1 Deficit Reduction Act Deficit Reduction Act of 2005 of 2005 (and Federal Update) (and Federal Update) What do we do NOW What do we do NOW ?!! ?!! Kim Musheno, Director, Legislative Kim Musheno, Director, Legislative Affairs, AUCD Affairs, AUCD Anne Rohall, Director, Government Anne Rohall, Director, Government Affairs, NACDD Affairs, NACDD August 24, 2006 August 24, 2006 Center for Disabilities Studies Center for Disabilities Studies Newark, Delaware Newark, Delaware
Transcript
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Deficit Reduction Act of Deficit Reduction Act of 2005 2005
(and Federal Update)(and Federal Update)What do we do NOWWhat do we do NOW?!!?!!
Kim Musheno, Director, Legislative Affairs, Kim Musheno, Director, Legislative Affairs, AUCDAUCD
Anne Rohall, Director, Government Affairs, Anne Rohall, Director, Government Affairs, NACDDNACDD
August 24, 2006August 24, 2006Center for Disabilities StudiesCenter for Disabilities Studies
Newark, DelawareNewark, Delaware
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What is the Deficit What is the Deficit Reduction Act?Reduction Act?
Deficit Reduction Act (DRA) of 2005 (P.L. 109-Deficit Reduction Act (DRA) of 2005 (P.L. 109-171) signed into law on Feb. 8, 2006 by 171) signed into law on Feb. 8, 2006 by President BushPresident Bush
Purpose was to reduce the deficit by reducing a Purpose was to reduce the deficit by reducing a wide range of Federal programs (e.g., housing)wide range of Federal programs (e.g., housing)
DRA makes changes to the Medicaid statute DRA makes changes to the Medicaid statute that could negatively or positively impact that could negatively or positively impact beneficiaries/people with disabilities. It limits beneficiaries/people with disabilities. It limits Medicaid, but also provides opportunities to Medicaid, but also provides opportunities to increase health & community-based servicesincrease health & community-based services
Advocates must be at the table to help Advocates must be at the table to help states make the right decisions about states make the right decisions about Medicaid!Medicaid!
DRA will reduce Federal Medicaid spending DRA will reduce Federal Medicaid spending by $7 billion from 2006-2010 and $28 billion by $7 billion from 2006-2010 and $28 billion from 2006-2015from 2006-2015
DRA will result in a net savings of $4.7 billion DRA will result in a net savings of $4.7 billion over 5 yearsover 5 years
75% of DRA savings will make it more difficult 75% of DRA savings will make it more difficult for individuals to qualify for long-term care and for individuals to qualify for long-term care and will impact Medicaid beneficiarieswill impact Medicaid beneficiaries
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Background on the DRA Background on the DRA (cont.)(cont.) Issue for advocates: is the DRA valid Issue for advocates: is the DRA valid
legislation?legislation? Lawsuits over constitutionality of the Lawsuits over constitutionality of the
DRADRA Why? It’s “High School Civics 101”:Why? It’s “High School Civics 101”:
The version of the DRA passed by the The version of the DRA passed by the U.S. House on February 1, 2006 differs U.S. House on February 1, 2006 differs from the version of the DRA passed by from the version of the DRA passed by the U.S. Senate on December 21, 2005the U.S. Senate on December 21, 2005
This This technicallytechnically violates the “bicameral” violates the “bicameral” requirement (same version of law must requirement (same version of law must be passed by House & Senate)be passed by House & Senate)
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Background on the DRA Background on the DRA (cont.)(cont.)
Federal Medicaid law may not Federal Medicaid law may not allow states to revise their cost-allow states to revise their cost-sharing requirements for sharing requirements for certain Medicaid populations, certain Medicaid populations, butbut......
