Medicaid 1115 Waivers and People With Disabilities

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Sharing...Subject: Medicaid 1115 Waivers and People With Disabilities.To: stevegoldada@...Medicaid 1115 Waivers and People With Disabilities.Information Bulletin #344 (11/1/11)There will be major structural and funding changes in the Medicaid program. These changes will happen regardless of therecommendations of the Congressional "Super Committee" or who wins the2012 Presidential election. States are pressuring for more flexibility tomake changes in Medicaid. We have no doubt that these changes willdetermine who will be eligible for and will receive Medicaid services, howmuch and what services they get, and the way these services are delivered.Many States are submitting or have already submitted what are called "1115Medicaid waivers" to get out from under some of the existing federalMedicaid rules. (California is just the latest state getting their waiverrequest approved.) Section 1115 of the Social Security Act allows theSecretary of the Department of Health and Human Services (HHS) to suspendcertain federal laws or regulations that govern programs authorized byMedicaid and SCHIP, in the context of an alleged state "research anddemonstration project." A Section 1115 Medicaid and SCHIP demonstrationproject/waiver are supposed to "promote the objectives" of the Medicaidprogram.Some 1115 Waivers are statewide, comprehensive demonstrations that affectthe majority of people who receive Medicaid in the state. These includewaivers that require people to enroll in a managed care plan or thatexpand coverage to all state residents with incomes below a certain level.Other demonstration projects are more limited in scope. Examples of theseinclude waivers that provide family planning services to low-income womenwho would not otherwise qualify for Medicaid, or those that allow certainpeople with disabilities to manage their health care purchasing (e.g. Cashand Counseling waivers).Section 1115 waiver projects are generally approved to operate for afive-year period and must maintain "budget neutrality." The budgetneutrality requirement means that the waiver program cannot cost thefederal government more than would have been spent on Medicaid for peoplecovered 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 tocontrol their Medicaid budgets and they see the 1115 waiver process as oneway 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, therewill be a new Secretary of Health and Human Services who may be more opento more state flexibility and "block grant" proposals. Another aspect ofthe current 1115 waiver process that should send up red flags in ourcommunity is the limited federal requirement for stakeholder/consumerinput into the design of the waiver. Literally the state (MedicaidDirector) can substantially change the way Medicaid services are fundedand delivered without holding one public hearing (CMS has new rules in theprocess to change this but they are not yet final.)We are very worried that people with disabilities, especially those withmore severe disabilities -- you know, expensive -- will not have theirneeds adequately addressed. The ADA applies to States that apply for 1115Waivers and also applies to private managed care agencies that may applyto 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 HumptyDumpty back together again" I always get these sayings mixed up!!! Don't Mourn...ORGANIZE, REGISTER and VOTE Steve Gold, The Disability Odyssey continuesBack issues of other Information Bulletins are available online athttp://www.stevegoldada.com<http://www.stevegoldada.com/>with a searchable Archive at this site divided into different subjects.As of August, 2010, Information Bulletins will also be posted on myblog located at http://stevegoldada.blogspot.com/To contact Steve Gold directly, write to stevegoldada1@... orcall .--Steve Gold, The Disability Odyssey continues