1 / 10

Health Reform

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);

issac
Download Presentation

Health Reform

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related