A U C DAssoc ia t ion of Univers i ty Centers on Disabi l i t ies

UCEDD Directors Meeting

December 2, 20123:15‐6:15 pm

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Welcome

A U C DAssoc ia t ion of Univers i ty Centers on Disabi l i t ies

Timm Vogelsberg, PhD (MT)

Judy Struck, MD (SD)

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Recognition

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Native American DD Needs Assessment PCPID 2012 Report to the President Involving People w/ Most Significant Disabilities Capacity Building Tool‐kit Minority Partnerships report UCEDD Annual Report

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UCEDD TA Updates

A U C DAssoc ia t ion of Univers i ty Centers on Disabi l i t ies

Allies in Self‐AdvocacyFinal Summit ReportPromotional videoState team progressListservOrganizational Development Mini‐grantsUpdated website www.AlliesInSelfAdvocacy.org 

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UCEDD TA Updates

A U C DAssoc ia t ion of Univers i ty Centers on Disabi l i t ies

UCEDD National Salary Survey ‐ elementsDirector & associate director $, degree, longevityUCEDD admin. home, budget, FTEUniversity Carnegie classificationSalary sourceUniversity support for UCEDD

UCEDD Evaluation Plans

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Upcoming Requests

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Self‐Advocacy Online

Amy Hewitt, PhD www.SelfAdvocacyOnline.org

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3 major effortsAIDD/AUCD FellowshipAUCD Policy FellowshipUCEDD Leadership Institute

Wonderful opportunities for early‐mid career network members and trainees

Strongly encouraging applicants with cultural, ethnic, linguistic diversity

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Leadership Development

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Sue Fox, Associate UCEDD Director, IOD, NH

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UCEDD Leadership Institute

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Mette Pedersen, PhD, 2012‐2013 Fellow Applications due December 15 for 2013‐2014!

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AIDD/AUCD Fellowship

A U C DAssoc ia t ion of Univers i ty Centers on Disabi l i t ies

Kristina Majewski, JD, 2012 Fellow Applications for 2013 due now!

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AUCD Disability Policy Fellow

A U C DAssoc ia t ion of Univers i ty Centers on Disabi l i t ies

Martha Roherty, Executive Director, NASUAD www.nasuad.org

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Partnership

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BREAK10 minutes

Don’t miss a minute of the ACA!

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KimMushenoAUCDDirectorofLegislativeAffairs

RachelPattersonAUCDPolicyAnalyst

Health Care Reform Update2012 AUCD Annual Meeting

UCEDD Directors

Impact of election

Affordable Care Act will not be repealed

ACA will continue to be implemented by HHS Secretary Kathleen Sebelius

Medicaid will not be block granted

Medicare will not be fundamentally altered 

House bills to consolidate and cut education and employment programs will not pass

Bills to weaken the ADA will not pass

Cuts to discretionary programs will not be as severe

Still need bipartisan support to pass any bill

Public Law 111-14 Historic Legislation

Patient Protection and Affordable Health Care Act 

and the 

Health Care and Education Reconciliation Act 

Signed into LAW on March 23, 2010

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Purpose

• Expands coverage and access

• Transforms focus from treating sickness to preventing illness and promoting wellness

• Strengthens protections for people with disabilities who have been discriminated based on pre-existing conditions or health status

• Goal to achieve health equity and reducing health disparities

• Bending the Cost Curve over time

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Insurance Market Reforms

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“Guaranteed issue and renewability” –Insurance companies must not deny anyone

“Medical loss ratio” means 80‐85% of premiums must be spent on medical care, not on advertising 

or  CEO paychecks‐‐Or you get money back!

Regulations require insurers to justify any unreasonable rate  increases

“Individual Mandate”

Everyone must share responsibility for lowering costs and covering more people

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Expanding Coverage

Temporary high‐risk pools

Small business tax credits to cover employees

Premium subsidies (133‐400% FPL)

Employer & individual responsibility

Medicaid expansion – 133% of FPL covered

Insurance Exchanges – more coverage, increased competition, lower costs

Expand Coverage: Medicaid

Expands Medicaideligibility for everyone up to 133 % of Federal Poverty Level (2014)

• Up to $14,600/ individual

• $29,400 /family of four

Federal share of costs to states:

• Administration lower than private insurance

• States will receive100% for newly eligible first 3 years (2014 – 2016)

• Phases down to 90% for 2020 and subsequent years

Estimated to cover 17 million more 

in 2014

Efficient

more info: www.kff.org

Cost‐effective Humane

Health Insurance Exchanges

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Exchange = = Market

If you can’t get MedicaidYou can shop in the 

marketplace for insurance with government subsidies

Making Coverage Affordable

Subsidies for marketplace comes in form of Tax Credits provided for individuals/families between 133% ‐ 400% Federal Poverty

Approximately

Up to $43,000 individualUp to $88,000 family of 4

Paid by Government

directly to Insurer

Limits out of pocket costs:

Deductibles, Coinsurance, Copayments

HOW?