Some states may be forced to Some states may be forced to make changes because of their make changes because of their own own state law state law requirementsrequirements
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Interesting State Law Interesting State Law StatisticsStatistics
States requiring legislative approval of States requiring legislative approval of state plan amendments: CT, D.C., MO, state plan amendments: CT, D.C., MO, NHNH
States with a provision requiring States with a provision requiring legislative approval of waivers: CO, FL, legislative approval of waivers: CO, FL, LA, MA, MO, MT, NV, NH, ND, OH, OR, LA, MA, MO, MT, NV, NH, ND, OH, OR, D.C., WYD.C., WY
States with statutory requirements States with statutory requirements related to Medicaid cost-sharing: AL, AK, related to Medicaid cost-sharing: AL, AK, CA, CT, FL, IL, IN, IA, KY, ME, MA, MN, CA, CT, FL, IL, IN, IA, KY, ME, MA, MN, MO, NE, NJ, NM, NY, OH, OR, TX, VT, MO, NE, NJ, NM, NY, OH, OR, TX, VT, WIWI
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Interesting State Law Interesting State Law Statistics (cont.)Statistics (cont.)
States with some form of statutory States with some form of statutory Medicaid benefits requirement: AK, AZ, Medicaid benefits requirement: AK, AZ, CA, CO, CT, ID, IL, IN, IA, ME, MD, MA, CA, CO, CT, ID, IL, IN, IA, ME, MD, MA, MI, MN, MS, MO, NE, ND, OH, PAMI, MN, MS, MO, NE, ND, OH, PA
States that do not have state regulations States that do not have state regulations that lay out substantive requirements for that lay out substantive requirements for state Medicaid program: AR, CT, MI, MS, state Medicaid program: AR, CT, MI, MS, NV, ND, VT, WYNV, ND, VT, WY
Courtesy of the National Health Law Program and National Courtesy of the National Health Law Program and National Association of Community Health Centers, Association of Community Health Centers, Role of State Law in Role of State Law in Limiting Medicaid ChangesLimiting Medicaid Changes
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What about What about Delaware?Delaware?
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Role of Delaware State Law Role of Delaware State Law on DRA Advocacyon DRA Advocacy
Delaware has a Delaware has a State codeState code that contains that contains substantive provisionssubstantive provisions for the State for the State Medicaid Program Medicaid Program (DEL.CODE.ANN. (DEL.CODE.ANN. 501-523 501-523 (2006)(2006)
Delaware has Delaware has State regulationsState regulations containing containing substantive provisions for the Medicaid substantive provisions for the Medicaid program (See DE Register of Regulations)program (See DE Register of Regulations)
Delaware has a Delaware has a State codeState code with an with an administrative procedures provision that administrative procedures provision that requires requires public notice and comment public notice and comment before regulations can be changed!before regulations can be changed! (DEL.CODE.ANN. (DEL.CODE.ANN. 10115) 10115)
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The Delaware Code and The Delaware Code and Regulations are online for Regulations are online for your searching pleasure!your searching pleasure!
Important note for Important note for advocates:advocates:
Often, state law covering Medicaid Often, state law covering Medicaid is “murky” at best!is “murky” at best!
This is a “fluid” area of the law, so This is a “fluid” area of the law, so advocates should always check on advocates should always check on the status of Delaware law before the status of Delaware law before mapping out an advocacy plan to mapping out an advocacy plan to prevent harmful changes to prevent harmful changes to Medicaid.Medicaid.
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Why is Medicaid the Why is Medicaid the Target? Target?
What are some What are some policymakers saying?policymakers saying?
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Some say Medicaid is:Some say Medicaid is:
BrokenBroken Out of control spendingOut of control spending Crowding out other state Crowding out other state
priorities, e.g., educationpriorities, e.g., education Unsustainable in its Unsustainable in its
current formcurrent form
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Advocates need to say that Advocates need to say that Medicaid:Medicaid:
Works for persons with Works for persons with disabilitiesdisabilities
Supports national health policy Supports national health policy goalsgoals
Allows other parts of the health Allows other parts of the health system to functionsystem to function
Is a good deal for statesIs a good deal for states Is a good investment, even in Is a good investment, even in
tough fiscal timestough fiscal times
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Medicaid Works for Persons Medicaid Works for Persons with Disabilitieswith Disabilities
Yes, improvements to Yes, improvements to Medicaid are needed, but no Medicaid are needed, but no other major public program other major public program has been more responsive to has been more responsive to the needs of persons with the needs of persons with disabilities…disabilities…
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Medicaid Works for Persons Medicaid Works for Persons with Disabilities (cont.)with Disabilities (cont.)
