Friday, July 28, 2017

Deadicaid

I know this blog is dedicated to The Toa Nafasi Project and the work we do supporting children with learning difficulties in public primary schools in Kilimanjaro, Tanzania, but I sometimes post slightly off-topic when I find something of interest concerning special education, early childhood development, or women's empowerment in other parts of the world.  This is one of those times.

In Trump-era America, services we Americans used to enjoy are seriously at-risk and it looks like the most vulnerable among us will be most affected.  The GOP health care bill, some MAJOR anti-Obamacare legislation, that is currently up for decision by the US Senate, is causing the most newsworthy sparks.  Besides taking away low-cost health care services for the masses, the repeal of the Affordable Care Act is expected to negatively affect the elderly, those with pre-existing medical conditions, women's reproductive rights, and, you guessed it, those with special needs or disabilities.

Below, please check out a recent article from the left-leaning magazine Mother Jones, and know that the developed world doesn't always have all the answers.  Just as we struggle to serve our students with disabilities here in Tanzania, so too do our counterparts back home in the United States.  More now than ever, it seems....

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Students with Disabilities Are the Overlooked Victims of GOP Health Care Repeal: Superintendents Are Concerned Cuts to Medicaid Will Threaten Crucial Medical Services


On the eastern end of Michigan's Upper Peninsula, Rachel Fuerer's school district depends on more than $870,000 in Medicaid funds each year.  About 5% of its overall annual budget, the money goes toward providing medical services for more than 1,000 special education students in 19 public schools across 4,000 square miles.

Those dollars, though, will be at risk if Republicans in Washington get their way.

Last week, Senate Republicans' efforts to repeal and replace—and then just repeal—Obamacare appeared to be dead.  But now, at President Trump's urging, senators are again poised for a vote on some sort of health care overhaul this week, though it remains to be seen whether they'll vote on a partial repeal of the Affordable Care Act (ACA) or a full repeal and replace effort.

What is clear is that passing either bill would greatly endanger the future of Medicaid.  The repeal and replace bill, the Better Care Reconciliation Act (BCRA), imposes a cap on Medicaid spending that would sharply reduce funds in future years.  The alternative, a bill introduced by Senate Majority Leader Mitch McConnell (R-Ky.) last week that mirrors a 2015 effort to mostly repeal Obamacare, would shrink Medicaid spending over the next decade, especially for people who were newly eligible to receive Medicaid through the ACA.

Though McConnell currently lacks the votes to ensure either bill's passage, school officials and advocates are keeping their eyes trained on the Senate.

"We're being told that special education is being spared," says Fuerer, who works as special education director at Michigan's Eastern Upper Peninsula Intermediate School District, "but that's not true at all if there are cuts to Medicaid."

Fuerer joined hundreds of school superintendents from across the country in recent weeks in descending upon Washington to lobby Congress, meeting with their state's representatives to convince them to leave Medicaid alone.  "They're lumping everything together in this repeal and replace," Fuerer says.  "In doing so, they are trying to fix something that's not broken.  Medicaid isn't broken."

To Fuerer's surprise, even just the few House members she met with the other week didn’t fully understand the extent of just how much schools rely on Medicaid dollars.  While the program is primarily used to fund health insurance for low-income families, it also doles out billions of dollars each year directly to school districts to fund special education services that are mandated by federal law and to support services for poor students.  Now school superintendents, from both red and blue states, are expressing concern that the GOP's health care plans would force districts to struggle to provide crucial services for their most vulnerable students. 

In talking about the bill as a "repeal" of Obamacare, Republican rhetoric can be misleading.  BCRA would fundamentally remake Medicaid, a program that has operated since 1965, slicing spending by $772 billion over the next decade and leaving 15 million more people uninsured.  It does this by turning Medicaid from an open-ended promise from the government to fund state needs into a block grant or per capita program starting in 2020 that will limit the amount of money each state receives.