Essential Benefits Package for Exchanges and Medicaid

Services Everyone Expects to be Covered by their Insurance

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Hospitalization, emergency services, 

ambulance  Prescription drugs and laboratory services

Rehabilitative and habilitative services 

and devices

Mental health and substance use disorder services 

including behavioral health treatment

Preventative and wellness services and 

chronic disease management 

Pediatric services including dental and vision care

Maternity and newborn care

HUGE Focus on Prevention and Wellness

Requires new plans to cover certain preventive and immunization services without deductible or co‐insurance (applies to Medicaid and Medicare)

One percent federal Medicaid share increase for States if it covers clinical preventive services 

Grants to provide state incentives to Medicaid beneficiaries who successfully participate in a wellness program

$11 billion increase FY 2011 for Community Health Centers

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Prevention and Wellness

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• Coordination and goals

National Prevention Council 

• $7 billion (FY 2010‐2015); $2 billion/yr (FY2015+)

• Sen. Coburn “prevention and public health slush fund”

Prevention and public Health Fund for 

transformational sustainedinvestments

• Community Transformation Grants• Comprehensive workplace wellness programs• Education and Outreach Campaign• Oral health prevention

Numerous Prevention and wellness programs such as:

Increasing and Improving the Workforce

National Health Care Workforce Commission established

Oral Health: Grants for dental and dental hygiene 

schools, residency programs, public health programs

Increases Medicaid reimbursement for 

primary care physicians and pediatricians to Medicare rates (2013 and 2014)

Primary Care Training Grants for Medical Schools • training on treating individuals with disabilities priority population

Accessibility

Access Board (under the Rehab Act) establish standards for accessibility of 

medical diagnostic equipment

Includes • examination tables and chairs

• mammography equipment

• x‐ray machines

Understanding Health Disparities:Data Collection

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Requires government to collect health survey data from people with disabilities to enable better understanding of the health of people with disabilities compared to other minority groups. 

Requires HHS to survey health providers to asses access to care and treatment for people with disabilities.

Requires development of recommendations for quality measures to improve the quality of health care for individuals with disabilities. 

New State Incentives for Community Living

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Community First Choice State Option• new Medicaid state plan option (beginning Oct. 2011) to provide comprehensive home and community‐based attendant services and supports for individuals who are eligible for an institutional level of care

Reforms 1915(i) State Option• Allows states to provide HCBS services without a waiver

Grants to assist states to balance their Medicaid systems in favor of community

Extends Money Follows the Person grants

CLASS Act – Community Living Assistance, Services and Supports Act

Legal ChallengeWon (mostly)

Congressional Challenges continue

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Challenges to Health Reform

Supreme Court Decision

Court upheld the individual mandate as constitutional exercise of Congress’ power 

to levy taxes

Medicaid expansion is unconstitutionally coercive of states• Power of Secretary to withhold all existing funds for state non‐compliance

Bottom line –Medicaid expansion 

in ACA is now an option

Medicaid expansion

4 Republican governors do not plan to join in the 

expansion16 yes

No deadline for states to decide on joining the expansion and 

they can drop out at any time

Partial expansion?  • E.g. limit enrollment to people with income up to 100 percent of the FPL rather than 133 %

Will Congress slash Medicaid 

budget?

Cutting Medicaid

Block grants off the table, but

Per Capita Caps still under discussion

Limitations on Medicaid provider taxes

Blended match rate

Limit federal reimbursement for certain expenses

Election Impact - Exchanges

States must have Exchanges ready by Jan. 2013

States took “wait and see approach” – now not ready

Secretary extended deadline for application from Nov. 16 to Dec. 14 (if partnership Feb. 15)

Two new Rules on Exchanges to come out soon

Election Impact

Managed Long-Term Services and Supports

Source: AARP, On the Verge: The Transformation of LTSS

As of February 2012

MLTSS – Power Tools

Benefits ConcernsRebalancing Fast implementation

Primary and Coordinated Care

Limited experience from states or MCOs

Cost containment Mandatory or passive enrollment Consumer protection

Lack of quality measures

MLTSS – Where UCEDDs are Needed

Quality measures focused on long term quality‐of‐life outcomes

Duals Demos

Duals Demos

Benefits Concerns

Medicare‐Medicaid coordination

Demonstration overreach

Care coordination Passive enrollment

Cost containment Consumer protection

Rebalancing Need for evaluation

Lack of experience from states or MCOs

Duals Demos – Where UCEDDs are Needed

Public Engagement

Monitoring and Evaluation

What you can do

Speak up and advocate for the 

Affordable Care Act

Volunteer your expertise to help plan

Coordinate with state partners• National Academy for State Health Policy

• National Association of Insurance Commissioners

• National Association of State Medicaid Directors

Resources

AUCD Health Reform HUB: http://www.aucd.org/healthreformhub• Text of the law• Detailed summaries and analyses

• Implementation resources• Archived webinars on 4 topics

US Dept. of Health and Human Services: 

http://www.healthcare.gov/

Kaiser Family Foundation: 

http://www.kff.org/

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Questions?

Thank You

A U C DAssoc ia t ion of Univers i ty Centers on Disabi l i t ies

Is your state considering any of the following: Managed Long Term Services & Supports (MLTSS) Dual eligibility demonstrations Expanding Medicaid Setting up healthcare exchanges

How are these issues being addressed in your state (task force, etc.)? How are experts being chosen to advise the process? How did you, or can you, get involved? Do you use AUCD’s Health Care Hub? 

What else would be helpful to include?

How else can AUCD assist through TA?

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Table Discussions

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Implications for TA

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