Largest source of funding for long-term services Largest source of funding for long-term services Largest source of funding for developmental Largest source of funding for developmental
disability servicesdisability services Largest source of funding for mental health Largest source of funding for mental health
servicesservices Early & Periodic Screening, Diagnosis & Early & Periodic Screening, Diagnosis &
Treatment (EPSDT) services provide for Treatment (EPSDT) services provide for screening, early detection and treatment of screening, early detection and treatment of disabilities and health conditions in children disabilities and health conditions in children (healthy children is a national priority)(healthy children is a national priority)
The so-called “optional” services tend to be The so-called “optional” services tend to be disability services – that’s not good public policy!disability services – that’s not good public policy!
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Our Nation’s Issues are Our Nation’s Issues are BIGGER than Medicaid…BIGGER than Medicaid…
Controlling health costs across all payers Controlling health costs across all payers Controlling escalating prescription drug Controlling escalating prescription drug
costscosts Financing access to new medical Financing access to new medical
technologytechnology Establishing a national system for Establishing a national system for
financing long-term services for people of financing long-term services for people of moderate income (takes pressure off moderate income (takes pressure off Medicaid)Medicaid)
Adapting to demographic changesAdapting to demographic changes
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What do we do now?What do we do now?
Advocacy is at the Advocacy is at the STATESTATE level level
““Bad things” stemming from Bad things” stemming from the DRA are preventable (or the DRA are preventable (or can be minimized) in many can be minimized) in many cases!cases!
There is light at the end of There is light at the end of the tunnel!the tunnel!
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Long Term Care Long Term Care Options in the Options in the
DRADRAGeared toward ending Geared toward ending the the institutional biasinstitutional bias in in
MedicaidMedicaid
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Home & Community Based Home & Community Based ServicesServices
Section 6086Section 6086
Establishes HCBS as optional Medicaid Establishes HCBS as optional Medicaid benefit for certain individuals at or below benefit for certain individuals at or below 150% of poverty (about $14,700 for 150% of poverty (about $14,700 for individual)individual)
A State Plan Service – no waiver requiredA State Plan Service – no waiver required No need to prove need for institutional level No need to prove need for institutional level
of careof care Includes any services allowed under current Includes any services allowed under current
HCBS waiver program (not room and board)HCBS waiver program (not room and board)
Permits states to establish enrollment Permits states to establish enrollment capscaps First time waiting lists specifically put First time waiting lists specifically put
into lawinto law New precedent for Medicaid state planNew precedent for Medicaid state plan
State does not have to make services State does not have to make services Statewide BUT services must be Statewide BUT services must be comparable for all populationscomparable for all populations
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HCBS-State HCBS-State requirementsrequirements
States required to establish needs-States required to establish needs-based criteria for eligibility for HCBS based criteria for eligibility for HCBS and for institutionsand for institutions
Criteria for eligibility for institutions Criteria for eligibility for institutions must be more stringent than for HCBSmust be more stringent than for HCBS
Idea is to change the institutional bias Idea is to change the institutional bias in Medicaidin Medicaid
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HCBS Needs-based criteriaHCBS Needs-based criteria Assessment of support needs and capabilities Assessment of support needs and capabilities May consider person’s inability to perform 2 or May consider person’s inability to perform 2 or
more activities of daily living (ADL) e.g., more activities of daily living (ADL) e.g., bathing, dressing, transferring, toileting, bathing, dressing, transferring, toileting, eating), or need for significant assistance to eating), or need for significant assistance to perform these activities/other risk factorsperform these activities/other risk factors
Permits states to modify the criteria if more Permits states to modify the criteria if more people become eligible than projected!people become eligible than projected! Public gets 60-day notice of changePublic gets 60-day notice of change Services to existing recipients guaranteed for Services to existing recipients guaranteed for
only 12 monthsonly 12 months Eligibility determined by independent evaluation Eligibility determined by independent evaluation
and assessmentand assessment Individualized plan developedIndividualized plan developed
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HCBS Option AdvocacyHCBS Option Advocacy Prepare comments to CMS when draft Prepare comments to CMS when draft
regulations are published – regulations regulations are published – regulations govern how broad/restrictive law will be at govern how broad/restrictive law will be at state levelstate level
