Fw: Medicaid 1115 Waivers and People With Disabilities

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Ellen

Ellen Garber Bronfeld

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Housing & Disability Issues <Housing.Disability.Issues@...>

Sent: Thu, November 3, 2011 8:29:19 PM

Subject: Medicaid 1115 Waivers and People With Disabilities

Subject: Medicaid 1115 Waivers and People With Disabilities.

From: steve gold <stevegoldada1@...>

stevegoldada@...

Medicaid 1115 Waivers and People With Disabilities.

Information Bulletin #344 (11/1/11)

I will bet anyone out there a Philadelphia pretzel (with mustard) that

over the next few years there will be major structural and funding changes

in the Medicaid program. These changes will happen regardless of the

recommendations of the Congressional " Super Committee " or who wins the

2012 Presidential election. States are pressuring for more flexibility to

make changes in Medicaid. We have no doubt that these changes will

determine who will be eligible for and will receive Medicaid services, how

much and what services they get, and the way these services are delivered.

Many States are submitting or have already submitted what are called " 1115

Medicaid waivers " to get out from under some of the existing federal

Medicaid rules. (California is just the latest state getting their waiver

request approved.) Section 1115 of the Social Security Act allows the

Secretary of the Department of Health and Human Services (HHS) to suspend

certain federal laws or regulations that govern programs authorized by

Medicaid and SCHIP, in the context of an alleged state " research and

demonstration project. " A Section 1115 Medicaid and SCHIP demonstration

project/waiver are supposed to " promote the objectives " of the Medicaid

program.

Some 1115 Waivers are statewide, comprehensive demonstrations that affect

the majority of people who receive Medicaid in the state. These include

waivers that require people to enroll in a managed care plan or that

expand coverage to all state residents with incomes below a certain level.

Other demonstration projects are more limited in scope. Examples of these

include waivers that provide family planning services to low-income women

who would not otherwise qualify for Medicaid, or those that allow certain

people with disabilities to manage their health care purchasing (e.g. Cash

and Counseling waivers).

Section 1115 waiver projects are generally approved to operate for a

five-year period and must maintain " budget neutrality. " The budget

neutrality requirement means that the waiver program cannot cost the

federal government more than would have been spent on Medicaid for people

covered by the waiver if the waiver didn't exist.

1115 waivers can be written in to resemble what we called " block grants. "

Most Governors and their Medicaid Directors are looking for any way to

control their Medicaid budgets and they see the 1115 waiver process as one

way to make this happen. We can " hope " that the current Administration

(HHS/CMS) would not approve any waiver that would harm people's services.

However in this economic and political environment nothing is certain.

Remember if in the November 2012 election change administrations, there

will be a new Secretary of Health and Human Services who may be more open

to more state flexibility and " block grant " proposals. Another aspect of

the current 1115 waiver process that should send up red flags in our

community is the limited federal requirement for stakeholder/consumer

input into the design of the waiver. Literally the state (Medicaid

Director) can substantially change the way Medicaid services are funded

and delivered without holding one public hearing (CMS has new rules in the

process to change this but they are not yet final.)

We are very worried that people with disabilities, especially those with

more severe disabilities -- you know, expensive -- will not have their

needs adequately addressed. The ADA applies to States that apply for 1115

Waivers and also applies to private managed care agencies that may apply

to administer the 1115 Waiver. For people with disabilities, living in

" the most integrated setting " must continue as a priority!

The hell with: NOTHING ABOUT US WITHOUT US!

Suggestions of things we can do now:

1. In the follow up to the historic DC " MY MEDICAID RALLY, " reach out to

other organizations in your state who have members that would be

effected if Medicaid funding is reduced or if the program was

drastically restructured. Form a Medicaid Action coalition (Texas is

starting a Texas - MY MEDICAID MATTERS Campaign);

2. Meet with your Medicaid Director and/or your Director of Health and

Human Services and find out what plans your state has in regard to

Medicaid and especially an 1115 Waiver application.

3. Demand that the state establish a statewide public input process

BEFORE for any proposed 1115 waiver process begins;

4. Develop an Action plan through 2012 to include: monitoring Medicaid

funding, cuts in services, all new waiver submitters and renewals,

outreach to the community and educate folks on Medicaid issues, develop

a media strategy, potential legal action and Direct Action activities.

" We must not fiddle while the sky is falling because we can't put Humpty

Dumpty back together again " I always get these sayings mixed up!!!

Don't Mourn...ORGANIZE, REGISTER and VOTE

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at

http://www.stevegoldada.com/unh.edu

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