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n4a Medicaid Update

n4a Medicaid Update. April 23, 2013. NHeLP. Public interest law firm working to advance access to quality health care and protect the legal rights of low-income & underserved people Offices in Washington D.C., Los Angeles, and North Carolina Visit our website at: www.healthlaw.org

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n4a Medicaid Update

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  1. n4a Medicaid Update April 23, 2013

  2. NHeLP Public interest law firm working to advance access to quality health care and protect the legal rights of low-income & underserved people Offices in Washington D.C., Los Angeles, and North Carolina Visit our website at: www.healthlaw.org New website coming soon!

  3. Question: What’s going on in Medicaid these days? Answer: A lot.

  4. Some Key Areas of Medicaid Activity Medicaid Expansion Medicaid benchmark benefit (ABP) Application & enrollment system Delivery system reforms New HCBS options for states

  5. (1) Medicaid Expansion • Today, to be eligible for Medicaid individuals must be low income and fit into an eligibility “category” • Many people living in poverty just don’t fit into any category • In 2014: The ACA creates a new category for everyone* below 138% FPL that doesn’t fit into traditional ones! • The traditional categories remain

  6. What happens to the uninsured?

  7. Medicaid Expansion Progress • The ACA meant for the Med Ex to be mandatory, but the Supreme Court said states can opt out • Many states are going to participate, some are undecided, and a few have said they’ll opt out • Some undecided states are trying to persuade HHS to give them special flexibilities to opt in • It is very important for your clients that states opt in!

  8. (2) Medicaid benchmarks (ABP) • In general, Medicaid Expansion enrollees will get Medicaid “alternative benefit plans” (ABP) instead of the traditional Medicaid benefit… • However, “exempt” vulnerable populations still get the traditional Medicaid benefit • The ABP benefit is modeled after typical employer coverage… • However, states have authority to add extra benefits, including traditional Medicaid and HCBS

  9. (3) Application & enrollment • The Exchanges (“Marketplaces”) are supposed to follow a “no wrong door” policy • HHS is designing a single streamlined application for Medicaid, CHIP, Exchange, & subsidies • Will the enrollment process connect everyone to the right programs and services? • HHS is also developing policies for consumer assistance: Navigators, In-person Assisters, Certified Application Counselors

  10. (4) Delivery system reform • Delivery system reform means: Testing new ideas about the best way to deliver care • Many states are going to test (or expand) managed care and care management – especially for dual eligiblesand LTSS • There are lot of different ways this is happening…

  11. (5) New HCBS options for states • The ACA offers new options and incentives for states to expand HCBS access • States have been so overloaded from the other ACA implementation issues that not many have been able to look into and implement the new HCBS opportunities • Get your state on board! • New managed care programs may also have a big impact on HCBS and institutional care

  12. THANK YOU

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