Presentation Transcript

1. Medicaid Policy Updates

   n4a Public Policy Briefing Fay Gordon, National Senior Citizens Law Center April 28, 2014
2. Big Picture: Strengthening Medicaid HCBS major priority for stakeholders
3. Trends driving policy development
4. Demand for Medicaid LTSS is increasing as population ages
5. SOURCE: Kaiser Commission on Medicaid and the Uninsured, Medicaid Spending by Long-Term Services and Supports (LTSS) Users, FY 2010 Medicaid continues to be the major funder for community-based LTSS Total Medicaid spending for Community-based and Institutional care: $114 billion
6. HCBS: High enrollmentInstitutional: High expenditures Distribution of Enrollment and Spending Among Medicaid LTSS Beneficiaries SOURCE: Bipartisan Policy Center, America’s Long-Term Care Crisis: Challenges in Financing and Delivery
7. Policymakers paying attention to Medicaid and its many changes
8. STATE BUDGET INITIATIVES
9. Two factors pushing State interest in Medicaid changes
10. Many states preparing or already implementing MLTSS 22 states implementing Medicaid managed LTSS through 1115 or 1915(b)/(c) waivers. 9 states implementing Medicaid managed LTSS through dual eligible demonstrations. Contract language is key to influencing changes Advocates Library of Managed Long Term Services and Supports Contract Provisions: http://www.nsclc.org/index.php/ltss-contracts-index-appeals-notices.
11. Example of MLTSS Contract Guide
12. More detail on MLTSS Contract Guide
13. Two issues to consider in shift to MLTSS
14. Olmstead and CMS:New HCBS Rule
15. The HCBS rule implementation is a big deal HCBS should be provided as an option to every Medicaid beneficiary who needs service. Rule sets, for first time, standards to ensure Medicaid-funded HCBS are provided in settings that are non-institutional in nature. Applies to: houses, apartments, residential care facilities, assisted living, and adult day care programs.
16. Rule’s intent: Ensure HCBS provided in the community Rule went into effect March 17, 2014 Applies to:
17. States will begin transition process this year
18. Stakeholders should engage with their state early in the process
19. ACA and Medicaid
20. Balancing Incentive Program 16 states moving forward: AR, CT, GA, IA, IL, IN, LA, MD, ME, MO, MS, NH, NJ, NY, OH, TX Concept: Three principal requirements: No-wrong-door/single entry point system. Conflict-free case management system. Standardized assessment agreement. In exchange for an enhanced FMAP
21. State Plan Option and Community First Choice 1915(i) State Plan Option No institutional level of care requirement Statewide, but can target by population More flexible financial eligibility 1915(k) Community First Choice Option Statewide 6% enhanced federal match
22. Medicaid expansion helps older adults obtain coverage Prior to ACA implementation, 15%, or 8.9 million 50-64 year-olds were uninsured. More than two-thirds of this group have incomes below $20,000. States that took up Medicaid expansion extended Medicaid to individuals under 65 with incomes up to 138% FPL.
23. New coverage transitions to consider in post-ACA implementation Medicaid expansion introduces coverage transitions when expansion coverage ends. Individuals will need education and assistance: Income gap: Beneficiary must meet traditional Medicaid income guidelines Resource gap: Beneficiary must meet traditional Medicaid asset/resource guidelines
24. Three takeaways MLTSS and Duals: Familiarize yourself with CMS guidance and contracts and make sure your state adheres. HCBS rule: Be involved and engaged in changes in your state. ACA Transitions: Become informed about ACA transition issues. Encourage your state to apply for enhanced FMAP options.
25. Resources: www.nsclc.org www.dualsdemoadvocacy.org Contact: Fay Gordon, FGordon@nsclc.org