Currently, John Hill, executive director of the National Alliance for Medicaid in Education, estimates that "almost half the children in this country are on Medicaid."  "So any cut is going to have an adverse effect on kids, no matter how much they'll assure us it's not going to happen," Hill tells Mother Jones. 

As mandated by the Individuals with Disabilities Education Act (IDEA) from 1975, schools must provide a free and appropriate public education to students with disabilities.  But Congress has historically fallen short on covering the cost of educating special-needs students under IDEA, so states and local agencies have turned to Medicaid to help offset the difference and pay the cost for medical services and equipment.  Starting in 1988, schools, like hospitals and insurance providers, have been able to request reimbursements from the Department of Health and Human Services for such expenditures.

In 2015, schools received nearly $4 billion in Medicaid funding, according to the Center on Budget and Policy Priorities, less than a third of what's doled out for special education spending under IDEA.

That $4 billion has been essential to schools covering the costs of speech and physical therapy, behavioral services, and medical equipment, such as wheelchairs and walkers.  For low-income students, districts use such funds to pay for vision, hearing, and other health screenings, as well as for school nurses and mental health services.  It's also important to note that school districts don't just offer services to poor and disabled students during school hours; they act as a connecting point to enroll eligible low-income families in Medicaid and in the Children's Health Insurance Program and help families find health care providers.  In turn, schools get reimbursed for their outreach efforts.

Sherri Smith, the superintendent of Lower Dauphin, a suburban Pennsylvania school district of just 4,000 students, was also in D.C. recently to meet with representatives.  She says the small but targeted $50,000 in Medicaid funding her district receives each year helps pay for more medical-related services, such as occupational and physical therapy, along with mental health services to serve a growing need for students in the district.  The money also allows the district to pay for additional nurses and personal care aides for students with disabilities and low-income students.

"Schools are doing more outside the peripheral of just teaching and educating," Smith says.  "So actually getting Medicaid dollars for medical services for our students, which they need, allows us the opportunity to do so.  I'm afraid that without those kinds of dollars, that will go away." 

In the broader Medicaid landscape, funding for school districts is just one tiny line item.  The National Alliance for Medicaid in Education projects that school districts receive less than 1% of all Medicaid reimbursements.

While neither the House nor Senate repeal-and-replace bill specifically targets funding for school districts, with less money coming from Washington, states would be forced to make cuts elsewhere in their budgets, which could impact the entire community.  Districts might be pushed to raise taxes, reduce spending on general education programs, or cut staff.

If schools opted to diminish services for special education students, they could be at risk of falling out of compliance with federal law, opening districts up to lawsuits and a potential further loss of federal dollars.  This is all the more complicated due to a recent Supreme Court ruling that raises the standard for what schools must offer and expands students' rights.

"We would have to be stringent on services" if Medicaid funding went away, Smith, of Pennsylvania, says.  "Depending on what types of services, if that child needs it, and it's mandated in their individualized education plan under IDEA, then we would have to provide those services.  We'd have to find our money, which means we would have to go back to our taxpayers in Pennsylvania, or we would have to look to cut from our regular programs to make up the difference."

Similarly, for Fuerer in Michigan, the cuts to Medicaid funding in the proposed health care bills would mean that her district might need to slash its overall budget just so the same level of services can be provided.  "The reality is, [the loss of Medicaid funding is] probably not cutting a speech provider.  It's probably cutting a gen ed teacher," she says.  "If you weaken the general education services, you are weakening the entire school community."

Sasha Pudelski, assistant director of policy and advocacy for the School Superintendents Association, says that changes to Medicaid could put schools in competition with hospitals and insurance providers for Medicaid dollars.  "Schools can't compete with other frontline healthcare providers for those dollars," Pudelski says.  "From our perspective, it could end Medicaid as we know it in schools."

Fuerer attended three meetings with Michigan representatives when she was in Washington this month, at least one of which really surprised her.  When she sat down with freshman Republican Rep. Jack Bergman, she says, "he had never heard about the Medicaid billing in schools and he listened very intently."  "He didn't commit to changing his position," she says.  "He voted for the House bill.  But he was interested and asked us for more information.  It was better than the other ones."