Advocate for legislative/other oversight, if DE Advocate for legislative/other oversight, if DE takes this option (e.g., by P&A/consumers)takes this option (e.g., by P&A/consumers)
Focus on:Focus on:- Initial & future changes to eligibility criteriaInitial & future changes to eligibility criteria- Individuals who may lose HCBS eligibility Individuals who may lose HCBS eligibility
under new criteria – “grandfather” themunder new criteria – “grandfather” them completelycompletely (not just for 12 months) (not just for 12 months)
Ensure states do not terminate Ensure states do not terminate optional Medicaid services, e.g., optional Medicaid services, e.g., rehab services, and offer them to rehab services, and offer them to persons who qualify for the HCBS persons who qualify for the HCBS option (where number of individuals option (where number of individuals receiving the option may be receiving the option may be CAPPED!)CAPPED!)
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Self-directed OptionSelf-directed Option
States may allow individuals (or States may allow individuals (or representative) to self-direct representative) to self-direct purchase and control of state plan purchase and control of state plan HCBSHCBS Service plan developed based on Service plan developed based on
assessment of needsassessment of needs Must include person-centered Must include person-centered
process and risk management process and risk management techniques techniques
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Quality Assurance/effective Quality Assurance/effective date of Self-directed Optiondate of Self-directed Option
HHS Secretary must consult with HHS Secretary must consult with consumers, among others, to develop consumers, among others, to develop performance indicators and measure performance indicators and measure client satisfactionclient satisfaction
Effective date is this Effective date is this January 1, January 1, 20072007
Federal cost is $766 million over 5 Federal cost is $766 million over 5 yrs.yrs.
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Cash and Counseling Cash and Counseling OptionOption
Section 6087Section 6087 Allows state to provide for self-direction of Allows state to provide for self-direction of services (using the Cash and Counseling services (using the Cash and Counseling individual budget model) without needing to individual budget model) without needing to request a waiverrequest a waiver Service provider may be a Service provider may be a relativerelative
HHS Secretary must assure that state proposals HHS Secretary must assure that state proposals include basic consumer protectionsinclude basic consumer protections
Self-directed services may NOT be provided to Self-directed services may NOT be provided to individuals who reside in a home or property individuals who reside in a home or property owned, operated, or controlled by a provider, not owned, operated, or controlled by a provider, not related by blood or marriagerelated by blood or marriage
State-wideness and comparability not requiredState-wideness and comparability not required
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Cash & Counseling, cont.Cash & Counseling, cont.
State may employ a financial State may employ a financial management entity to make payments management entity to make payments to providers and track coststo providers and track costsReimbursed at Medicaid Reimbursed at Medicaid
administrative rate (generally 50%)administrative rate (generally 50%) Effective this January 1, 2007Effective this January 1, 2007 Federal costs $100 million over 5 Federal costs $100 million over 5
Cash & Counseling demonstrations Cash & Counseling demonstrations have been studied and monitored by have been studied and monitored by several groups – there are “lessons several groups – there are “lessons learned” that advocates should know learned” that advocates should know about…about…
E.g., Alliance for Health Reform has E.g., Alliance for Health Reform has described 5 steps for getting started:described 5 steps for getting started:
www.allhealth.orgwww.allhealth.org
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Money Follows the PersonMoney Follows the PersonSection 6071Section 6071
HHS Secretary may provide competitive HHS Secretary may provide competitive grants to states to increase use of Medicaid grants to states to increase use of Medicaid HCBS services over institutional servicesHCBS services over institutional services
Increases the Federal Medicaid match rate Increases the Federal Medicaid match rate (FMAP) for cost of transitioning an (FMAP) for cost of transitioning an individual from institution to communityindividual from institution to community Federal share increased to 75% to 90% Federal share increased to 75% to 90%
depending on statedepending on state After 12 months, state continues services at After 12 months, state continues services at
regular FMAPregular FMAP
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MFP EligibilityMFP Eligibility
Eligible if residing in institution Eligible if residing in institution for no less than six months or a for no less than six months or a longer time determined by state longer time determined by state (up to maximum of 2 years)(up to maximum of 2 years)
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MFP State requirements MFP State requirements – many!– many!
