Elder Law Prof Blog

Medicaid program pays for unapproved drugs

Medicaid paid nearly $198 million from 2004 to 2007 for more than 100 unapproved prescription drugs for beneficiaries, according to an Associated Press analysis of federal data...The drugs in question, most of which are used to treat common conditions such as colds and pain, have been on the market before the early 1960s when FDA enhanced restrictions on pharmaceuticals. The drugs have not been evaluated by FDA for safety or effectiveness and could put beneficiaries at risk of adverse events or, in some cases, death.

For the report, AP checked medications covered by Medicaid from 2004 to 2007 against FDA databases and used agency guidelines to determine if the medications had been approved. Data for 2008 were not available. According to AP, unapproved drugs comprise about 2% of those sold in the U.S., or about 72 million prescriptions each year. In most cases, doctors, pharmacists and patients are not aware that these drugs are not approved. "Over the years, they have become fully entrenched in the system," Patti Manolakis, a North Carolina pharmacist, said.

FDA has implemented a program to "weed out drugs it had never reviewed scientifically," but many have "continued to escape scrutiny," and "conflicting federal laws" allow Medicaid to continue paying for them... FDA estimates there could be thousands of drugs sold in the U.S. that never have been approved. Many manufacturers claim their drugs were "grandfathered in" under earlier laws and exempt from FDA regulation. However, FDA compliance lawyer Michael Levy questioned the grandfather status of unapproved drugs, saying that to qualify, the drugs would have to be exactly the same in formulation and other aspects as medications sold decades ago.

  Response 
Critics say that FDA's "case-by-case approach" is ineffective and that the agency must create a comprehensive list of drugs that have not been approved to ensure that Medicaid and private insurers do not pay for them.  Jon Glaudemans, senior vice president of Avalere Health, said, "FDA does not appear to have a systematic mechanism to report these drugs out, and there doesn't seem to be a systematic process by which health insurance programs can validate their status," adding, "And everyone is pointing the finger at someone else as to why we can't get there."

The agency says it would be difficult to create such a list because drugmakers do not list unapproved products with the agency. The analysis found that some of the drugs are listed, which could provide a "possible starting point" for such a list... Levy said, "The situation is complicated by the fact that Medicaid and Medicare have a different regulatory regime than FDA does," adding, "There are products that we may consider to be illegally marketed that could be legally reimbursed under their law."

Medicaid officials say Congress needs to step in to help address the matter. Medicaid Chief Herb Kuhn said, "I think this is something we ought to look at very hard, and we ought to fix it." He added, "It raises a whole set of questions, not only in terms of safety, but in the efficiency of the program -- to make sure we are getting the right set of services for beneficiaries." Senate Finance Committee ranking member Chuck Grassley (R-Iowa) has asked the HHS Office of Inspector General to investigate the issue. Grassley said, "The problem I see is bureaucrats don't want to make a decision. There is no reason why this should be such a house of mirrors when so much public money is being spent" ...

Source/more:  KFF/AP/Houston Chronicle, http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=55724

                         

New book: Theories on Law and Ageing

Springer has just published "Theories on Law and Ageing", edited by Israel Doron (U. Haifa).  The book is available in hard copy or as an e-book. 

Theories on Law and Ageing:  The Jurisprudence of Elder Law

Publisher	Springer Berlin Heidelberg
DOI	10.1007/978-3-540-78954-3
Copyright	2008
ISBN	978-3-540-78953-6 (Print) 978-3-540-78954-3 (Online)

Table of Contents:

Elder Law: A Personal Perspective
A. D. Bogutz

Later Life Legal Planning
L. A. Frolik

A Therapeutic Approach
M. B. Kapp

A Feminist Approach to Elder Law
A. K. Dayton

A Multi-Dimensional Model of Elder Law
I. Doron

A Law and Economics Approach
R. L. Kaplan

What can Elder Law Learn from Disability Law?
D. Surtees

Equity Theory: Responding to the Material Exploitation of the Vulnerable but Capable
M. I. Hall

Law and Aging: Mental Health Theory Approach
W. C. Schmidt

The Future of Elder Law
R. C. Morgan

More info/order/download:  http://www.springerlink.com/content/j004j7/?p=aab0db9b38c1419597f333e45d3044e3&pi=0

