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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

Health Reform

Key Issues, Concerns and Opportunities for MIGs and Medicaid

1

brief history
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).

2

current status
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.

3

key components of the bill s
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.

4

key components of the bill s5
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.

5

key components of the bill s6
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).

6

key components of the bill s7
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.

7

potential impact to people with disabilities
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.

8

potential impact to people with disabilities9
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.

9

for more information
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
      • nrelave@aphsa.org
      • (202) 682-0100 x241
    • Damon Terzaghi, Policy Associate
      • dterzaghi@aphsa.org
      • (202) 682-0100 x265

10