Keeping and Seeking Opportunities for AT in Today’s

Medicaid Programs

Deb Parker Wolfenden, M.Ed. CCC-SLP

Policy Director

ATAP

NATTAP Conference

June 13, 2006

Topics Covered

• What is a Medicaid Waiver?

• Potential positive impacts for AT

• P.L. 109-362 (a.k.a. The Deficit Reduction Act of 2005)– Benefit or Beast?– Advocacy Strategies

CMS- Approved Waivers

• Allows state to operate outside the specified Federal mandates

• Allows state to experiment with innovative service delivery models

• Allows state to extend or expand coverage for specified populations

3 Most Common Waivers

• Freedom of choice (1915 (b) waiver)

• HCBS waiver (1915 (c) waiver)

• Demonstration waiver (1115 waiver)

Requirements for HCB Waivers

• Risk of institutional level of care

• Cost neutrality

• Waive income and resources requirements of legally responsible spouses or parents

HCB Waiver Services

• Case Management• Homemaker services• Home health aid

services• Personal Care Services• Adult day health• Habilitation• Respite

• Partial hospitalization• “Other” services

approved by CMS as cost effective and necessary to avoid institutionalization

Getting invited to the “table”

• Know how your state program is organized, managed and what the input points are

• Have an AT point person on the inside

• Have well prepared, data driven talking points - KISS

• Network

Staying at the “table”

• Bring a wealth of information, technical assistance and resources in an area where it is lacking

• Cost saving benefits– AT Demonstration Centers– Reutilization– Decrease in levels of abandonment– Expand provider base - AT Assessments

Deficit Reduction Act

Cost Sharing Provisions

• Comparability is no longer required

• States can impose premiums and copays

• States can impose premiums for any type of service

• Children, elders and people with disabilities are all affected by these changes.

Advocacy Implications

• Provide state officials with literature documenting that even small copayments and other forms of cost-sharing result in low income people foregoing necessary health care or loss of Medicaid eligibility due to cost of premiums (Leighton Ku and Victoria Wachino (7/05), (Samantha Artiga & Molly O’Malley (5/05)

HCBS provisions• Home and Community Based Alternatives

to Psychiatric Residential Treatment for Children (§6063)

• Money Follows the Person (§6071)

• Expanded Access to HCBS for Elderly and Disabled (§6086)

• Self-directed Personal Assistance Services (Cash and Counseling) (§6087)

Advocacy Strategies• Submit comments to proposed draft

regulations when they are published

• Advocate for oversight (legislative, consumer, P&A)– Initial and any future changes in eligibility– Individuals who loose eligibility under the

adjusted eligibility criteria are grandfathered completely

– Broad eligibility criteria includes cognitive, neurological and mental health disorders

– Inappropriate care includes overly restrictive care

Bibliography:

J. Perkins, The Deficit Reduction Act of 2005: Implications for Advocacy (April, 2006) This is available at www.healthlaw.org

Neighborhood Legal Services, Resources for 2006 Annual Conference of AT Act Programs (June, 2006)