Mike Meyers' Elder Law Forum offers wisdom and sometimes chicken soup for the elder's soul

Elder Law Prof and general cool dude Mike Meyers runs a full service elder law shop at the University of South Dakota, with a clinic, hotline, and very cool radio show that is broadcast all over the Upper Midwest.  The radio shows are archived at  http://www.usd.edu/elderlaw/radioshow.cfm

Here's a listing of some recent shows:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

Whistleblowers Guest:  Dr. Janet Parker, National Whistleblower Support Group	Show 302
Veterans, Agent Orange and Other Chemicals Guest:  Steve Fiscus, U.S. Vets with Parkinsons	Show 301
The Aging Workforce and Worker's Compensation Guest:  Dennis Finch	Show 300
Elder Justice and Policy Guest: Prof. Iris Freeman, Wm. Mitchell School of Law	Show 299
The Elderly and the Financial Downturn Guest: Marc Feinstein, Attorney	Show 298
"How to Live to Be 100" Guest:  Dr. Bruce Hagen	Show 297
The Elderly and Saving for Retirement Guest:  Chad Ericson, Financial Advisor	Show 296
The Elderly and Inflation	Show 295
Elder Law and Probate Matters Guest:  Alice Rokahr, Attorney	Show 294
Age Discrimination in Employment Guest:  Stephanie Pochop, Attorney	Show 293
Healthy Aging Guest:  Bill Nelson, Founder and Director, Living Well Lifestyle Program, Bloomington, Minnesota	Show 292
The Plant Based Diet, Meditation and the Long Life Guest:  Karin Treiber, Professor, Walden University	Show 291
Elderlaw News Update	Show 290
Current Headlines in Elderlaw	Show 289
"Re-Jeweled" Revisited Guest:  Sue Christensen	Show 288
Tough Economic Times for Seniors Guest:  Marc Feinstein, Attorney	Show 287
Low Income Taxpayer Clinic Guest:  Prof. Randall Gingiss, USD School of Law	Show 286
Aging - The Process Guest:  John Blackburn, Attorney	Show 285
The Health Care Industry - Peer Sham Review Guest:  Gil Mileikowsky, M.D.	Show 284
Long Term Care - Health Care Industry Guest:  Matthew Heard, Ward Enterprises	Show 283
Long Term Care - Medicaid	Show 282
Long Term Care - Financing	Show 281

States slash Medicaid --old, disabled, vulnerable, as always, pay the price of market excesses

Faced with widening budget shortfalls, several states are rolling back support services for the elderly and disabled. The move is making it tougher for them to continue living on their own, advocates say.

At least 15 states, including Alabama, Virginia and Massachusetts, are targeting such funding, mostly for programs that allow low-income shut-ins to receive personal care -- like cooking, cleaning and basic health services -- in their own homes, according to the Center on Budget and Policy Priorities, a liberal-leaning Washington, D.C. think tank that studies state budgets.

Pruned Programs

• With the economy slowing, cash-strapped states are cutting services for the elderly and disabled:
• The cuts are making it harder for some vulnerable people to stay in their own homes.
• Waiting lists for home and community-based services are lengthening.
• Many states expect to make further cuts in the coming year, as budgets continue to tighten.

The cutbacks are exacerbating the already long waiting lists for home-care support services in many states. That leaves the low-income elderly and disabled to dip into their meager incomes to hire their own help, reach out to family or charity, or seek more restrictive and expensive care in a nursing home, advocates say.

"We are beginning to see serious cuts and we are expecting those cuts to get worse," says JoAnn Lamphere, director of state government relations at AARP, an advocacy group for the elderly.

As the economy falters, declining revenues and tax receipts have led state agencies to cut spending, with 41 states facing current or looming deficits, according to the Center on Budget and Policy Priorities.

Source/more:  Wall St. Journal, http://online.wsj.com/article/SB122714130153442755.html

Everything you need to know about elder law podcasts....

