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Health Reform Key Issues, Concerns and Opportunities for MIGs and Medicaid Brief History Senate Finance Committee Released a “Call to Action” (11/08) and a Series of White Papers Outlining Reform Proposals (4/09-5/09);

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Health Reform

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Health Reform

Key Issues, Concerns and Opportunities for MIGs and Medicaid


Brief History

  • Senate Finance Committee Released a “Call to Action” (11/08) and a Series of White Papers Outlining Reform Proposals (4/09-5/09);

  • Senate Health, Labor, Education and Pensions Committee Released Draft Bill to Overhaul Healthcare System (06/09);

  • House of Representatives Introduces Comprehensive Bill (07/09) – Bill is divided and sent to 3 committees;

  • Senate Finance Committee Introduces Legislation (10/09).


Current Status

  • House bill has been amended in committee, recombined and reintroduced to the full chamber;

  • Senate Finance bill and HELP bill both cleared their committees and are currently being combined by Senate leadership;

  • Floor debates expected to extend well into December, if not 2010;

  • Still in contention – debates about policy are ongoing.


Key Components of the Bill(s)

  • Medicaid Changes:

    • Expand Medicaid to everyone under 133% (Senate) or 150% (House) of FPL;

    • Current eligibility levels, procedures and methodologies are frozen with no sunset date indicated (House) or until 7/1/2013 (Senate);

    • Restructures income calculation for many Medicaid beneficiaries (Senate) to IRS calculation – Elimination of income disregards;

    • Mandatory increase to the provider rates Medicaid pays;

    • Creates offices and demonstrations to increase coordination of care between Medicaid & Medicare.


Key Components of the Bill(s)

  • Medicaid (continued):

    • Removes asset test for many Medicaid categories, but not SSI, MBI, 1915(c), Medicare Savings (House);

    • Removes asset test for people who have their income determined by IRS standards (Senate);

    • Provides increased FMAP for long-term care expansion/restructuring;

  • CLASS Act (House + Senate):

    • Creates a national, premium-funded, opt-out Long-Term Care insurance program.

    • Eligibility for LTC Services done by ADLs, not income;

    • Benefits provided in “Cash & Counseling” style.


Key Components of the Bill(s)

  • Private Insurance Reforms:

    • “Community Rating” – no more than 2:1 (house) or 6:1 (senate) variation in premiums for individuals within a geographic area;

    • Prohibits exclusion of pre-existing conditions;

    • “Guaranteed Issue/Renewal” – no one can be denied coverage/dropped due to health conditions;

    • Removes annual/lifetime limits on care;

    • Required Benefits Package (Including Rehabilitation, Habilitation, MH treatment).


Key Components of the Bill(s)

  • Individual mandate to buy insurance;

  • Establishment of “Exchange”

    • Based on Massachusetts “Connector” model

    • Provides centralized marketplace to compare insurance and purchase plans

    • Federal government provides subsidies for people with low-to-moderate income to assist with the purchase of insurance

  • Public Plan/Co-ops

    • Establishes public option (House/possibly Senate) or co-ops (Senate) to compete with private insurance.


Potential Impact to People with Disabilities

  • Positives:

    • Greater availability of services in the private sector.

    • No preexisting condition exclusion, denial of coverage or termination of coverage.

    • Less premium variation.

    • CLASS act – LTC without income/asset test.

    • New Medicaid coverage for low-income people, including those with serious conditions that don’t meet SSA listings.


Potential Impact to People with Disabilities

  • Concerns:

    • Eliminating income disregards;

    • Emphasis on acute care & individuals accessing private plans in the exchange;

    • Impact of mandatory expansion on optional Medicaid services/eligibility;

    • Reduction in “DSH” – Many States use DSH to help support care for people with Mental Illness;

    • Large expansion may cause access issues.


For More Information:

  • Center for Workers with Disabilities

    • National Association of State Medicaid Directors

    • 1133 19th Street NW, Suite 400Washington, DC 20036

  • Staff contacts:

    • Nanette Relave, Director


      • (202) 682-0100 x241

    • Damon Terzaghi, Policy Associate


      • (202) 682-0100 x265


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