n4a Aging Policy Briefing

1. n4a Aging Policy Briefing Medicaid: The Evolution, Opportunities & Challenges of the Health Care Safety Net Brenda Sulick, Ph.D., Senior Policy Advisor National Committee to Preserve Social Security and Medicare sulickb@ncpssm.org Washington Court Hotel, Washington, D.C. April 23, 2013

2. National Committee to Preserve Social Security and Medicare • The mission of the National Committee to Preserve Social Security and Medicare, a membership organization, is to protect, preserve, promote, and ensure the financial security, health, and the well being of current and future generations of maturing Americans. The National Committee to Preserve Social Security and Medicare acts in the best interests of its members through advocacy, education, services, grassroots efforts and the leadership of the Board of Directors and professional staff. • The efforts of the National Committee to Preserve Social Security and Medicare are directed toward developing better-informed citizens and voters.

3. Dual Eligible Population • 10.2 million individuals • Medicare/Medicaid eligible • Low-income • High health needs/costs • Most are older adults: • 60% seniors • 40% people with disabilities

4. Dual Eligible State Demonstrations • Medicare-Medicaid Coordination Office (MMCO) established under the Affordable Care Act • Two financial alignment demonstration models • Capitated:Centers for Medicare and Medicaid Services (CMS) and states pay a managed care organization a blended payment to provide Medicare and Medicaid services. • Managed fee-for-service: States provide care coordination and receive part of the Medicare savings. • 26 states sent proposals to CMS for one of these models • 5 signed a Memorandum of Understanding (MOU) to move forward – Massachusetts, Ohio, Illinois, Washington and California • 6 states withdrew their proposals; remainder of proposals are pending

5. Key Demonstration Issues • Size/scope • Readiness • Enrollment • Quality measures • Rate transparency • Ombudsman/oversight • Appeals • Continuity of care • Consumer engagement

6. National Advocacy Efforts • Meetings with Policymakers • MMCO (duals office), CMS, Administration for Community Living and Congressional offices • Recommendations/Correspondence (examples) • Letter to Secretary of Health and Human Services on demonstration savings and financing • Letter to MMCO expressing consumer issues and recommendations • Letter to MMCO requesting ombudsman programs • Congressional testimony on demonstrations – Senate Special Committee on Aging; House Committee on Ways and Means • Paper on designing state-based ombudsman programs in managed long-term services and supports and the dual eligible demonstrations

7. Ombudsman Programs • Goal: Ensure that consumers have access to a conflict-free ombudsman program that can address concerns about the demonstration. Core functions 1. Individual assistance 2. Systems monitoring and reporting 3. Consumer education/empowerment • States to determine how they want to develop/implement programs. • Additional funding is needed for new/existing programs.

8. Progress Made • Ombudsman – All MOUs include a proposal for an ombudsman, except Massachusetts, which is committed to establishing an office. Funding is needed. • Passive Enrollment – Some states include a temporary “voluntary” enrollment period. • Implementation date – Many states are delaying their start dates to make sure they are prepared to serve a large influx of dual eligible individuals. • Demonstration size – States adjusting enrollment size to smaller, phased enrollments. • Person centered care – MOUs include commitment to person centered care planning.

9. How Can You Become Involved? • Monitor state MOUs and demonstrations • Contact policymakers • about concerns • Reach out to state and national advocacy organizations

10. Resources • National Committee to Preserve Social Security and Medicare: www.ncpssm.org • n4a: http://www.n4a.org/ • NHELP: http://www.healthlaw.org/ • Community Catalyst: http://www.communitycatalyst.org/ • National Senior Citizens Law Center: www.dualsdemoadvocacy.org