Fuerer also met with an aide to Republican Rep. Justin Amash, who voted yes on the House bill that included cuts to Medicaid spending similar to those in the Senate proposals.  In the meeting, Fuerer recalls the staffer saying that Amash believed that responsibility for funding education and healthcare should be left to states.  Fuerer says she finds that response "a little frustrating."

Chris Kjolhede, co-director of the school-based health program at Bassett Healthcare Network, which runs in-school health clinics across 15 school districts in rural upstate New York, says that though it's still too early to know the extent of damage on schools in the GOP's legislation, it is "terrifying to think about major cuts to Medicaid."  He says roughly half of children who work with his program receive care as a result of Medicaid funding and New York’s Child Health Plus program.

Kjolhede's program relies on the federal funds to provide dental, physical, and mental health services for more than 7,500 kids.  He adds that Bassett has advocated with elected officials to let them know that the group was concerned about the loss of Medicaid reimbursements in his red district.  "If the funding goes away, theoretically, I have to figure out how to pay for the services or the services go away," Kjolhede tells Mother Jones.  "There’s a lot of pressure on those of us trying to make it happen."

Wednesday, July 26, 2017

Turn, Turn, Turn

"The Reverend Mother always says, 'When the Lord closes a door, somewhere he opens a window.'"

So says Maria in The Sound of Music as she finally admits her love for Captain von Trapp.

So say I this week as we at The Toa Nafasi Project commemorate the two-year anniversary of former head teacher and Toa co-founder Vumi Temba's tragic passing, and the formal hiring of our ninth Special Education Teacher, Marieth Michael Laswai.

Marieth joins a team of eight other special ed teachers who are supervised by three Assistant Head Special Education Teachers, all of whom are commandeered by the beautiful (and very pregnant!), Project Leader/Head Special Education Teacher, Hyasinta Macha.

Though we miss our beloved Vumi EVERY SINGLE DAY, we remember her in the work we do, and we are proud to have not only continued this work but expanded into our satellite sites.

We are also so pleased to have grown our staff to double digits and to welcome newcomers like Teacher Marieth!

Mwalimu Marieth, karibu sana Toa Nafasi, karibu sana timu yetu!  Welcome to Team Toa!!

Monday, July 17, 2017

"Superstar!"

Hey readers, and pole sana for the delay in posting this blog entry.  I've been here, there, and everywhere in between with barely a moment to catch my breath!  At any rate, I am now back in La Mosh, at home with Drogo and at work with Hyasinta and the rest of the Toa teaching staff.  Things seem to have gone well in my ten-week absence, so it's not been bad picking up where we left off.

In case you're wondering, the title of this post refers to the iconic Molly Shannon Saturday Night Live skit in which she plays awkward Catholic schoolgirl, Mary Katherine Gallagher.  Though I managed not to bury my fingers in my armpits and sniff them nor bare my undergarments to the world in a spastic fit, I was acutely aware of my professional angles the whole time I was in Australia.  "Superstar!" all over the place.

You see, I had come to Perth as the sole emissary of The Toa Nafasi Project at the 2017 Biennial Conference of the International Association of Special Education with Angi being otherwise occupied back in Zanzibar and Gasto stranded in Arusha without a visa.  This led to a very heightened state of awareness on my part, a mixture of being super-nervous and hyper-confident, practically thrumming with energy and anxiety literally the whole time.  Really, I think the next time I attend a professional event alone, I need some sort of meds....preferably with a long half-life....

According to my pals at the IASE, however, I did superbly, so I guess I managed to hide my nerves fairly well.  No spontaneous utterances of "Superstar!" followed by extended falling down and damage of the immediate surroundings....at least not in public anyway....

The conference itself was quite a marvel.  There were roughly 200 attendees from 33 different countries around the world, all gathered together at the Perth Convention and Exhibition Center in downtown Perth, Western Australia (aka the end of the world!).