OK, not everything.  But I did a search today to see what's out there, and there is a lot.  Here are some examples:
 
Hull & Hull Elder Law Podcasts (Canada), http://estatelaw.hullandhull.com/articles/podcasts-audio/

Prof. Mike Meyers' Elder Law Forum Radio Show, http://www.usd.edu/elderlaw/radioshow.cfm

    NB:  Prof. Iris Freeman of the Center for Elder Justice and Policy, Episode 299

Podcasts from the 2007 National Aging and the Law Conference, http://www.abanet.org/aging/cle/home.shtml

Elder Law Answers Podcast Page, http://www.elderlawanswers.com/PodCast/PodCast.asp

Elder Law Today Podcast, http://elderlawtoday.libsyn.com/

Help With Elders Podcasts, http://www.helpwithelders.com/page/podcasts

Note:  NOT INTENDED AS A COMPREHENSIVE LIST!!!

Tom Daschle tabbed for HHS Secretary

President-elect Barack Obama Wednesday named former Sen. Tom Daschle to lead the nation's Department of Health and Human Services.  GOP senators say former Sen. Tom Daschle "knows how the Senate works."  Daschle, D-S.D., is one of Obama's first Cabinet picks. If confirmed by the Senate, he will replace HHS Secretary Michael Leavitt in guiding critical, high-profile federal agencies, including the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS) and the National Institutes of Health (NIH). The massive job includes oversight of a department budget that exceeded $707 billion for fiscal year 2008.

Daschle was Senate majority leader under President Clinton. Even before Obama was elected, he had reportedly told confidantes he was most interested in a position at HHS because he thought health care would be one of the most important issues facing the new administration.  His book, "Critical: What We Can Do About the Health Care Crisis," was published in February this year.  "By almost any measure, the situation is grim," he wrote in his book. "We like to boast that we have the highest standard of living in the world, and yet, at the dawn of the twenty-first century, we are the only industrialized nation that does not guarantee necessary health care to all of its citizens. It is stunning and shameful."

Health care group Families USA Wednesday was quick to react to Obama's selection.  "The appointment of Sen. Daschle as secretary of the Health and Human Services Department is the best news possible for those who want to achieve meaningful health care reform," said Families USA executive director Ron Pollack in a statement.

The RNC, however, took a different stance.  "Barack Obama is filling his administration with long-time Washington insiders," said RNC spokesman Alex Conant. "Since losing his Senate seat, Tom Daschle has worked for a major lobbying firm. For voters hoping to see new faces and fewer lobbyist connections in government, Daschle's nomination will be another disappointment."

Source and more:  ABC News, http://abcnews.go.com/Politics/President44/story?id=6199235&page=1

Editor:  What can I say but...well done, Mr. President-elect.

One heckuva Social Security scam....

A woman accused of helping her religious leader hide a decaying corpse on her toilet so they could continue collecting her Social Security was convicted of a misdemeanor in a deal for her to testify against the leader, a prosecutor said Monday.  Tammy Lewis, 36, of Necedah, pleaded no contest to obstructing a police officer and fined $350 in a plea bargain that defers prosecution of more serious charges. Juneau County Circuit John Roemer ordered her to pay the fine within 60 days or serve a seven-day jail sentence.

Lewis and Alan Bushey, 58, were accused of hiding 90-year-old Magdeline Alvina Middlesworth's body on a toilet in Lewis' home after she died in March. Investigators said Middlesworth and Lewis were members of a religious sect Bushey led called the Order of the Divine Will.

Bushey told Lewis that God would revive Middlesworth, who friends and family said was from Washington state, investigators said.  Lewis in May initially told a sheriff's deputy that Middlesworth was on vacation.  The deputy later discovered the elderly woman's rotting body in Lewis' stench-filled home.

She also told authorities she was Middlesworth's power of attorney, and the older woman used all of her money to support their six-member religious group. Investigators believe Middlesworth's Social Security and annuity checks totaling nearly $3,000 were deposited after her death into a bank account she shared with Lewis.

As part of Lewis' plea deal, five other charges, including three felony counts of hiding a corpse and causing mental harm to a child, will be dismissed in two years if she cooperates with prosecutors and follows other court orders involving her children, District Attorney Scott Southworth said.

"We view her as a victim as well of Alan Bushey," Southworth said. "We also understand the power, the mental power, that Alan Bushey was exercising over her, the coercion he was exerting over her."  A deferred prosecution agreement calls for Lewis to continue to receive mental health treatment and testify against Bushey in a trial set to begin in April, the prosecutor said.  She and her two children, now ages 12 and 15, will be witnesses in the trial, he said.