Must show proposed methods to increase Must show proposed methods to increase investment in home and community-based investment in home and community-based servicesservices
Methods used to eliminate barriers to Methods used to eliminate barriers to paying for LTC services in settings of paying for LTC services in settings of individuals’ choiceindividuals’ choice
Preference given to states that balance Preference given to states that balance target groups and geographic distributiontarget groups and geographic distribution
Preference given to states that offer self-Preference given to states that offer self-directiondirection
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MFP (cont.)MFP (cont.) $250 million for FY 2007 that begins this $250 million for FY 2007 that begins this
January 1, 2007 ($1.8 billion over 2007-2011 January 1, 2007 ($1.8 billion over 2007-2011 period)period)
$2.4 million for technical assistance$2.4 million for technical assistance $1.1 million for national evaluation and $1.1 million for national evaluation and
report requiredreport required A copy of the A copy of the “2006 Money Follows the “2006 Money Follows the
Person Rebalancing Initiative Demonstration Person Rebalancing Initiative Demonstration Program,” Program,” including the application forms, including the application forms, can be obtained at can be obtained at www.grants.govwww.grants.gov. .
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MFP AdvocacyMFP Advocacy
Individuals potentially eligible for Individuals potentially eligible for services, their family members, services, their family members, providers, and other interested parties providers, and other interested parties MUST BE INCLUDED in developing the MUST BE INCLUDED in developing the MFP projectMFP project
State will determine service area, State will determine service area, targeted groups of eligible individuals, targeted groups of eligible individuals, and number of individuals to be served, and number of individuals to be served, but…but…
Advocates must be at the table to Advocates must be at the table to help with the rest!help with the rest!
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Family Opportunity ActFamily Opportunity ActSection 6061-6062Section 6061-6062
Took over six years to get enacted – championed Took over six years to get enacted – championed by Sens. Grassley (R-IA) and Kennedy (D-MA) by Sens. Grassley (R-IA) and Kennedy (D-MA) and Reps. Waxman (D-CA) and Sessions (R-TX)and Reps. Waxman (D-CA) and Sessions (R-TX)
Creates Medicaid “buy-in” for children with Creates Medicaid “buy-in” for children with disabilities with family income below 300% of disabilities with family income below 300% of poverty (monthly income of $4,150 for a family poverty (monthly income of $4,150 for a family of 3 in 2006)of 3 in 2006)
Premiums paid in sliding scalePremiums paid in sliding scale under 200% of poverty, premiums and cost-under 200% of poverty, premiums and cost-
sharing limited to 5% of family incomesharing limited to 5% of family income 200-300% poverty, premiums and cost-sharing 200-300% poverty, premiums and cost-sharing
limited to 7.5% of family incomelimited to 7.5% of family income
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FOA cont.FOA cont.