I had never been to Australia before so this in itself was a brand-new experience for me.  I traveled from New York to Dubai and Dubai to Perth, spent about a week in Perth, and then left Perth for Doha, Doha to Kilimanjaro.  Shortly after reuniting with Drogo and friends in Moshi, I was off to Zanzibar for Round Two of my escapades with Kaitlin who was due back in the U.S. to prepare for her sophomore year of college.  That, however, is a whole other blog entry as we celebrated the ten-year anniversary of my stepping foot in Africa on July 4, 2007.  Hijinks, capers, and shenanigans galore.

But back to the IASE conference.  Never mind I had just traveled 36hours from NYC and arrived in Perth in the dead of night on a Sunday; the very first day, I was scheduled to give a presentation about Toa Nafasi as an IASE "volunteer service project" site and talk about how IASE members could come to Moshi and help work with us, namely in the vein of teacher training.

This went pretty well as it was a round-table seated discussion and even though I was the speaker, it was not an "all eyes on me" situation where my nerves really kick in.  I don't know what it is, I am certainly not shy nor introverted by any means, but for some reason, public speaking makes me absolutely insane and my essential tremor kicks in like nobody's business!  It happened in the States too, at fundraising pitches and it is soooo embarrassing.  One of my friends here in Moshi joked that he should put a piano under my fingers and I'd play like Beethoven!


The second day, I had to present my paper, so this was the BIG DAY.  And yes, I shook like a leaf!  But my audience was small, engaged, and encouraging, so I was able to make it through and field questions with confidence ("Superstar!") and some modicum of knowledge.  Obviously, since I was the one speaking, I don't have pics of this, but here are a few mementos from the day: my conference badge and program (with a note reminding me not to forget my photo album), the sign outside my room and the podium within, and my little blurb in the program.






As you can see from the above blurb, the talk that I gave about Toa centered around the teachers, not the students, and how Toa has provided them with a sense of professional achievement outside of government-sanctioned means.  Not that they are lawless and running wild, but that where the government of Tanzania has failed these girls - in their studies, in their employment opportunities, in the making of them anything other than wife or mother - Toa has picked up the slack and offered them the chance to work and learn a valuable skill, training them in-service as they go.

The paper itself is a bit idealistic and self-congratulatory I concede, but not everyone need know our dirty laundry, right?!  And, obviously, creating change on this level is going to carry its share of challenges some of which we were able to overcome, some of which we are still tackling.  At any rate, I think it went over really well, and the paper titled "Gaining from Training: Cultivating a Professional Persona in a Rural Setting" will be published in the JIASE (Journal of the International Association of Special Education) sometime in the near future.  (Allow me here a quick finger sniff of righteous vainglory....)

Day Three brought yet another spotlight on me/Toa ("Superstar!" all over again) as I clambered onto an even bigger stage to speak to ALL the conference participants and tout the next biennial conference which will be held in July 2019 here in Tanzania.  I was not as nervous for this as Iris (the president of the IASE) was up on stage with me and we labored through some tech problems to run the PowerPoint presentation about Sebastian Kolowa Memorial University in Lushoto where that conference will be held.  The (very green) save the date card is below.


When that mess was finally over, I got to relax and simply be an attendee in peace and quiet with as many finger sniffs as needed to settle my frazzled nerves.  

I enjoyed the talks of other conference-goers, such as Morgan Chitiyo, a Zimbabwe-born professor at Duquesne University (before you get your hopes up, he's married, Mom....).  Morgan took my breath away, quite frankly.  His talk was amazing and resonated on so many levels.  I guess I was lucky because it was all about disability within the African context, so very relevant to the work that Toa does.  (Although after I gave my talk the previous day, a frantic Vietnamese woman sought me out to say that she was experiencing the same obstacles and challenges about disability in her part of the world!  So, really, the African context is kind of indicative of the greater human context, is it not?)