Lewis' son told detectives Bushey told him demons were destroying Middlesworth's appearance as she decayed in the bathroom to make it look like she wouldn't rise from the dead, the criminal complaint said.

Source:  AP/The Capital Times (Madison, WI), http://www.madison.com/tct/news//index.php?ntid=314772

40% of all prescription medications go unused

The Community Medical Foundation for Patient Safety is a nonprofit organization and leader in patient safety research and education.  In 2004, the Foundation created the National Unused & Expired Medicines Registry and began systematic collection of unused and expired (UEM) data from drug take-back programs in the country. The Foundation produced the first standardized data collection instrument and protocol for the classification and analysis of UEM.  This Registry is the first and only national one of its kind that is collecting and compiling UEM data.

The Registry can characterize UEM, calculate waste and cost of returned medicines, and identify potential adverse environmental impacts. The Registry is a useful repository of information that can be shared among different agencies to 1) monitor and compare UEM collections by geographical regions and over time, 2) evaluate the efficacy of collection and disposal programs and identify best practices, 3) provide data for public policy analysis;  4) conduct research regarding patient safety and public safety, and 5) detect emerging problems with pharmaceutical products (e.g., non-adherence to medicines due adverse side effect or drug interaction).

The Registry contains data on more than 20,000 items representing returned medicines that would otherwise be thrown in the trash or flushed down the sink or toilet and data on more than an estimated 1 million pills, capsules, and tablets. UEM Collection samples from the west and east coasts indicate an estimated 40% waste of prescription medicines (items and proportion of the medicines that were never used by the patients). Preliminary results of the first annual survey, which identified 61 drug take-back programs across the nation, were presented at the recent Sixth Annual Maine Benzodiazepine Study Group Conference & Fifth Annual Unused Drug Return Conference.  http://www.epa.gov/aging/resources/epareports.htm#2008-sfhe

Source/more:  http://www.epa.gov/aging/resources/presentations/2008_0911_she2008-rx-sykes-2.pdf

EPA Aging Initiative announces winners of Rachel Carson Intergenerational essay, photography, and poetry contest

EPA's Aging Initiative, Generations United, and the Rachel Carson Council, Inc. are pleased to announce the winners of this year's Rachel Carson "A Sense of Wonder" Intergenerational Essay, Photography, and Poetry Contest.

The contest was designed to increase environmental stewardship and public awareness of environmental issues. This year, the theme is commemorating the 100th anniversary of environmentalist Rachel Carson's life. The contest's intergenerational approach reflects Carson's efforts through her writings to have adults share with children a sense of wonder about nature and help them discover its joys. All teams included both a person under age 18 and a person 50 years of age or older.

More than 140 individuals submitted entries to the Rachel Carson contest. Participants came from all over the US and the world and included intergenerational teams of families, neighbors, friends, and senior centers. Finalists in each category were selected by an intergenerational team of judges. Winners were then selected by public voting on the Aging Initiative website. More than 1,500 individuals cast their votes for their favorite entries.

The categories are Photography, Essay, Poetry and Mixed (Photo, Essay and Poetry).

Editor:  I encourage everyone to visit the website and see the winning submissions!

OECD chief says we must encourage older workers to stay in the job force

"In an era of rapid population aging, we can no longer afford policies, employment practices and attitudes that discourage work at an older age. They not only deny older workers the choice of when and how they should retire, but are costly for business, the economy and society.

The key message that emerges from the OECD's work on population aging is that it is both a challenge and an opportunity. If nothing is done, population aging poses serious economic and social challenges. But it is also raises the prospect of longer, more prosperous lives, if increases in longevity are matched by longer working lives.

We are living longer and healthier lives on average than previous generations. If we have the courage to change our outdated policies, attitudes and employment practices with respect to work at an older age, we should be able to enter a virtuous circle where longevity promotes activity, and activity, in turn, promotes wealth and well-being.

