Medicaid Matters

1. Medicaid Matters

2. Medicaid is Important Medicaid is the single most important federal funding source for persons with disabilities.

3. What is Medicaid? • Medical Assistance in Minnesota • Federal/state partnership • Federal funds match state spending Dollar for Dollar • 50% federal match = improved services and increased coverage

4. Why is Medicaid Important? • Important health care services funded by Medicaid • Doctor, hospital, clinic visits • Long term or continued care • Home & community based waivers (HCBW) • Personal care attendant services • Physical, occupational & speech therapies • Mental health services

5. Minnesotans Eligible 96,000 persons with disabilities are eligible for Medicaid in Minnesota 54% 46% 54% 46% Basic Care Long Term Services Out of the 96,000 eligible, 44,000 (46%) persons with disabilities use Medicaid for long term services (PCA, HCBW, etc) as well as for basic and specialty health care services

6. Medicaid vs. Medicare • Medicare • Available for those who paid Social Security and their dependents • Covers health care services • Does not cover long-term supports, personal care assistance or home and community waiver services • Funded with federal funds • “Dual eligibles”

7. Medicaid Under Fire • Federal and state budget crisis led to rapid rise in Medicaid costs in early part of this decade • Tough economic times meant more people needed public coverage • In recent years, the rate of growth has slowed substantially

8. Medicaid is Cost Effective • Medicaid is a safety net health coverage program serving • Low income families with children • Senior citizens over age 65 • Children and adults with disabilities • Medicaid coverage costs less per person than private coverage* *Studies have shown that Medicaid coverage costs less per person than private coverage after adjusting for health differences

9. Federal Deficit Breakdown Cost of legislation enacted 2001-2005 48% Tax Cuts Defense, Homeland Security and International 37% 8% Entitlements Domestic Discretionary (except Homeland Security) 8% CBPP calculations from Congressional Budget Office data. Reflects costs in 2005 above a CBO January 2001 current services baseline projection for 2005. May not add to 100% due to rounding. 70% of the deterioration in the budget in 2005 resulted from legislation enacted by Congress and the President. And 85% of the cost of that legislation stems from tax cuts or increases in defense, international aid, and homeland security – not domestic spending.

10. Cuts to Medicaid Continuing federal budget problems threaten Medicaid • Massive federal deficit puts pressure on domestic spending including Medicaid. • The Gregg bill in Senate (S. 3521) cuts spending and protects tax cuts, allows President to withhold funds appropriated by Congress, gives Congressional power to commission.

11. Institutional Bias? • Some favor cuts in Medicaid because of the “institutional bias” of the program • Nationwide more Medicaid funds are spent on institutional care than community services • But not in Minnesota…

12. Ending the Notion of Institutional Bias in MN Medicaid spending for long-term services for persons with disabilities in Minnesota 84% Community Services, (HCBW, PCA, etc.) Institutional Care(Nursing facilities, ICF/MR’s) 16% Minnesotans with disabilities have benefited mightily from Medicaid’s coverage of personal care assistance services, other types of home care and home and community based waiver services

13. Changes Ahead for Medicaid Two areas of significant change for Minnesota’s Medical Assistance I. State options for new Medicaid changes allowed by the Federal Deficit Reduction Act (DRA) of 2005. II. State changes to increase persons with disabilities in MA managed care health plans.

14. Deficit Reduction Act (DRA) State Options The DRA provides states with a number of options to change their Medicaid programs in both positive and negative ways

15. DRA State Options 1. Reduce Benefit Set • Medicaid benefit set = list of health services covered by Medicaid • State can change the Medicaid benefit set • The “slimmed down” benefit set does not apply to persons eligible for Medicaid due to a disability. • Possible results of reduced benefit set • People lose precious treatment time • People get lost in the bureaucratic process

16. Minnesota should not reduce benefits covered by Medicaid for any eligible group.

17. DRA State Options 2. Premiums and Co-payments • DRA eliminated federal protections • Protections prohibited states from charging premiums/co-payments beyond nominal amount • States can now decide to charge those above 100% of the poverty level • Minnesotans with disabilities have already experienced significant problems with co-payments and increased cost sharing • THIS LIMITS NEEDED MEDICAL CARE

18. DRA State Options 3. Home and Community Services State Plan Option • MN could add ten specific home and community waiver services to MA state plan benefit set, such as: • Respite Care • Adult day services • Habilitation services • Could ease substantial waiting lists for waiver services • Unfortunately, with opportunity comes loss…

19. DRA State Options 3. Home and Community Services State Plan Option • State could decide to • Limit number of people who get the new benefit • Limit amount spent for new service • Shift a current state plan service to this option Current MN law does not limit regular MA state plan services such as doctor visits, physical therapy or a wheelchair, no waiting list allowed. • If you are on MA and medically need the state plan service, you can get it.

