Mh and addiction services for service members and veterans
Nc live 6 8-2010 kohler presentation [compatibility mode]
1. Health Reform
Ann Kohler
Director of Health Services
National Association of State Medicaid Directors
American Public Human Services Association
June 8, 2010
www.TheNationalCouncil.org
2. Current Status
> Legislative Status:
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• The House passed the Senate’s version of the bill;
• The House passed a package of amendments to the Senate bill
through a reconciliation bill;
• The Senate passed the reconciliation bill with minor changes;
• The House passed the amended reconciliation bill; and
• Both of the bills have been signed into law.
law
> Implementation:
• Staggered time-line of effective dates;
• Major Medicaid and private-market changes effective 2014;
• CMS, NASMD, NGA & State Representatives forming
workgroups to address Medicaid Changes.
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www.TheNationalCouncil.org
3. Key Components of Reform
> Medicaid Changes:
• Expands Medicaid to everyone under 133% of FPL, with increased
Federal funds for this population;
• Current eligibility levels, p
g y , procedures and methodologies are frozen
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until 12/31/2013 for adults and 9/30/2019 for children (including
CHIP);
• Restructures income calculation for many Medicaid beneficiaries (but
y (
not people with Disabilities) to IRS income calculation – Elimination
of income disregards;
• Elimination of asset/resource test for individuals who have the
income calculation restructured;
• Mandatory increase to the provider rates Medicaid pays for primary
care services (100% Federal funds).
funds)
www.TheNationalCouncil.org
4. Key Components of Reform
> Medicaid (continued):
• Expands Medicaid to any individual under 25 previously served
through Child Welfare;
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• Creates State-plan option for family planning services;
> Other programs:
• Includes grants and incentives to expand and subsidize high-risk
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pools;
;
• Increases funding for ADRCs;
• Establishes grants for School-based health services.
www.TheNationalCouncil.org
5. Key Components of Reform
> Long term Care
Long-term Care:
• Establishes the CLASS Act:
• National long term care insurance program funded by payroll
deductions;
• Eligibility determined by ADLs, not finances;
• C t new options for community-based l
Creates ti f it b d long-term care through
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Medicaid;
• Provides FMAP incentives to increase long-term care in the
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community;
• Provides grants and demonstrations to address IMD coverage.
www.TheNationalCouncil.org
6. Key Components of the Bill(s)
> Private Insurance Reforms:
• “Community Rating – limits on variation in premiums for
Community Rating”
individuals within a geographic area;
• Prohibits exclusion of pre-existing conditions;
• “Guaranteed Issue/Renewal” – no one can be denied
coverage/dropped due to health conditions;
• Removes annual/lifetime limits on care;
• Required Benefits Package (Including Rehabilitation, Habilitation,
MH treatment).
www.TheNationalCouncil.org
7. Key Components of th Bill( )
K C t f the Bill(s)
> Individual mandate to buy insurance – allows some individuals to
“opt-out” f
“ t t” of mandate;
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> Establishment of “Exchange”:
• Based on Massachusetts “Connector” model; ;
• Provides centralized marketplace to compare insurance and purchase plans;
• Federal government provides subsidies for people with low-to-moderate income
to assist with the purchase of insurance.
insurance
> Competition:
• Establishes Health care nonprofit cooperatives;
• State may offer an insurance plan up to 200% FPL
> State Innovation:
• Waivers for states to try alternate coverage methods.
www.TheNationalCouncil.org
8. Potential Impact to State Programs
> Potential Issues:
• Eliminating income disregards;
• Increased costs on state budgets due to mandatory Medicaid
expansions & costs associated with developing and operating the
exchanges;
• Changes to eligibility systems & interoperability with the exchanges;
• Loss of revenue through restructuring of drug rebate programs;
• Reduction in “DSH”;
• Large expansion may cause access issues for everybody (not just
Medicaid recipients).
www.TheNationalCouncil.org
9. Potential Impact to State Programs
> Potential Positive Changes:
• Greater availability of insurance in the private sector;
• Broader range of services available through private insurance
plans;
• N preexisting condition exclusion, denial of coverage or
No i ti diti l i d i l f
termination of coverage;
• CLASS act – LTC without Medicaid funding; g;
• New Medicaid coverage for low-income people – including
individuals currently served in some State-only programs.
www.TheNationalCouncil.org
10. Future Considerations
> State Budget issues:
• 48 states experiencing budget shortfalls;
• Increased Federal Funds (FMAP) expire 1/1/2011;
• Bills containing extensions to FMAP increase have passed both the
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Senate & House, but have not been reconciled;
• Loss of FMAP would lead to significant rate cuts & service
reductions.
reductions For more information on proposed cuts:
http://www.aphsa.org/Home/Doc/WhitePaperFMAP.pdf
www.TheNationalCouncil.org
11. For More Information:
Ann Kohler, Director of Health Services
National Association of S
N i lA i i f State M di id Di
Medicaid Directors
American Public Human Services Association
Ann.Kohler@aphsa.org
202.682.0100
Ext. 299
www.TheNationalCouncil.org
12. Use telephone or computer speakers
> Call 888.259.8414 for
technical support
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13. Webinar
Recordings/Presentations
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Available 48 hours AFTER the live event at
www.TheNationalCouncil.org
(Click on Resources & Services and then on
National Council Webinars and Recordings and
Presentations)
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14. National Council Membership
> Are you making the most of your National
Council membership?
www.TheNationalCouncil.org/cs/member_be
nefits
> Not yet a member? Join today!
Email Membership@thenationalcouncil.org or
call 202.684.7472
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15. Mental Health First Aid Instructor
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Trainings
> Blue Bell, PA May 3-7
> Denver, CO May 10-14
> Washington, DC
W hi t June 28 J l 2
J 28-July
> Houston, TX July 12-16
> Chicago,
Chicago IL August 2-6
> San Francisco, CA September 13-17
> Atlanta, GA
, September 27 - October 1
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Apply at www.MentalHealthFirstAid.org
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17. National Council JOBank
> Recruit top-notch mental health
and addictions executive,
administrative, policy, clinical,
d i i t ti li li i l
and direct care staff
> P t openings and b
Post i d browse j bjobs
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18. National Council E-Learning
> 400+ courses for CE credits
> Special price for organizations with
60 or fewer employees
p y
> Helping you meet compliance,
licensing, and insurance requirements
Partnership with Essential Learning
www.TheNationalCouncil.org
20. > April 21: Geoffrey Canada on
Weaving a Community Safety Net
> April 27: National Council Client
Engagement and Retention Best
Practice Findings
> May 18 Cli i l Feedback Tool
18: Clinical db k l
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