But if nothing is done to promote better employment prospects for older workers, the number of retirees per worker will double over the next 50 years in OECD countries. This will place severe strains on the financing of social protection systems. Labor force growth has been an important contributor to economic growth in the past; but this will slow considerably over the next 50 years and in some OECD countries the labor force could even shrink. We have projected that Japan's total labor force could shrink by over one-third between now and 2050. Recruitment difficulties will also increase. In Europe, the number of workers retiring each year is likely to exceed the number of younger people entering the workforce by more than one million from around 2020 onwards. Employers may face even greater recruitment difficulties in the future in specific sectors such as health care.

To help meet these daunting challenges, work needs to be made a more attractive and rewarding proposition compared with the siren songs of early retirement. But how can this be achieved? The OECD's 2006 report, Live Longer, Work Longer, offers some answers based on its 4-year study of aging and employment policies in 21 OECD countries. It shows that there are three key factors discouraging older people from work, which need to be tackled urgently."

Source and more:  AARP International, http://www.aarpinternational.org/resourcelibrary/resourcelibrary_show.htm?doc_id=727357

ABA surveys lawyers about the economy and their practices

The ABA Journal is surveying lawyers about the job market and the current state of the economy. Connect to the survey. Answers will be kept confidential and used only in combination with all other responses received.

Not elder law: scientists id path of ancient wooly rhino

The 460,000-year-old skull of a woolly rhino, reconstructed from 53 fragments, is the oldest example of these mighty, ice age beasts ever found in Europe.  The extinct mammals reached a length of three-and-a-half metres in adulthood and, unlike their modern relatives, were covered in shaggy hair.Details of the work appear in the journal Quaternary Science Reviews.  The team says the find from Germany fills a gap in our understanding of how these animals evolved.

"This is the oldest woolly rhinoceros found in Europe," said Ralf-Dietrich Kahlke, from the Senckenberg Research Institute in Weimar, Germany.  He added: "It gives us a precise date for the first appearance of cold-climate animals spreading throughout Asia and Europe during the ice ages."

Source/more:  BBC,  

Economic worries drive Japanese elders to crime

Via Bloomberg (and Neal Axton)

More senior citizens are picking pockets and shoplifting in Japan to cope with cuts in government welfare spending and rising health-care costs in a fast-ageing society.  Criminal offences by people 65 or older doubled to 48,605 in the five years to 2008, the most since police began compiling national statistics in 1978, a Ministry of Justice report said.   Theft is the most common crime of senior citizens, many of whom face declining health, low incomes and a sense of isolation, the report said. Elderly crime may increase in parallel with poverty rates as Japan enters another recession and the budget deficit makes it harder for the government to provide a safety net for people on the fringes of society.

``The elderly are turning to shoplifting as an increasing number of them lack assets and children to depend on,'' Masahiro Yamada, a sociology professor at Chuo University in Tokyo and an author of books on income disparity in Japan, said in an interview yesterday. ``We won't see the decline of elderly crimes as long as the income gap continues to rise.''  Crime rates among the elderly are rising as the overall rate for Japan has fallen for five consecutive years after peaking in 2002. Over 60s accounted for 18.9 percent of all crimes last year compared with 3.1 percent in 1978, with shoplifting accounting for 80 percent of the total, the report said.   The trend has captivated Japan's media, which include regular accounts of the latest thief or pickpocket as well as undercover footage of people shoplifting food in convenience stores and supermarkets.

Source: http://www.bloomberg.com/apps/news?pid=20601101&sid=as80aWlHdA1M&refer=japan

Census updates Older Worker Profile materials

The Census Bureau has recently updated its list of summary profiles of older workers in various states.  Profiles are available for twenty states   Find them here.

Reminder: Part D Plan Finders may help detangle the enrollment mess

It's Part D enrollment season, and the options available to beneficiaries are, well, myriad.  Plan finders purport to assist in finding the best plan for each potential enrollee.  Here are a few links to Part D online plan finding-tools.  I suggest putting information into at least a couple of these, to see if they produce the same recommendation.

