Health Care Reform and Implications for Persons with Disabilities Equip for Equality May 27, 2010 Stephanie F. Altman, Health & Disability Advocates

Health Care Reform and Implications for Persons with Disabilities

Equip for Equality May 27, 2010

Stephanie F. Altman, Health & Disability Advocates

Prepared & presented by Health & Disability Advocates, April 2010. For more info: 312-223-9600.

COMPONENTS OF PATIENT PROTECTION & AFFORDABLE CARE ACT Community Living Assistance Services & Support

Act (CLASS) National High Risk Pool (HRPs) Community First Choice Option Changes in Medicaid

Medicaid Maintenance of Effort Requirements Extending Money Follows the Person grants Additional $ for Aging & Disability Resource

Centers Demonstrations & Pilots


COMMUNITY LIVING ASSISTANCE SERVICES & SUPPORT ACT (CLASS)

Monthly premium: $120-$150/month 5 years before individual is vested and can

draw down a benefit Benefit is $50/day (at a minimum); $75/day is

estimated at this point Qualifying services: for ADLs or IADLs Services in home, or residential

Considerations for Illinois:1. How do we encourage people to

participate?2. Do we know who would use the program?3. Does it change the way we currently

deliver services?


HIGH RISK POOLS: BACKGROUND

Approximately 200,000 people are enrolled in 35 state high risk pools nationally

Individuals are uninsurable in the private market due to pre-existing conditions

Health care reform legislation creates a national transitional high risk pool to begin in June 2010 (unless a state opts to expand their own high risk pool) and operate until the Exchange is implemented in 2014


CURRENT HIGH RISK POOL PLANS

Nationally, steep premiums that increase with age; range from 125 to 200% of individual market rates for the state

High levels of deductibles and co-insurance; similar to other individual policies

Limits on some benefits, such as preventive services, prescriptions, and mental health

In Illinois the Comprehensive Health Insurance Program (I-CHIP) premium is 143% of the individual market rates16,000 enrollees

Source: Jean P. Hall & Janice Moore, University of Kansas


TEMPORARY HIGH RISK POOLS IL has opted to run its own pool (SB 240)

National pool will be managed by Health & Human Services

National and new state pools will require being uninsured for 6 months prior to enrollment – there will be no wiggle room on definition of “uninsured”

Both will cap premiums at 100% of individual market rates, and guidance on package and deductibles is forthcoming; however, plans must cover at least 65% of health care costs.


HIGH RISK POOL CONSIDERATIONS FOR ILLINOIS I-CHIP premium is higher (143%) than the temporary

high risk pool (100%) New funding -- $5 billion – must be used for new

enrollees; and cannot be used for existing enrollees IL estimated share to be $200 million total but it can’t be

used for premium parity between programs Will IL try to use GRF for Section 7 Pool and Insurance

Assessment for HIPPA CHIP pool to create premium parity?

Temporary High Risk Pool enrollees must be uninsured for at least six months and HHS has not issued guidance on definition of pre-existing condition I-CHIP uses 31 presumptive conditions and has a catchall

category for people without presumptive conditions but rejected on two insurance applications.


COMMUNITY FIRST CHOICE OPTION Medicaid State Plan Option –1915 (k) to provide

attendant care services & supports Must be categorically eligible for Medicaid Income under 150% fpl or have income that does not

exceed income thresholds for institutional level care Services: health related tasks with ADLs, IADLs, hands

on supervision or cueing; acquisition of skills to accomplish ADLs, IADLs, and voluntary training for managing attendants

Optional Services: transition costs (rent, utility deposits, first month’s rent and utilities, bedding, basic kitchen supplies and other “necessities”), and services that increase independence or substitute for human assistance.

Reimbursement rate for Optional Services is an additional 6% points above FFP – i.e. 56%


COMMUNITY FIRST CHOICE OPTION: IMPLICATIONS IN ILLINOIS Will Illinois determine a 1915 (k) State Plan

Amendment is more efficient than the 1915(c) waivers we currently operate for attendant care and health related services?

