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Health Reform

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  1. Health Reform Key Issues, Concerns and Opportunities for MIGs and Medicaid 1

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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