Wednesday, February 22, 2017

Update on ACA and Medicaid Restructuring

from National Family Voices:


ACA Repeal and Medicaid Restructuring
On February 16, the House Republican leaders released a "policy brief" outlining their plan to repeal and replace the Affordable Care Act (ACA) AND drastically restructure the Medicaid program. (The ACA proposal starts on page 10 Medicaid proposal starts on page 14.) The document is very general, so it is difficult to assess how it would affect the access to affordable insurance.
ACA Replacement. This ACA replacement plan would: eliminate the penalty for failure to have health insurance coverage (individual mandate) and the employer mandate, provide refundable age-based (not income-based) tax credits for the purchase of insurance plans, including catastrophic plans, "enhance and expand" Health Savings Accounts, allow the sale of insurance across state lines, and provide "State Innovation Grants," which states could use to make health care or insurance more affordable, including the creation of high-risk pools.
Notably, the policy brief does not mention how the plan might protect individuals with pre-existing conditions. But last week Rep. Greg Walden (R-OR), the Chairman of the House Energy and Commerce Committee, which has jurisdiction over Medicaid and many other health care issues, introduced the Pre-Existing Conditions Protection Act of 2017, which purportedly would prohibit group health-plan issuers from using an individual's pre-existing conditions to determine eligibility for coverage, the services covered, or individuals' premiums. But, as drafted, the bill does not seem to limit the premiums that can be charged for people buying insurance in the individual market.
It is difficult to assess the Ryan plan without knowing critical details, although, based on past experience, there are reasons to think that Health Savings Accountsinterstate insurance sales, and high-risk pools may not be effective in expanding coverage. House Speaker Paul Ryan said a bill would be released and committees would start to consider the legislation during the week of February 27, although it is quiet possible that date will slip.
Medicaid. The plan would cut federal Medicaid spending by imposing "per capita caps" on federal Medicaid payments to states. In other words, a state would receive a fixed amount per enrollee, varying by type of enrollee - "aged, blind and disabled, children, and adults." States would have the option of taking a block grant instead, meaning they would get a fixed amount regardless of their population of Medicaid enrollees. Under either system, the starting amount each state would get (baseline) would be based on that state's historical Medicaid payments, with some sort of annual inflation adjustment. This raises the politically thorny issue of how to treat the difference in historical payments between the states that took up the ACA Medicaid expansion option and those that did not. Under the plan outlined in the policy brief, the former group would eventually lose their enhanced matching payments for the expansion population, while the non-expansion States would be eligible to receive "additional temporary resources for safety net providers" during a transition period.
The key point is that federal payments to states would be increasingly lower than they would under current law. In exchange for receiving less federal money, states would be given more flexibility in designing their Medicaid programs - in services and supports covered, and/or in populations served. (In the paragraph on block grants, however, the brief says that states "would be required to provide required services to the most vulnerable elderly and disabled individuals who are mandatory populations under current law.") See 5 Key Questions: Medicaid Block Grants & Per Capita Caps (Kaiser Family Foundation). The Center for Law and Social Policy has prepared a brief on how block grants have worked (or not) in other programs.
Prospects. Many House Republicans are not ready to commit to the ACA-replacement outline released by Speaker Ryan. Furthermore, it is not clear how much support there would be for this plan in the Senate, particularly for Medicaid restructuring. Additionally, some governors will be opposed to capping Medicaid payments, since states stand to lose billions of federal dollars over time. Moreover, there will be a "formula fight" (a.k.a., "food fight") among governors over how to treat Medicaid expansion funding in determining the baseline for future federal payments.
A new tool from the Kaiser Family Foundation allows users to compare some of the different proposals to replace the ACA.

Saturday, February 18, 2017

Act Now to Protect the ACA

From Save My Care:

Friends, the next ten days could determine the fate of health care for 30 million Americans.

Congress is on recess in their home states and districts through February 26th. Many members are hosting town halls, forums, and events to speak directly to constituents. This is our opportunity to hold them accountable for their views on our health coverage. Members of Congress will only consider alternatives to repeal if they are faced with our growing movement.