Given the budget situation, can IL opt for the Optional Services and will the cost of the expansion without a cap on enrollment be higher than the increase in federal funding through the FFP enhancement?

How does the Community Choice First Option fit within the Money Follows the Person re-balancing effort? Consideration: MFP has changed its focus to include

individuals living in a facility for 3 months or more and has a new emphasis on employment


OVERVIEW OF HCR & MEDICAID: IMPLICATIONS FOR STATE MEDICAID PROGRAMS Potentially Four Medicaid Vehicles

“Regular Medicaid”: Medicaid programs for “categorically eligible” populations not changed by PPAC

“New Medicaid”: New eligibility category for adults under 133% of FPL Begins 2014 unless Early Implementation

“Optional Medicaid” category for those over 133% FPL “Benchmark” Plan under Insurance Exchange

Different from current Medicaid structure in Categorical Eligibility, Coverage Packages, Reimbursement to Providers and Delivery System.


MEDICAID & MAINTENANCE OF EFFORT

PPACA extends the MOE requirement of the American Recovery & Reinvestment Act (ARRA) prohibition on reducing eligibility for Medicaid until December 31, 2013 States are prohibited from altering eligibility for

any existing Medicaid program even though enhanced match may not be extended beyond December 31, 2010 (possibly expanded to June 30, 2011.)

CMS verbal interpretation is that states can improve programs without penalty, but not reduce eligibility

The MOE requirement does not apply to the “new” Medicaid expansion population


DELIVERY SYSTEM AND ACCESS REFORMS

Medicaid Physician Primary Care Reimbursement Increases to Medicare Level:

what will the definition of primary care codes be especially for people with special needs and can state afford to keep rates up after 100% FFP ends?

New Patient Care Models Center for Medicare & Medicaid Innovation Varies pilots Demonstrations: Independence at Home Demo;

Hospitals Readmissions Reduction Program; Community-based Care Transitions Program

WHAT DOES THIS MEAN FOR MEDICAID IN ILLINOIS?

“Regular Medicaid”– Covered Services Defined

“New Medicaid” – Covered Services NOT Defined

Insurance Exchange– Covered Services NOT Defined

AABD – 100% of FPLEligible Population: people with disabilities who meet or equal disability standard; people over 65Federal Match Rate: 50%

133% of FPLEligible population: any adult who is not otherwise categorically eligibleFederal Match Rate: 100% until 2017

Benchmark Plan (could be Medicaid Service Package)Eligible Population: Adults above133% of FPLFederal Match Rate: 100% until 2017

HBWD– 350% of FPLEligible Population: must meet a disability standard; must be working & paying FICAFederal Match Rate: 50%

State Option for Medicaid for over 133% FPL (50% Federal Match Rate) until 2017

Spend-down -- ?%Eligible population: must meet or equal a disability standard or otherwise categorically eligibleFederal Match Rate: 50%


KEY CONSIDERATIONS FOR ILLINOIS

1. What happens to people with disabilities who are not working and are above 133% of FPL?

2. With 100% match rate through 2017, is there more of an incentive to move more people into expansion group or exchange which may have weaker benefits packages?

3. Will the Exchange connect with 1915 (c ) or (k) services like the HBWD program currently does for working people who earn out of HBWD but still need long-term care services & supports?


KEY CONSIDERATIONS FOR ILLINOIS

4. What happens to people who have chronic conditions, self-insured with astronomical premiums? If they’re not in the I-CHIP, do they need to go “bare” in order to get affordable coverage?

5. What about assets? New expansion populations don’t have asset limits – is this something we should consider for other Medicaid populations to increase state FFP opportunities?


NEW “SEAMLESS” DELIVERY SYSTEM BY 2014 WITH A SINGLE APPLICATION

Documents

Health Care Reform and Implications for Persons with Disabilities Equip for Equality May 27, 2010 Stephanie F. Altman, Health & Disability Advocates