CMS:  http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp?version=default&browser=Firefox|3|Windows+Vista&language=English&defaultstatus=0&pagelist=Home&ViewType=Public&PDPYear=2009&MAPDYear=2009&MPDPF_MPPF_Integrate=N

Medicare Part D Dot Com:  http://www.medicare-partd.com/PartD-SearchPDPMedicarePartDPlanFinder.php

Destination RX:  http://www.drx.com/medicare-partd/compare/default.aspx

CVS Plan Finder:  https://cvs.planprescriber.com/mapd/client/156894/web/index.jsp?groupid=156894

Heart failure accounts for 37% of Medicare expenditures

Medicare beneficiaries with heart failure have many more doctor visits and take more medications than those without heart failure, researchers are reporting.

They based their conclusion on an analysis of data on 173,000 Medicare beneficiaries. The overall average age of the beneficiaries was 70.7 years, while the average age for those with heart failure was between 76 and 77 years.

The analysis found that:

Patients with severe heart failure saw an average of 23 different Medicare providers a year, compared with about 7.9 providers for typical Medicare beneficiaries.Those with mild heart failure saw an average of 15.9 providers a year, and those with moderate heart failure saw an average of 18.6 providers a year.Patients with all stages of heart failure received an average of 61 prescriptions annually, compared with 29 for a typical beneficiary.About 26 percent of office visits for heart failure were to internal medicine specialists and about 20 percent were to family practice physicians. Visits to cardiologists for those with mild, moderate and severe heart failure increased as heart failure worsened and were 16 percent, 18 percent, and 20 percent, respectively.About 46 percent of severe heart failure patients had diabetes, 46 percent had chronic obstructive pulmonary disease (COPD) or other respiratory diseases, and about 32 percent had kidney disease.In 2005, beneficiaries with heart failure accounted for 37 percent of all Medicare spending and almost 50 percent of all hospital inpatient costs. Typical inpatient costs for a severe heart failure patient were about $24,000 a year, compared to about $3,000 for a typical beneficiary. 

Source:  Washington Post, http://www.washingtonpost.com/wp-dyn/content/article/2008/11/12/AR2008111201456.html

Canadian Conference on Elder Law/financial elder abuse issues in the news

Financial abuse of seniors quickly emerged as a hot topic Thursday as health-care experts, lawyers, academics and policy makers gathered in Vancouver for the fourth annual Canadian Elder Care conference.  But it was who was missing from the debate that generated the most comment among the estimated 150 international conference participants.  "So much of elder abuse is financial abuse and that involves the banks . . . and they're not here," said Graham Webb, a lawyer with the Toronto-based Advocacy Centre for the Elderly.  Margaret Easton of Westminster Savings Credit Union was the only voice representing financial institutions nationwide.  Easton, a counsellor in planning for elders, said her interests lie in educating people about seniors' rights related to the often complex and delicate negotiations around financial guardianship, and the creation of joint accounts.Without adequate training, bank workers can increase seniors' vulnerability to the bad -- or, in some cases deliberately misleading -- advice of family members or caregivers.It's a situation that can be corrected with proper education and motivation, Easton said. A recent U.S. survey found that 14 of the 22 leading indicators of financial abuse can be caught right at the bank teller window by an alert clerk.

Source/more:  Vancouver Sun, http://www.canada.com/vancouversun/news/westcoastnews/story.html?id=e4193e77-13a1-4dea-a0cf-9edb43a0efe5

Hospice/palliative care visionary dies at age 91

Florence S. Wald, whose vision of bringing the terminally ill peace of mind and, to whatever extent possible, freedom from pain led to the opening of the first palliative care hospice in the United States, died on Saturday at her home in Branford, Conn. She was 91.  Florence S. Wald, right, being inducted into the National Women’s Hall of Fame in 1998. She was introduced by Lyn Bedell.  Mrs. Wald, who was dean of the Yale University School of Nursing from 1959 to 1966, was the prime mover, in 1974, in starting the Connecticut Hospice, the nation’s first home-care program for the terminally ill. Six years later, a 44-patient hospice — where the dying could be comforted by their loved ones around the clock and where the staff would do what it could to alleviate suffering — opened in Branford.

“This hospice became a model for hospice care in the United States and abroad,” the publication Yale Nursing Matters said this week, adding that Mrs. Wald’s role “in reshaping nursing education to focus on patients and their families has changed the perception of care for the dying in this country.”

There are now more than 3,000 hospice programs in the United States, serving about 900,000 patients a year.