We've created a congressional recess events tracker with all of the events members of Congress are hosting over the next ten days. Find an event close to you, and RSVP to attend.

Find an event near you

At these events, we must show the real impact of repealing health care. When our elected officials get back to D.C., "save our care" should be stuck in their heads, alongside the memory of hundreds and thousands of their constituents demanding the protection of their coverage. 

The events are searchable by state so you can find those closest to you. When you RSVP to an event, we'll pass along information to help you make the most of your attendance. 

And be sure to check back frequently, especially if you don't yet see events in your area. Members of Congress don't always give a lot of notice for public appearances, and we're looking for and adding events you can attend every day.

RSVP to attend an event, and ask your elected officials how they will protect your health care from repeal.

Thank you. 

Save My Care

Friday, February 17, 2017

Proposed Plans Would Would Reverse ACA Coverage Gains and Radically Overhaul Medicaid

from  Center on Budget and Policy Priorities:
House Republican leaders yesterday released a set of talking points they described as their substitute for the Affordable Care Act (ACA). But the document reveals that House Republicans still plan to repeal the ACA without putting forward a comprehensive replacement.

They also plan to fast track a proposal to radically overhaul Medicaid, putting coverage for children, seniors, and people with disabilities at risk, in addition to ending the ACA’s Medicaid expansion for low-income adults.

The document makes clear that the starting point for any House Republican bill is the “repeal and delay” legislation that President Obama vetoed last year. By the end of a decade, that bill would result in 32 million people losing coverage and individual market premiums doubling, the Congressional Budget Office estimated.

The provisions that yesterday’s outline suggests House Republicans will add fall far short of repairing that damage; in the case of Medicaid, they would cause additional harm to millions of families across the country.
Read the Report

A Special Note to the Professionals

By Heather Dane, Health Information Specialist

As a mom with two kids with significant special health care needs, I have had my share of experiences with professionals. I have lost count of the number of doctors, nurses, teachers, therapists, case managers, and social workers that have crossed our path at one point or another. When I think back to all of these people, I have some fond memories and some not so fond memories. My hope is that after you read this, you will become one of those professionals whom parents and patients look back on fondly.

Those first months after my son was diagnosed I was timid when speaking to all the professionals who were all of a sudden invading our life. Don’t get me wrong, I would ask questions; but if I didn’t get an answer or was rushed through an appointment, I didn’t push. Many times when my child or I was treated unfairly or unkindly I wouldn’t say anything to defend us. I would just cry after the appointment and feel powerless. It only took me a few months to realize that if I was going to be the best advocate for my child I had to start advocating where it mattered most.  I knew that I was going to have to change my approach, but I also had to figure out what it was I wanted from all these professionals.

I decided that I wanted to be a meaningful part of the team. I wanted those professionals to speak TO me and not at me. I wanted my child to be seen as an individual and not fall into the trap of “what we usually see” with no higher expectations. I wanted the professional to speak to and acknowledge my child even though he couldn’t verbally respond. I wanted honesty with compassion. I wanted realism with hope. I wanted real conversations. Most of all, I wanted to be heard. I wanted the person sitting across from me to understand and acknowledge that I was also an expert. I could tell you what each cry, facial expression, and movement meant. I could tell you what helped, what didn’t, and what made things worse. I was the one person who was present at every meeting, doctor appointment, procedure, and therapies. I was the one up late almost every night on the internet and at the library reading and searching for answers which, frustratingly so, also gave more questions. I was a wealth of knowledge, ideas, and questions just yearning to share, brainstorm, and be part of the problem solving process.

With each passing year I find that as a parent I become more comfortable, more confident when speaking to all the professionals in our lives, new and old. This is due in part to those professionals who have treated me and my family as a real part of the team and not as an unwilling and uneducated participant. There are many doctors, therapists, teachers, nurses, social workers, and case managers that I owe a huge THANK YOU to because they fulfilled my list and more. By listening to me and working with me, they were able to perform their job better which in turn gave my child better quality care.

