make sure a loved one with a handicap, a child, or an adult is able to remain independent, they need a government on their side.

So my amendment will delay the implementation. It is not my amendment, it is our amendment. It is a bipartisan amendment. I say to my colleagues from the other side of the aisle, let's be those compassionate conservatives whom you once talked about. Join with us. Let's do this.

At the appropriate time, I will call up this amendment officially, and I will ask for a vote on it.

I yield the floor.

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