Phased in coverage – in 2007, available to Phased in coverage – in 2007, available to families with incomes up to $60,000 for a families with incomes up to $60,000 for a family of four if their child is under the family of four if their child is under the age of 6. age of 6. In 2008 to children under 12; and in 2009, In 2008 to children under 12; and in 2009,
children under 19children under 19 Parents must participate in family group Parents must participate in family group
coverage if offered and employer pays at coverage if offered and employer pays at least 50% of the premiumleast 50% of the premium
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FOA cont.FOA cont. States can establish a demonstration States can establish a demonstration
program for children with “potentially program for children with “potentially severe” disabilitiessevere” disabilities
Children who receive inpatient psychiatric Children who receive inpatient psychiatric services are eligible for HCB waiver servicesservices are eligible for HCB waiver services
Newborns with significant disabilities are Newborns with significant disabilities are presumed eligible for Medicaid and no presumed eligible for Medicaid and no longer have to wait for the first day of the longer have to wait for the first day of the next month for coveragenext month for coverage
$22 million over 5 years to develop family-$22 million over 5 years to develop family-to-family health information centers in every to-family health information centers in every statestate
States must develop legislation to implement States must develop legislation to implement the FOAthe FOA
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FOA AdvocacyFOA Advocacy
Advocates should note that some Advocates should note that some children may already be eligible for children may already be eligible for Medicaid under other Medicaid Medicaid under other Medicaid categories, e.g., some kids of families categories, e.g., some kids of families with higher income brackets.with higher income brackets.
Advocates should compares cost Advocates should compares cost sharing/benefits for kids who fall sharing/benefits for kids who fall within 2 or more categories and decide within 2 or more categories and decide which option is which option is more comprehensivemore comprehensive
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FOA Advocacy (cont.)FOA Advocacy (cont.) Advocates should monitor Advocates should monitor
coordination of benefitscoordination of benefits:: - Children enrolled in FOA option will have - Children enrolled in FOA option will have
same benefit package as other needy same benefit package as other needy children, including EPSDTchildren, including EPSDT
- Medicaid would be secondary payer to any Medicaid would be secondary payer to any employer-sponsored family coverage employer-sponsored family coverage (purchased as a condition of FOA coverage)(purchased as a condition of FOA coverage)
- Some states enroll children under age 19 in Some states enroll children under age 19 in “benchmark” plans with Medicaid EPSDT “benchmark” plans with Medicaid EPSDT wrap-around coverage (i.e., 3 potential plans wrap-around coverage (i.e., 3 potential plans to coordinate!)to coordinate!)
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Cost Sharing, Section Cost Sharing, Section 60416041 DRA modifies current cost-sharing provisions DRA modifies current cost-sharing provisions
effective since March 31, 2006effective since March 31, 2006 Services can be denied for failure to pay cost-Services can be denied for failure to pay cost-
sharingsharing For individuals below poverty, supposed to be For individuals below poverty, supposed to be
limited to nominal standards (i.e. $3 per limited to nominal standards (i.e. $3 per service) but indexed to medical inflationservice) but indexed to medical inflation
For individuals with incomes between 100 For individuals with incomes between 100 and 150% of poverty, premiums not and 150% of poverty, premiums not permitted and cost-sharing capped at 5% permitted and cost-sharing capped at 5% total family income and 10% for item or total family income and 10% for item or serviceservice
For individuals with incomes above 150% of For individuals with incomes above 150% of poverty, cost-sharing and premiums would be poverty, cost-sharing and premiums would be allowed but capped at 5% incomes and 20% allowed but capped at 5% incomes and 20% for item or servicefor item or service
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Cost sharing exemptionsCost sharing exemptions No cost-sharing on:No cost-sharing on:1.1. children under 18 and foster childrenchildren under 18 and foster children2.2. Preventive services to childrenPreventive services to children3.3. Services to pregnant women, if services Services to pregnant women, if services
are pregnancy relatedare pregnancy related4.4. Services for hospiceServices for hospice5.5. Any inpatient in hospital, NF, ICF/MRAny inpatient in hospital, NF, ICF/MR6.6. Emergency service; and Emergency service; and 7.7. Family planning services and suppliesFamily planning services and supplies