So if you are a professional who is listening to the parents, making them a meaningful part of the team, and treating the patients as individuals I salute you. I salute your dedication, hard work, and determination. Lastly, I wholeheartedly thank you.

Resources for you

As your child’s most consistent caregiver, you know your child/youth with special health care needs (CYSHCN) in ways that no one else does. You want to be sure that your child’s health care needs are met. You need to share what you know with the providers who treat your child. Tell them if something is wrong with your child. Let them know how your child responds to a treatment or medication.

You can develop partnerships with your child’s doctors and other providers. These partnerships will help your child receive the best healthcare. Start with clear communication between you and providers. Be sure to share your cultural differences so that they do not become barriers to access and service.

You might find this tip sheet on Communicating with Providers helpful. Feel free to contact us if you need additional resources.

Thursday, February 16, 2017

Care Coordination: Shared Plan of Care

Miss our Twitter Chat about Shared Plans of Care? You're in luck! See the transcript below:

Why You Should Care About Looming Medicaid Cuts

Headlines across the country mention looming changes to the Medicaid Program. Make no mistake when reading these articles, what they mean by change is severe cuts. The threats facing Medicaid in Washington, D.C. point to a fundamental problem facing our nation: a civil rights crisis that affects us all.
Cuts to Medicaid would take away medical care from millions of Americans, putting their health and even their lives at risk. For many people with disabilities, Medicaid cuts would also imperil access to essential services that support individuals to exercise their basic human right to live and participate in the community.
Chances are, you probably know someone who benefits from Medicaid:
  • Your child’s classmate with cerebral palsy might rely on Medicaid for crutches, physical therapy, and transportation to get to and from medical appointments and after-school programs.
  • Your elderly neighbor’s primary form of health care might be Medicaid, helping her to stay in her own home and volunteer in your community.
  • The woman with intellectual disability working as a part-time bagger at your local grocery store might use a Medicaid personal care attendant to help her eat, bathe, dress, and get to work.
Can you imagine if your child’s classmate, your elderly neighbor, or the worker at your local grocery couldn’t get medical care, or was forced into a nursing home or institution because they couldn’t get the services and supports they need?
If you care about civil rights, I want you to understand how proposed cuts to Medicaid threaten the values we hold dear as a nation – and why we must work together to protect health care and access to community living for people with disabilities.
Let’s start with three important facts about Medicaid:
  • Medicaid provides health care for one in five Americans, including people with disabilities, working families, children, and seniors. For people with disabilities, Medicaid is the primary health insurance program; it currently covers over 10 million non-elderly people with disabilities. Medicaid is particularly important for people with disabilities because they often lack access to employer-based or other private coverage, typically have greater medical needs, and may need essential medical supplies like a wheelchair.
  • Medicaid helps make life in the community possible. For many people with disabilities, Medicaid is the only source of services that help them to live and work in the community with friends and families. Medicaid helps both children and adults with a significant disability to remain at home and avoid being placed in costlier and harmful segregated nursing homes or institutions. Medicaid also provides long term supports and services such as personal care aides who help people in their own homes with basic human needs such as bathing, dressing, eating, and managing medications. It can even provide supports in the workplace for individuals with disabilities who are employed.
  • Medicaid is federal-state partnership. States can tailor services to meet their residents’ needs, while also guaranteeing core services and rights. The federal government pays for nearly 60 percent of Medicaid costs, on average, with a match rate that varies from state to state. Under the current structure, the federal government has a commitment to help states cover costs, and in turn states must provide specific benefits to certain groups of people, including people with disabilities. Nationwide, state, and federal Medicaid together provide more than 75% of the funding for services for people with intellectual and developmental disabilities (I/DD).
What could change? An inside the beltway term you may have heard, but not fully understood, is “per capita caps”. It doesn’t sound so bad, until you get into the details of what that really means: drastic cuts in Medicaid services and access.
How does it work? While Congress has yet to make decisions about how the per capita cap is designed, the premise is that the federal government would provide a fixed amount of money to each state based on the number of people enrolled. Unlike the current funding system, the amount provided under a per capita cap will not automatically increase when the cost of providing covered services to eligible individuals goes up. The intent of the per capita cap is to reduce federal spending by restructuring the program and significantly cutting the cost to the federal government. Using this technique, the federal government limits spending, regardless of the needs of the people receiving Medicaid services. While Congress might include a small growth adjustment for increases in enrollment, it is unlikely that it would be sufficient to make up for the overall cuts to the program.
The result, simply put, would be less money available to the states to fund services that are essential to the lives of so many people. The needs of people who rely on Medicaid are not decreasing, which is why fixed funding like this does not make sense. Inevitably, it will result in a decrease in services for those who rely on Medicaid and an additional burden to already cash-strapped states.
If states receive reduced federal support to run Medicaid, they will be forced to raise state taxes or – and more likely, in most states – to reduce eligibility, limit services and supports, cut reimbursements to providers, or take other drastic steps. This is all in a decade when states have already slashed human services budgets due to the great recession which will only make waiting lists grow and allow millions to suffer.
We can’t be certain exactly what states will do if faced with this scenario, but we do know that these kinds of cuts would lead to painful real life consequences for people with disabilities and their families, and many more. Without needed medical care, many people would see their health worsen, and some would die. Without early intervention, many infants and toddlers with disabilities would never develop to their full potential. Without community services and supports, too many adults and children with disabilities would have no alternative but to consider the unthinkable: a return to a past of segregated, harmful, and costly institutions.
The bottom line is that slashing federal funding means people will lose vital benefits and services that support their basic human right to a life in the community. That is a fact that people and, most importantly, elected officials need to understand.
Now that you know the facts, you can see that this is a civil rights fight – will you join us? We can’t afford to go back to the era when people with I/DD didn’t have the rights they have today – Medicaid has made life in the community possible for millions of people with disabilities. It’s critical to people’s lives and it must not be cut. We are better than that as a nation.
The Arc is the nation’s largest and oldest human rights organization for people with intellectual and developmental disabilities (I/DD), serving more than a million individuals and their families. For more information about Medicaid -

