Monday, March 22, 2010

Health Care Reform passes the House - What Does it Do for Medicaid?

The good news about the Senate bill is that it provides many state incentives to provide care to individuals in their homes rather than making them go to a nursing home for help.

The bill's Medicaid provisions include: a new program that will provide states more money to cover home and community-based services (HCBS); a new Community First Choice Option for individuals otherwise eligible for Medicaid institutional coverage; an enhanced HCBS state plan benefit authorized by the Deficit Reduction Act of 2005; spousal impoverishment protections for spouses of all individuals receiving HCBS waiver and certain state plan services; authorization of the Money Follows the Person program through 2016; and additional funding for Aging and Disability Resource Centers.

The National Senuior Citizens Law Center provided an an analysis of these provisions and I am outlining some of the key provisions below.

The Senate’s approach will be a welcome change if passed since its proposals would further weaken Medicaid’s institutional bias by providing more, and better, opportunities for prospective Medicaid enrollees to avoid unnecessary institutionalization.

Community-Based Attendant Service Option

The Alabama Medicaid agency generally develops a clinical eligibility standard for Medicaid coverage. Individuals who meet this standard and also meet Medicaid’s financial eligibility requirements are guaranteed coverage for nursing facility services. In Alabama there is really no other option for the person who does not want to bew insitutionalized.

Section 2401 of the Senate bill, entitled "Community First Choice Option," would make a new service available to the Medicaid population and would offer states the incentive to provide coverage for it. The provision provides states the option to offer community-based attendant services as a state plan benefit to individuals who meet the state’s nursing facility clinical eligibility standard. The provision would not only free states from the expenditure caps currently applicable in HCBS waiver programs, but it also dictates that states receive an increase in their standard Medicaid reimbursement rate of six percentage points for the services provided through the option.

Money Follows the Person (Section 2403)

The Deficit Reduction Act of 2005 (DRA) authorized $1.7 billion for the Money Follows the Person program (MFP), under which 31 states (not Alabama) were awarded grants to transition Medicaid-enrolled nursing facility residents to their homes or other community settings. The "grants" states have received come in the form of an enhanced federal match for the services provided to program participants for the first 12 months after a participant’s transition. Approximately 37,000 individuals were projected to be transitioned under MFP. The DRA authorized MFP through 2011.

Section 2403 of the Senate bill, entitled "Money Follows the Person Rebalancing Demonstration," authorizes continued federal support for MFP through 2016, and also relaxes one of the program’s primary eligibility requirements. The DRA mandated that program participation be available only to Medicaid-enrolled nursing facility residents who have been institutionalized for not less than six months. The law also authorized states to impose a longer minimum residency of between six months and two years. The Senate bill reduces the minimum residency requirement from six months to 90 days and eliminates the state authority to impose a longer minimum period. However, any days an individual spends in an institution receiving short-term rehabilitative services will "not be taken into account for purposes of determining the 90-day period" under the proposal.

Temporary Expansion of Spousal Impoverishment Protections (Section 2404)

Section 2404 of the Senate bill, "Protection for Recipients of Home and Community-Based Services Against Spousal Impoverishment," would modify the spousal impoverishment statute to mandate that states include the spousal impoverishment protections in their waiver programs, and that the spouses of all HCBS waiver participants.