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Premiums exemptionsPremiums exemptions
No premiums can be imposed onNo premiums can be imposed on::
1.1. Children and foster childrenChildren and foster children
States can provide medical assistance States can provide medical assistance through enrollment that provides benchmark through enrollment that provides benchmark coverage or benchmark equivalent coveragecoverage or benchmark equivalent coverage
Benchmark plans may be modeled after Benchmark plans may be modeled after FEHB, state employees, largest non-Medicaid FEHB, state employees, largest non-Medicaid HMO, actuarially equivalent coverage, or any HMO, actuarially equivalent coverage, or any Secretary-approved coverageSecretary-approved coverage
EPSDT must be maintained but state can EPSDT must be maintained but state can enroll kids in private plans & provide a state enroll kids in private plans & provide a state wrap for EPSDT coveragewrap for EPSDT coverage
People with disabilities are exempted from People with disabilities are exempted from flexible benefit packages flexible benefit packages howeverhowever, CMS , CMS guidance allows states to shift protected guidance allows states to shift protected groups into benchmark plans as long as it is groups into benchmark plans as long as it is “voluntary”“voluntary”
Advocates should monitor how their Advocates should monitor how their state implements Section 6044state implements Section 6044
Individuals in certain categories are Individuals in certain categories are excluded from mandatory participation, excluded from mandatory participation, BUT, many folks are eligible for BUT, many folks are eligible for Medicaid under more than one category Medicaid under more than one category – Medicaid applicants will need to select – Medicaid applicants will need to select their eligibility category carefully to their eligibility category carefully to avoid mandatory enrollment in a avoid mandatory enrollment in a benchmark planbenchmark plan
Advocates should know that the DRA Advocates should know that the DRA does not prohibit states from offering does not prohibit states from offering voluntaryvoluntary enrollment in the option to enrollment in the option to excluded groupsexcluded groups
This can be confusing, especially to This can be confusing, especially to some individuals with developmental some individuals with developmental disabilities, and can disrupt caredisabilities, and can disrupt care
Advocates should ensure that a state Advocates should ensure that a state exercising this DRA option does so with exercising this DRA option does so with great care – with the interest of people great care – with the interest of people with disabilities in mind!with disabilities in mind!
Advocates should monitor any limits Advocates should monitor any limits placed on benefits – scope of benefits AND placed on benefits – scope of benefits AND delivery systems (e.g., managed care, fee delivery systems (e.g., managed care, fee for service, vouchers)for service, vouchers)
It is not clear under the DRA whether the It is not clear under the DRA whether the Federal Medicaid Act’s managed care Federal Medicaid Act’s managed care consumer protections will apply to section consumer protections will apply to section 6044 – new rules for accountability and 6044 – new rules for accountability and consumer protection may be required…consumer protection may be required…
The DEVIL is in the DETAILS!The DEVIL is in the DETAILS!
Advocates should be aware of the impact of Section Advocates should be aware of the impact of Section 6044 benefit packages on 6044 benefit packages on kidskids and EPSDT services and EPSDT services
This section in the DRA has not been drafted clearly This section in the DRA has not been drafted clearly and there is confusion – even among advocatesand there is confusion – even among advocates
There is a risk that benchmark packages and wrap-There is a risk that benchmark packages and wrap-around EPSTD benefits could be uncoordinated around EPSTD benefits could be uncoordinated
Advocates should work to ensure CLEAR guidelines Advocates should work to ensure CLEAR guidelines and education for familiesand education for families
For DE’s track recordFor DE’s track record, advocates should review , advocates should review how the state has coordinated the provision of how the state has coordinated the provision of services of managed care plans that do not provide services of managed care plans that do not provide the full scope of Medicaid benefits, e.g., dental or the full scope of Medicaid benefits, e.g., dental or mental healthmental health
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HOMEWORK for HOMEWORK for Delaware Disability Delaware Disability
Advocates…Advocates…
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Homework (cont.)Homework (cont.)
