Medicaid Advisory Committee October 24, 2018 9:00am-12:00pm 1 - PowerPoint PPT Presentation

Medicaid Advisory Committee October 24, 2018 9:00am-12:00pm 1

Webinar Housekeeping • Register: https://attendee.gotowebinar.com/register/3721828556762702851 • MAC website: https://www.oregon.gov/oha/HPA/HP-MAC/Pages/index.aspx • Join audio by calling in: 1-888-398-2342 Code: 3732275 (public line) *Member code on calendar invite* • Public line is muted. Please don’t put the line on hold! • Those on the member line – remember to mute your phone when not speaking • Send questions using the “Questions” box in the control pane • Public comment at 11:45. Please let us know in the “questions” box if you would like to submit written comment. • Meeting/webinar is being recorded and will be posted online 2

Welcome & Introductions

Remembering Bob DiPrete Bob DiPrete recently passed away after a battle with cancer. Bob was a Medicaid Advisory Committee member and former director of the MAC. He helped Oregon become a national leader in health policy, including helping lead the launch and early administration of the Oregon Health Plan in 1989, and serving as the Deputy Director of the Office of Health Policy and Research for 10 years. Bob will be greatly missed.

Meeting objectives • Regular business (e.g. approve minutes) • Understand the latest updates for the Medicaid program from OHA and DHS • Understand the current federal proposal to amend public charge rules; potential implications for Medicaid • Understand Oregon Governor’s office and agency work to analyze and respond to proposals • Understand and discuss various options for the Medicaid Advisory Committee to engage in this work • Better understand the Long-Term Services and Supports (LTSS) system and coordination with CCOs from the perspective of the Office of Developmental Disabilities Services at DHS and OHA • Receive public comment related to the Medicaid program 5

AGENDA Purpose Time Item Presenter Welcome and Introductions • 9:00 Adopt minutes Co-chairs Action • Recruitment 9:15 OHA/DHS Medicaid update OHA Staff Informational Jeannette Taylor, OHA 9:45 Public Charge Linda Roman, Office of Informational Governor Brown 10:20 Stretch/rest break Anna Lansky, DHS Long-term Services & Supports 10:40 Bruce Baker, DHS Informational (LTSS) system coordination, Part 2 Rhonda Busek, OHA Public Comment 11:45 Co-chairs 11:55 Closing comments

OHA/DHS Medicaid Update Chris Norman, Lori Kelley, OHA Anna Lansky, DHS

Public Charge and Medicaid Jeannette Taylor, OHA Linda Roman, Office of Governor Brown 8

Review of Public Charge Proposed Rule Presentation to the Oregon Medicaid Advisory Committee October 24 th , 2018 Jeannette Taylor Government Relations, OHA

Background 10

Overview of Public Charge Proposed Rule • October 10, Department of Home Security, published proposed rule, Inadmissibility on Public Charge Grounds – 60 day comment period; comments due December 10 • Rule proposes to change how DHS determines whether immigrants — entering the U.S., extending their stay, changing their visa type, or adjusting their status to become a lawful permanent resident —are “likely at any time to become a public charge” (i.e. dependent on the government for financial support • The proposed rule: – Expands the list of public benefits considered – Increases the importance of income and benefits used in the public charge analysis • Impacts: consumers, states, localities and providers 11

Current Public Charge Definition • An individual may be considered to be (or likely to become) a public charge if he/she is “ primarily dependent ” on public benefits – May be denied entry or, if they live in the U.S., barred from changing their temporary status to permanent residency • Totality of Circumstances: – Age – Health – Family Status – Assets, Resources, & Financial Status – Education & Skills – Two types of government assistance: cash assistance and “institutionalization” for long -term care *Affidavit of support for certain immigrants Sources: Field Guidance on Deportability and Inadmissibility on Public Charge Grounds (“Field Guidance”), 64 Fed. Reg. 28689 (May 26, 1999); Inadmissibility on Public Charge Grounds, 83 Fed. Reg. 51114 (October 10, 2018), available at: https://www.gpo.gov/fdsys/pkg/FR-2018-10-10/pdf/2018-21106.pdf 12