Here's a clip of Morgan's keynote speech in which he talks about the massive population of the African continent and the large number of people with disabilities living within.  By shutting them out of schools and the workforce, African governments are essentially losing vast numbers of people who are perfectly qualified to learn and work.  He refers to this group as "the forgotten tribe."  Morgan also talks about how, if Africa as a continent truly wants to develop and move forward in the global community, it will need this tribe to do so.  The strength of Africa is in its people and by marginalizing vast numbers of its citizenry, it is holding its own development back.  I strongly recommend taking a moment to watch this, and to look Morgan up if you are even remotely interested in disability (or development) in Africa.
 
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Aside from Morgan's talk, I did get to attend others' as well as make a lot of new contacts.  I think once my time in the spotlight was over, I was able to loosen up and just schmooze like my normal self (still a "Superstar!").  There were many Africans in attendance, so we tended to band together, but also people from all over Asia and Europe.  Not so many from the Americas, however....

For the better part of the week, I was indoors but did get a lovely view of Perth's Elizabeth Quay out the conference center's windows.  I was able to book a boat trip on the Swan River later in the week during which I Mary Katherine-spazzed upon seeing a group of baby dolphins splashing in the waves.


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The conference ended with a gala dinner during which some special needs children from the Perth area performed for the audience and I took video to show the Toa teachers that even wazungu kids have special needs and they piga ngoma (play drums) just like Danny and Vincent here at the Gabriella Center.  (Just as an explanatory FYI, that is Mary Gale, the past-president of the IASE wearing the Statue of Liberty foam crown.  The last night, everyone came garbed to rep their respective countries, so MG was lady Liberty from the USA for the evening.)
 
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I was also gifted with not one but TWO certificates that I personally don't really care about, but I knew the Toa teachers would die over.  Certification and paperwork is the law of the land here and everyone from the highest parliament member to the girl who cleans your house loves a cheti.  So I brought them back to show the teachers and, as I expected, got a lot of ooh's and aah's over them.  One is for attending the conference and the other is for being a VSP site.  I mean, okay, but I'm much more interested in what the chetis represent than the piece of paper themselves....

 

Finally, I had a couple days to myself to explore the beauty of Perth unencumbered by nerves and work responsibilities.  In addition to my adventures with dolphins on the high seas, I went out to Fremantle, the infamous prison and a World Heritage Site.  The British sent their convicts to Australia to form a new colony in the mid-1800s, but first on the to-do list?  Build your own prison!  Yeah, turns out it really sucks to be a convict....



My last day, I went to Caversham Wildlife Park and like an idiot, left my phone (camera) charging in the hotel.  Thus begun one of the most awkward days of my life.  It truly was like an SNL skit as the only other people on my tour were a Malaysian family who I basically just attached myself to, in order to get some photos taken.

Actually, Shikin, Shahrol, their cousin, auntie, and uncle were the kindest, sweetest people to allow me to tag along on their wildlife tour, from the wombat section to the dingo cage.  By the time we got to the penguin pool, we were fast friends.  Still, a strange experience to say the least.  Mary Katherine definitely would have spazzed out at some point on this tour, but I think I was just too exhausted. 

Here's a kangaroo who got super-excited to see me and thought I had food for him before I'd even had my coffee!  He took a little off my program and nipped my finger too!!



When we came back later in the day, I finally got the hang of kangaroo-feeding and became quite popular among the hungry marsupial population.


I also got to touch, not hold, a koala.  And do not dare call them bears!  Like kangaroos and quokkas, they are marsupials!!  And, these poor beautiful creatures are under threat of extinction due to a rampant chlamydia epidemic, poor buggers!  Makes me so sad because they are the cutest things ever and really have the life: eighteen hours of sleep a day, waking only for feeding and presumably the behavior that got them in trouble with chlamydia in the first place!!


Here's an excellent photo of me with my adopted Malaysian family at the Caversham sign.  It's like a game of "which one of these things does not belong?"  I should put it on the Toa assessment when we want to test for differentiation....


Finally, I now have proof that real men wear Uggs.  An impromptu trip to the Apple store led to this sighting of an Aussie man in his fine, furry footwear.  They're not just for sheilas, after all.