HCBS Option: Push DE to keep people in HCBS Option: Push DE to keep people in personal care and rehab options. Push for personal care and rehab options. Push for commitment commitment not to capnot to cap community services community services
Cost-sharing: Educate DE policymakers Cost-sharing: Educate DE policymakers that it is counter-productive that it is counter-productive
FOA/MFP: Push DE to take advantage of FOA/MFP: Push DE to take advantage of these opportunities these opportunities
Benefits: Pressure DE to continue Benefits: Pressure DE to continue providing comprehensive medically providing comprehensive medically necessary Medicaid servicesnecessary Medicaid services
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Homework (cont.)Homework (cont.) Explain to DE Policymakers that the Explain to DE Policymakers that the
Medicaid Medicaid Institutional Bias is a Civil Institutional Bias is a Civil Rights Issue:Rights Issue:
- Medicaid has mandatory services that - Medicaid has mandatory services that states must provide and optional services states must provide and optional services for which states can receive federal for which states can receive federal matching paymentsmatching payments
- Under the Medicaid Act, nursing facility Under the Medicaid Act, nursing facility services are services are mandatorymandatory and many and many community-based services are community-based services are optionaloptional
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Homework (cont.)Homework (cont.) Explain Institutional Bias in MedicaidExplain Institutional Bias in Medicaid
(cont.)(cont.)- Community services are scarceCommunity services are scarce- More than 206,000 people with disabilities More than 206,000 people with disabilities
are on waiting lists for waiver services are on waiting lists for waiver services - Average waiting period for some waivers is Average waiting period for some waivers is
more than 2 years more than 2 years ((Source: Disability Policy Institute)Source: Disability Policy Institute)
- People can die while waiting for servicesPeople can die while waiting for services- Talk about what the DE waiting lists are Talk about what the DE waiting lists are
likelike
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DRA Resources OnlineDRA Resources Online
1.1. Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid Services (CMS): (CMS): www.cms.hhs.gov/DeficitReductionAct/www.cms.hhs.gov/DeficitReductionAct/
Developmental Disabilities Assistance and Developmental Disabilities Assistance and Bill of Rights (DD) Act is scheduled to be Bill of Rights (DD) Act is scheduled to be reauthorized in 2007reauthorized in 2007
Advocates, including the DE Council and Advocates, including the DE Council and DE UCEDD, should begin to market the DE UCEDD, should begin to market the Act to their Federal delegation, Act to their Federal delegation, highlighting disability issues and projects highlighting disability issues and projects in the state and what the Act is doing for in the state and what the Act is doing for people with disabilities in Delawarepeople with disabilities in Delaware
REMEMBER: If we don’t tell Congress REMEMBER: If we don’t tell Congress about the DD Act, no one else will!!about the DD Act, no one else will!!
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Current Political Current Political AtmosphereAtmosphere
2006 is an election year for Congress2006 is an election year for Congress Very few bills will pass this fall Very few bills will pass this fall Mostly reauthorizations, not new programs Mostly reauthorizations, not new programs Bills that contain issues that Republican Bills that contain issues that Republican
party can highlight in campaigns, e.g. tax party can highlight in campaigns, e.g. tax cuts, pension reform, ant-gay marriage cuts, pension reform, ant-gay marriage amendment, etc.amendment, etc.
Even annual appropriations bills may wait Even annual appropriations bills may wait until post election “lame duck” sessionuntil post election “lame duck” session
Lifespan Respite Lifespan Respite Care ActCare Act
Combating Autism Combating Autism ActAct
Developmental Developmental Disabilities Act and Disabilities Act and Family SupportFamily Support
NCLB NCLB ReauthorizationReauthorization
WIA/Rehab ActWIA/Rehab Act Social Security Social Security
PrivatizationPrivatization
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Contact AUCD and Contact AUCD and NACDDNACDD
Kim MushenoKim Musheno, Director of Legislative Affairs , Director of Legislative Affairs Association of University Centers on Association of University Centers on Disabilities Disabilities (301) 588-8252(301) 588-8252 [email protected]@aucd.org http://www.aucd.orghttp://www.aucd.org
Anne RohallAnne Rohall, Director, Government Relations, Director, Government Relations
National Association of Councils on National Association of Councils on Developmental DisabilitiesDevelopmental Disabilities (703) 739-4400, ext. 4(703) 739-4400, ext. 4 [email protected]@nacdd.org http://www.nacdd.orghttp://www.nacdd.org