Source/more:  New York Times, http://www.nytimes.com/2008/11/14/health/14wald.html

New pension rule may affect payouts for some retirees

A growing number of defined-benefit pension plans, especially small- to-mid-sized plans, could be in trouble this year because of the struggling stock market combined with a little-known provision in the Pension Protection Act of 2006.  Under PPA, firms with defined-benefit plans have to use something called the Adjusted Funding Target Attainment Percentage, or AFTAP, when calculating pension distributions for newly retiring workers.
The AFTAP, in essence, measures a plan's funded status. A plan that can pay out all that it owes its retiring workers is 100% funded. In days of yore, employers would typically offer retiring workers the option of taking their pension either in a lump sum or an annuity. But starting in 2008, the law requires employers tell workers if their plan does not have sufficient funds to pay out all of the employees, according to Brett Goldstein, pension administrator and president of the Pension Department, a consulting firm in Plainview, N.Y.  If the pension plan does not have enough money to pay at least 80% of the employees, then the notice states that employees can only get 50% of their pension as a lump sum and the remainder as an annuity. If the pension plan does not have enough money to pay at least 60% of the employees, then the notice states that employees can't get their benefit as a lump sum, only as an annuity.

Given the big decline in the stock market this year, the AFTAP will likely come into play, especially for would-be retirees at many small- to mid-sized firms, Goldstein said. Goldstein estimates that workers at some 25% of small- to mid-sized firms will be offered the "under-funded" payout options when they retire in 2008 instead of the traditional full lump sum or annuity options. And that could lead to financial distress for some households, he said.

Source/more:  Market Watch

CRS report discussing proposed Section 8 housing issues for seniors and persons with disabilities

RL34728
Section 811 and Other HUD Housing Programs for Persons with Disabilities
November 03, 2008

Download Locations:

Open CRS (User submitted)

Summary:

The ability of persons with disabilities to live independently in affordable, accessible housing became a prominent issue starting in 1999 as the result of a Supreme Court decision, Olmstead v. L.C. The court held that institutionalization of persons with mental disabilities in lieu of community-based care may constitute discrimination. Shortly after the Olmstead decision, on February 1, 2001, the President announced the New Freedom Initiative, an effort through multiple federal agencies to ensure full participation in society of persons with disabilities. Part of the New Freedom Initiative was Executive Order 13217, which implemented the Olmstead decision by ensuring (among other things) that all people with disabilities, not just those with mental illness, benefit from community-based treatment. In order to ensure that persons with disabilities may live in community settings rather than in institutions, affordable and accessible housing is necessary. The Department of Housing and Urban Development (HUD) operates a number of programs that provide housing for persons with disabilities in various ways. The Section 811 Supportive Housing for Persons with Disabilities program provides capital grants and project rental assistance to nonprofit developers of housing targeted specifically to persons with disabilities. Prior to creation of Section 811, persons with disabilities lived together with elderly residents (defined by HUD as households with one or more adults age 62 or older) in developments funded through the Section 202 Supportive Housing for the Elderly program. The project-based Section 8 and Public Housing programs give project owners the option of dedicating facilities to elderly residents, residents with disabilities, or both populations together. Both the Section 811 and Section 8 programs set aside housing vouchers for persons with disabilities. And two HUD block grant programs -- HOME and the Community Development Block Grant -- may be used by states and communities to construct or rehabilitate housing for persons with disabilities. In addition to these HUD programs, the Low Income Housing Tax Credit (LIHTC), administered by the Internal Revenue Service, may be used by states to target housing to special needs populations, including persons with disabilities. The LIHTC may be used in conjunction with HUD grants, including capital grants through the Section 811 program. The Housing and Economic Recovery Act of 2008 (P.L. 110-289) made it possible for developers of Section 811 housing to qualify for a higher tax credit rate, which could potentially make these mixed financing developments more feasible. In the 110th Congress, the Frank Melville Supportive Housing Investment Act (H.R. 5772), a bill that would make changes to the Section 811 program, was approved by the House on September 17, 2008. Among its changes, the bill would turn over funding of Section 811 vouchers to the Section 8 program and would create a demonstration program for Section 811 rental assistance to be used in conjunction with other funding streams, including the LIHTC and HOME program. A version of the bill was also introduced in the Senate (S. 3593). This report will be updated as events warrant.