FACULTY DISCLOSURE I have no financial relationships to disclose. I have no conflicts of interest to disclose. I will not promote any commercial products or services. Amy Westling MEDICAID MATTERS Executive Director Association of Regional Center Agencies THIS MORNING WE’LL TALK ABOUT The basics of federal Medicaid rules; Special Medicaid programs; and, How to advocate for essential Medicaid programs. MEDICAID 101 Basic Principles of Healthcare Delivery
THE BASICS OF MEDICAID WHO QUALIFIES FOR MEDICAID? Began in 1965 to "improve a wide All states required to cover: range of health and medical services for Families under the Federal Americans of all ages.”; Poverty Level (FPL); and, Called “Medi-Cal” in California; and, Individuals with disabilities on SSI. State and federal funding partnership. Some states (including California) expanded and include: Individuals up to 138% of FPL; and, Childless adults. MEDICAID FUNDING STRUCTURES FEDERAL REVIEWS AND APPROVALS Federal Medical Assistance Percentages Each State Plan Amendments (SPA) (FMAP) determine federal outlines the details of services that each reimbursements. state provides. Different FMAPs for various programs Centers for Medicare and Medicaid incentivize behavior. Services (CMS) approves, denies, or comments on SPA applications.
STATE MEDICAID REQUIREMENTS THE FLOOR Statewide; Different Mandatory Benefits for adults and children (under age 21); Comparable; A specific list for adults; and, Reasonable promptness; and, A more comprehensive scheme for Provider choice. children. WHAT IS EPSDT (CHILDREN’S FLOOR)? WHAT SERVICES ARE MANDATORY FOR ADULTS? Early: Assessing and identifying problems Inpatient/Outpatient Hospital; early; Nursing Facility; Periodic: Checking children's health at periodic, age-appropriate intervals; Home Health; Screening: Providing physical, mental, Physician/Family Nurse Practitioner; developmental, dental, hearing, vision, and other screening tests to detect potential Laboratory/X-Ray; problems; Family Planning/Birth Center/Nurse Diagnostic: Performing diagnostic tests to follow up when a risk is identified; and, Midwife/Tobacco Cessation; and, Treatment: Control, correct or reduce health Transportation to Medical Care. problems found.
WHAT ABOUT OTHER SERVICES FOR ADULTS? Optional Benefits are more comprehensive, but at each state’s discretion. Examples: Prescription drugs; Physical, speech, occupational therapy; Rehabilitative services; Podiatry; Optometry/eyeglasses; Dental; Private duty nursing; MEDICAID 201 Inpatient psychiatric services (under A Brief Seminar in Service to age 21 and over age 65); and, Special Populations Hospice. A DEEPER DIVE INTO OPTIONAL BENEFITS BUT WAIT…THERE’S MORE! Personal care; Beginning in 1981, states could “waive” certain Medicaid requirements. Community First Choice Option - 1915(k); Different rules apply to different waivers. Case management; 1915(c) allows the waiver of Services in an intermediate care facility comparability and statewidedness to for Individuals with Intellectual Disability; provide Home and Community-Based and, Services. State Plan Home and Community Based Services - 1915(i).
REMEMBERING KATIE BECKETT More Waiver Details Allow for the provision of additional Continuously hospitalized from 4 months services; to age 3; Must be cost-effective; Highlighted the need for reform; and, Can cap enrollment; and, Established concept of “institutional deeming.” Are limited to one per person. UNCERTAINTIES Federal efforts aimed at Medicaid reform: Block grants; and, Per person caps. State Budget challenges and decisions SHAPING POLICY FOR GOOD A Practicum in Public Policy
THE IMPORTANCE OF ADVOCACY STAYING INFORMED Disability advocates changed recent Subscribe to relevant news updates; federal healthcare debate through: Find trusted sources; and, Staying informed; Don’t obsess, but don’t forget. Getting engaged; Telling their stories; and, Showing up. GETTING ENGAGED TELLING YOUR STORY Know who your representatives are; Be short; Meet them before you need something; Be clear; and, Be truthful; Call or write letters ahead of key votes. Be constructive; Be focused; and, Be memorable.
SHOWING UP Go to hearings when you can; Watch for hearings outside of Sacramento/Washington D.C.; and, Find other public meetings or forums too.
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