Key Changes to Public Charge 13

Immigrants Subject to Public Charge Current (1999 Field Guidance) Proposed Rules adds: ✓ Individuals seeking to legally  Individuals seeking an enter the U.S. extension of stay (e.g., extending a current visa) ✓ Individuals legally in the U.S.  Individuals seeking to and seeking to become a Lawful Permanent Resident change visa types (e.g., from (i.e., obtain a “green card”) a student to employment visa) EXEMPT: Refugees, asylees, and certain Cuban, Haitian, Central American and various other categories of immigrants are statutorily exempt from public charge. DHS also proposes to allow victims of trafficking, witnesses or informants, and several other categories of immigrants to apply for waivers so that the public charge determination is not applied to them. 14

Public Charge Defined Current (1999 Field Guidance) Proposed Rule ▪  An individual may be An individual may be considered to be (or likely to considered a public charge if he/she “receive[s] one or become) a public charge if he/she is “ primarily dependent ” mor e public benefits” on public benefits ✓ Use of benefits is one ✓ Use of benefits is one component of the “totality of component of the “totality of circumstances” analysis used circumstances” analysis used to make a public charge to make a public charge determination determination The proposed rule indicates that DHS will not consider benefit use by an immigrant’s dependent’s when determining whether the immigrant is likely to become a public charge; benefit use by members of the Armed services also will not be considered. 15

How are Public Benefits defined? Source: State Health and Values Strategies, October 10, 2018, “Examining the Public Charge Proposed Rule” 16

Public “Health” Benefits Considered Non-emergency Medicaid • Does not include emergency Medicaid, school-based Medicaid benefits, Medicaid benefits under the Individuals with Disabilities Education Act [IDEA], and Medicaid for certain children of U.S. citizens with pending citizenship) Medicare Part D Low Income Subsidy Not currently included : • Children’s Health Insurance Program (CHIP) – not included in the proposed list of benefits, but DHS is seeking comment on whether to include CHIP • Marketplace subsidies 17

Potential Impacts of Proposed Rule 18

Impact on Individuals and Families • Chilling effect deters legal immigrants and their family members from using public benefits they are entitled to receive – Increase poverty, loss/reduced productivity & educational attainment, adverse health effects, increase medical expense due to delayed health care • Direct (health programs) impacted: – Non-emergent Medicaid (w/exemptions) – Medicare Part D Low Income Subsidy (not administered by OHA) • Indirect (health/public programs) impacted – CHIP (DHS is seeking comment on whether to include CHIP) – Citizen/Alien Waived Emergency Medical (CAWEM)/CAWEM Plus – Cover All Kids – Reproductive Health Equity program – Women, Infants, and Children (WIC) – Others… 19

Impact States, Localities & Providers • Implementation Costs • Uncompensated health care – More uninsured – Increase in costly emergency and acute care • Added costs for social services/safety net 20

Questions JEANNETTE.T.TAYLOR@dhsoha.state.or.us 21

Long-term Services and Supports Overview Part 2: Office of Developmental Disabilities Services Anna Lansky, DHS Bruce Baker Rhonda Busek, OHA 22

Office of Developmental Disabilities Services Anna Lansky, ODDS Deputy Director Bruce Baker, Manager, Children’s Services October 24, 2018

Our Vision People and families access quality supports that are simple to use and responsive to their strengths, needs and choices, while they live and thrive as valued members of their community. 24

Our Commitment to Those We Serve ODDS Strategic Plan Choice, self- determination and Children and families Health, safety, and together respect person-centered practices Community inclusion Service equity and and Strong relationships access community living 25

Who We Serve We serve over 27,000 people who experience Intellectual and/or Developmental Disabilities (I/DD). This includes down syndrome, cerebral palsy, autism spectrum disorders, acquired brain injury (children), drug and alcohol affected children. 26

Supports We Provide ODDS services support people with I/DD to have the opportunity to have fulfilling and meaningful lives allowing them to contribute to and enjoy their communities: • Attendant Services • Employment Services • Environmental Modifications and Assistive Technology • Transportation • Nursing Services and Professional Behavioral Services • And other services