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Health ReformHealth Reform
Ann KohlerAnn KohlerDirector of Health Services
National Association of State Medicaid DirectorsAmerican Public Human Services AssociationAmerican Public Human Services Association
June 8, 2010
www.TheNationalCouncil.org
Current Status> Legislative Status:g
• The House passed the Senate’s version of the bill;• The House passed a package of amendments to the Senate bill
through a reconciliation bill;through a reconciliation bill;• The Senate passed the reconciliation bill with minor changes;• The House passed the amended reconciliation bill; and• Both of the bills have been signed into law• Both of the bills have been signed into law.
> Implementation:• Staggered time-line of effective dates;• Major Medicaid and private-market changes effective 2014;• CMS, NASMD, NGA & State Representatives forming
workgroups to address Medicaid Changes.
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g p g
Key Components of Reform> Medicaid Changes:
• Expands Medicaid to everyone under 133% of FPL, with increased Federal funds for this population;
• Current eligibility levels, procedures and methodologies are frozen g y , p guntil 12/31/2013 for adults and 9/30/2019 for children (including CHIP);
• Restructures income calculation for many Medicaid beneficiaries (but y (not people with Disabilities) to IRS income calculation – Elimination of income disregards;
• Elimination of asset/resource test for individuals who have theElimination of asset/resource test for individuals who have the income calculation restructured;
• Mandatory increase to the provider rates Medicaid pays for primary care services (100% Federal funds)
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care services (100% Federal funds).
Key Components of Reform
> Medicaid (continued):• Expands Medicaid to any individual under 25 previously served
th h Child W lfthrough Child Welfare;• Creates State-plan option for family planning services;
> Other programs:> Other programs:• Includes grants and incentives to expand and subsidize high-risk
pools;p ;• Increases funding for ADRCs;• Establishes grants for School-based health services.
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Key Components of Reform> Long term Care> Long-term Care:
• Establishes the CLASS Act: • National long term care insurance program funded by payrollNational long term care insurance program funded by payroll
deductions;• Eligibility determined by ADLs, not finances;
C t ti f it b d l t th h• Creates new options for community-based long-term care through Medicaid;
• Provides FMAP incentives to increase long-term care in the gcommunity;
• Provides grants and demonstrations to address IMD coverage.
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Key Components of the Bill(s)
> Private Insurance Reforms:• “Community Rating” limits on variation in premiums for• Community Rating – limits on 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;Removes annual/lifetime limits on care;• Required Benefits Package (Including Rehabilitation, Habilitation,
MH treatment).
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K C t f th Bill( )Key Components of the Bill(s)> Individual mandate to buy insurance – allows some individuals to
“ t t” f d t“opt-out” of mandate;> 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 insuranceto assist with the purchase of insurance.> Competition:
• Establishes Health care nonprofit cooperatives;• State may offer an insurance plan up to 200% FPL
> State Innovation:• Waivers for states to try alternate coverage methods.
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Waivers for states to try alternate coverage methods.
Potential Impact to State Programs> Potential Issues:
• Eliminating income disregards;• Increased costs on state budgets due to mandatory Medicaid
expansions & costs associated with developing and operating the exchanges;
• Changes to eligibility systems & interoperability with the exchanges; • Loss of revenue through restructuring of drug rebate programs;• Reduction in “DSH”;• Large expansion may cause access issues for everybody (not just
Medicaid recipients).
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Medicaid recipients).
Potential Impact to State Programs> Potential Positive Changes:
• Greater availability of insurance in the private sector;• Broader range of services available through private insurance
plans;N i ti diti l i d i l f• No preexisting condition exclusion, denial of coverage or termination of coverage;
• CLASS act – LTC without Medicaid funding;g;• New Medicaid coverage for low-income people – including
individuals currently served in some State-only programs.
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Future Considerations
> State Budget issues:• 48 states experiencing budget shortfalls;48 states experiencing budget shortfalls;• Increased Federal Funds (FMAP) expire 1/1/2011;• Bills containing extensions to FMAP increase have passed both the g
Senate & House, but have not been reconciled;• Loss of FMAP would lead to significant rate cuts & service
reductions For more information on proposed cuts:reductions. For more information on proposed cuts: http://www.aphsa.org/Home/Doc/WhitePaperFMAP.pdf
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For More Information:
Ann Kohler, Director of Health ServicesN i l A i i f S M di id DiNational Association of State Medicaid Directors
American Public Human Services [email protected]
202.682.0100Ext. 299
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Use telephone or computer speakers
> Call 888.259.8414 for technical supportpp
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Webinar Recordings/Presentationsg
Available 48 hours AFTER the live event at www.TheNationalCouncil.org
(Click on Resources & Services and then on National Council Webinars and Recordings and Presentations)Presentations)
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National Council Membership
> Are you making the most of your National Council membership?Council membership?www.TheNationalCouncil.org/cs/member_benefitsnefits
> Not yet a member? Join today! Email [email protected] orEmail [email protected] or call 202.684.7472
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Mental Health First Aid Instructor Trainingsg> Blue Bell, PA May 3-7> Denver, CO May 10-14
W hi t DC J 28 J l 2> Washington, DC June 28-July 2 > Houston, TX July 12-16> Chicago IL August 2-6> Chicago, IL August 2-6> San Francisco, CA September 13-17> Atlanta, GA September 27 - October 1, p
Apply at www.MentalHealthFirstAid.org
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National Council JOBank> Recruit top-notch mental health
and addictions executive, d i i t ti li li i ladministrative, policy, clinical,
and direct care staff> P t i d b j b> Post openings and browse jobs
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National Council E-Learning> 400+ courses for CE credits> Special price for organizations with
60 or fewer employeesp y> Helping you meet compliance,
licensing, and insurance requirementsPartnership with Essential Learning
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> April 21: Geoffrey Canada on Weaving a Community Safety Net> April 27: National Council Client Engagement and Retention Best Practice Findings
18 Cli i l db k l> May 18: Clinical Feedback Tool
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