20. Allowing states to limit new services in regular Medicaid (as opposed to waiver services) erodes the very nature of Medicaid as an entitlement

21. DRA State Options 4. Family Opportunity Act • Allows states to offer Medicaid coverage to children who qualify as disabled but whose families are up to 300% of the federal poverty level ($4,150 per month for family of 3) • Covers more kids than TEFRA/MA option • Premiums (fees) paid by parents • Phased for • 2007 for children under 6 • 2008 for children under 12 • 2009 for children under 19

22. DRA Options 5. Money Follows Person • Provides competitive federal grant funds to states • Increase the number of persons who move out of institutions with help of Medicaid community based services • Matches funds for first 12 months after moving out of an institution (nursing facility, ICF/MR)

23. DRA Options 6. Cash and Counseling • States provide for self-directed services with an individual budget, no waiver required • States can limit new program to certain locations and to specific populations • State must have a reliable budget methodology • MN has Consumer-Directed Community Supports (CDCS) under waivers • Only 2,000 Minnesotans use CDCS because of restrictive state budgets

24. Federal Approval of State Changes to Medicaid under DRA 05 • Kentucky • Received federal approval to • Split up Medicaid • Increase co-payments and charge sliding scale premiums • Idaho • Received federal approval for changes without any public disclosure of proposed changes • West Virginia • “Personal Responsibility Plan” required for those who choose the “enhanced benefit package” • Fractured benefit structure could leave people without care

25. Changes Ahead for Medicaid Two areas of significant change for Minnesota’s Medical Assistance I. State options for new Medicaid changes allowed by the Federal Deficit Reduction Act (DRA) of 2005. II. State changes to increase persons with disabilities in MA managed care health plans.

26. Managed Care For Persons with Disabilities 2006 Session of the Minnesota Legislature expanded managed care • Medicare SNP + MA Basic Care • Voluntary participation • Basic care only • Excludes: Home and community waiver services, other home care services, case management for persons with developmental disabilities, ICF/MR services

27. Managed Care for Persons with Disabilities • Department of Human Services is working on managed care development issues with stakeholder group • DHS required to provide information about managed care health plans’ services and spending

28. Conclusion • Continuing federal budget pressure threatens Medicaid • Medicaid is main source of funding • Understand the facts to gain broad public support • Many challenges lie ahead • Action needed at both federal and state levels

29. Effective Advocacy Protect Medicaid (MA)

30. What Should We Do? • Educate ourselves about the issues • Talk with policymakers • Get involved in the 2006 elections • Participate in the CCD 2007 budget campaign at the state legislature • Talk to your friends, neighbors, and loved ones

31. Educate Ourselves Today’s forum is a great first step! • Learn more about MA and its programs • MA = Medical Assistance = Medicaid • Find out who represents you • Learn about the legislative process

32. Talk to Policymakers • Educate them about the importance of MA for persons with disabilities. • TELL YOUR PERSONAL STORY • How has Medicaid improved your life or the life of your family? • What would happen if the Medicaid services you depend on were unavailable or unaffordable?

33. Effective Advocacy Tips and Tactics For contacting Elected Officials

34. The Do’s and Don’ts of Visiting Elected Officials Do: • Make an appointment by e-mail or phone • Be on time for the visit • Be positive and friendly • State the reason for your visit • Personalize the issue • Provide additional resources (like the DRA factsheet)

35. The Do’s and Don’ts of Visiting Elected Officials Do: • Ask for their support • Have a picture taken,if possible • Write a thank you letter • Follow up with additional meetings, phone calls, or e-mails

36. The Do’s and Don’ts of Visiting Elected Officials Do Not: • Be late for the visit • Be confrontational • Spend so much time on small talk that you run out of time to address your issues • Forget to speak about the personal impact of the MA program on YOU • Give incorrect information

37. Effective Advocacy E-mailing and Writing How To Be An Effective Advocate

38. Tips on Writing to Officials • Limit the size of your letter to several paragraphs or one page • State your purpose clearly in writing • Identify yourself as a constituent,if you are • Explain how the bill or policy affects you or your family member

39. More Tips on Writing to Officials • Provide or reference factual material that supports your position • Ask for their support on the issue • Thank them for any previous support • Make sure to provide your full contact information so that the elected official can follow up with you

40. Effective Advocacy Taking Action! Candidate Forums and Voting

41. 2006 Elections • Entire state legislature up for re-election, House and Senate • Governor, Attorney General, Secretary of State, also up for re-election • One U.S. senate seat • All eight U.S. congressional seats • Local elections: • City, county, school board, etc…

42. Get Involved with Elections! • Register to vote and help register others • Research candidates and their positions • Ask candidates to support MA • Attend and speak out at candidate forums • Volunteer on a campaign • Assist with Get Out The Vote efforts • Vote your values!!!

43. Hold Them Accountable • Meet and talk with those elected soon after Nov. 7 • Build relationships with newly elected members and strengthen relationships with those who win re-election • Participate in “Days on the Hill” and other accountability forums

44. CCD 2007 Budget Campaign • All these efforts are about getting ready for the 2007 Legislative Session and being able to influence what happens • Minnesota will set its next two-year budget during the ’07 session (Jan-May) • The most critical decisions regarding MA will be made

45. Keep Active • Stay involved with the organization(s) that most closely reflect your concerns • Attend organizational events and other activities to stay involved • Join coalitions and volunteer on task forces or advisory committees

46. Talk To Others • Talk with your friends, neighbors and loved ones about these issues • Help them learn about Medicaid • Ask them to get involved with you and bring them along to activities and events • No one person can do this, We Must All Work Together

47. MN CCD Call to Action Review: Talk to policymakers Participate in elections Hold your elected officials accountable Become a part of CCD’s 2007 Budget Campaign Talk to others