Wednesday, February 15, 2017

NHeLP Protect Medicaid Webinars

Proposals to drastically cut federal Medicaid spending are moving front and center as Congress wrangles over repealing the Affordable Care Act (ACA). Per capita caps/block grants would fundamentally alter and undermine Medicaid, which serves as a lifeline for low income and underserved communities. NHeLP's Protect Medicaid webinar series will provide health advocates with facts to resist these harmful proposals.

In the first webinar slated for February 24 at 2:00 PM (EST), NHeLP/DC Managing Attorney Mara Youdelman describes how Republican-led efforts to impose Medicaid per capita caps or block grants will shift costs onto states and lead to cuts in services, eligibility, and provider reimbursements.

Subsequent webinars will examine the harmful impact of per capita caps/block grants on key features of the Medicaid program, including: services and benefits geared for vulnerable populations; affordability and cost sharing protections; advances under the ACA's low income adult expansion; and consumer protections and due process guarantees. 

The series will conclude with a focus on Medicaid's Section 1115 demonstration project/waiver authority, conducted by NHeLP's Legal Director Jane Perkins who will be joined by Cindy Mann, former director of the Center for Medicaid and CHIP Services at CMS and now partner at Manatt, Phelps & Phillips, LLP.

Please click on the link below to register for the first webinar and visit for more information and resources. Please share this email with your networks.

Protect Medicaid Series: Per Capita Caps/Block Grant Program Cuts
Join us for a webinar on Feb 24, 2017 at 2:00 p.m. EST.
Register now! 

After registering, you will receive a confirmation email containing information about joining the webinar. (View System Requirements)

Mark your calendars for these upcoming webinars (registration information forthcoming):

Friday, March 3
2-3 p.m. EST - Medicaid Services
Friday, March 102-3 p.m. EST - Affordability

Friday, March 17
2-3 p.m. EDT - Medicaid Expansion

Friday, March 24
2-3 p.m. EDT - Consumer protections/due process

Friday, April 17
Noon-1 p.m. EDT - Section 1115 authority 

Senior Attorney - DC Office
National Health Law Program