Transcript CWD Health Policy and Disability Briefing

Health and Disability Policy
Briefing
The American Public Human Services
Association
July 2007
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Disability: The Numbers
 Approximately 50 million Americans
(19.3 percent) have a disability of some type.
 Many individuals have more than one type of
disability.
 The likelihood of disability increases with age.
 Nearly 70 percent of people with disabilities
are children or working age adults.
Source: Access of Health and Long-Term Services for People with Disabilities, Jeffrey S.
Crowley, Health Policy Institute, Georgetown University, April 2006
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Overview:
Work & Health Coverage Interaction
 People who work use their health insurance
less.
 Employer-sponsored health insurance is
declining and becoming less
comprehensive.
 Many people with disabilities have healthrelated needs that are not covered by
private insurance.
 Private coverage is often unavailable or
unaffordable to people with disabilities.
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Medicaid: The Basics
 Medicaid provides coverage for designated
groups of low-income individuals and
individuals with disabilities.
 Jointly financed by the federal and state
governments.
 States determine services covered, provider
payments, and certain eligibility qualifications,
within federal guidelines.
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Medicaid: Mandatory and
Optional Services
Mandatory Services
Optional Services
 Physician’s services
 Laboratory and x-ray
 Inpatient and outpatient
hospital services
 Early and periodic
screening, diagnostic,
and treatment (EPSDT)
services for individuals
under 21
 Nursing facility services
 Home health services (for
those entitled to nursing
home care)
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Prescription drugs
Dental services
Physical therapy
Prosthetic devices
Intermediate Care
Facilities for persons with
Mental Retardation
(ICF/MR) services
Personal care services
Rehabilitation services
Private duty nursing
Hospice services
Home and communitybased services
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Ten Things to Know About Health and
Disability Policy
1. Disability/chronic illness can affect all
aspects of someone's life: employment,
education, health, housing, income, and
the need for medical and support
services.
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Nearly half of Medicaid expenditures cover
services for people with disabilities.
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17 percent of Medicaid enrollees are people
with disabilities (2006)
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46 percent of Medicaid expenditures are for
people with disabilities (2006)
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Medicaid Spending on Categories
of Enrollees
Elderly
9%
Blind & Disabled
17%
Adults
26%
Elderly
23%
Blind & Disabled
46%
Adults
13%
Children 19%
Children
48%
Enrollees
2006 U.S. Total = 59.7 million
Expenditures
U.S. Total = $299 billion
in 2006
Note: Expenditure distribution based on spending only on services. Excludes DSH, supplemental provider payments,
vaccines for children, and administration.
SOURCE: Health Management Associates estimates based on CBO Medicaid Baseline, March 2006.
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Ten Things to Know About Health and
Disability Policy
2. Medicaid provides a comprehensive set
of acute and long-term care benefits to
meet the needs of people with
disabilities.
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Medicaid Expenditures by Service
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Ten Things to Know About Health and
Disability Policy
3. Disabilities include both physical and
mental impairments. Medicaid provides
coverage for both, and is the single
largest payer of mental health services.
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Ten Things to Know About Health and
Disability Policy
4. Medicaid is leading the way in supporting
employment for people with disabilities.
 Medicaid covers mandatory services that are
essential to employment: acute care, longterm care, and inpatient and outpatient
hospital services.
 Medicaid Infrastructure Grants (MIG)
 Another critical support is retaining health
coverage through the Medicaid Buy-In, SSI
sections 1619 (a) and (b), and other options.
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Supporting Employment (Continued)
 States have implemented Medicaid
programs and demonstration projects to
allow working people with disabilities to
retain health coverage.
 Medicaid Buy-In program
 1902(r)(2)
 1115 waiver
 DRA Benchmark Benefits
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Medicaid Buy-In: Overview
 The Medicaid Buy-In program allows states
to expand Medicaid coverage to working
individuals with disabilities whose income
and assets would otherwise make them
ineligible.
 Currently 33 states have Buy-In programs.
 As of 2005, more than 161,000 people have
participated in state Buy-In programs.
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National Buy-In Enrollment by Quarter
(2000-2005)
Source: The Interaction of Policy and Enrollment in the Medicaid Buy-In Program, 2005:
Final Report, Mathematica Policy Research, Inc., May 2007, Figure III.1
 Note: Missouri rescinded its Buy-In program in August 2005 causing a drop in total 14
enrollment. The program has been reinstated in 2007.
Medicaid Buy-In Program:
Basic Guidelines & Requirements
 The Medicaid Buy-In program was created in
the Balanced Budget Act of 1997 (BBA).
 Must be below 250 percent of FPL.
 Cannot exceed Supplemental Security Income (SSI)
resource standard.
 Section 1902(r)(2)
 Ticket to Work and Work Incentives
Improvement Act of 1999 (TWWIIA) expanded
the Medicaid Buy-In program.
 Added two new optional eligibility groups.
 States can establish their own income and resource
standards.
 Do not have to be below 250 percent of FPL.
 Participants must be between the ages of 16 and 64.
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Other Work Incentive Programs
 Social Security Disability Insurance (SSDI): trial
work period of 9 months
 Supplemental Security Income (SSI):
 gradual reduction in benefits
 1619 (a)
 1619 (b)
 Disability Program Navigators (DPNs): assist
individuals with disabilities in accessing services
at One-Stop Career Centers
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Medicaid Infrastructure Grants
 Medicaid Infrastructure Grants (MIGs) were
authorized by TWWIIA to provide funding for
states to facilitate the employment of people
with disabilities through:
 Medicaid Buy-In programs
 Improvements to Medicaid services that support
employment
 Coordinated, cross-programmatic approaches to
remove barriers to employment
 40 states, plus the District of Columbia, currently
have a MIG.
 Most MIG states also have a Medicaid Buy-In
program.
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Ten Things to Know About Health and
Disability Policy
5. Medicaid facilitates independent living in
the community for people with disabilities.
 Medicaid support services include:
 Home and Community-Based Services (HCBS)
 Rehabilitation services
 Personal care services
 Durable medical equipment
 Home and Community-Based Services
(HCBS) are on the rise.
 In 1994, represented 19 percent of Medicaid LTC
spending
 In 2004, represented 36 percent of Medicaid LTC
spending
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Ten Things to Know About Health and
Disability Policy
6. The Deficit Reduction Act of 2005 (DRA)
provides opportunities to expand new
services to people with disabilities.
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Benchmark Benefit packages
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Self-Directed Personal Assistance Services
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New options to provide HCBS
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Cash and Counseling
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Money Follows the Person
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Ten Things to Know About Health and
Disability Policy
7. Medicaid fills in the gaps in Medicare
coverage.
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7 million “dual eligibles” – low-income seniors and
people with disabilities who qualify for Medicaid
and Medicare.
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A person with a disability must wait 24 months to
become eligible for Medicare. Medicaid
provides coverage when Medicare is not
immediately available.
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Medicaid provides long-term care services and
“wrap-around” coverage for services not
covered by Medicare.
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Ten Things to Know About Health and
Disability Policy
8. Medicaid provides comprehensive
services for youth with disabilities.
 Half of the 1 million children with severe disabilities
age 4 and under receive Medicaid benefits.
 30 percent of the 5.3 million children ages 5 to 17
with disabilities receive Medicaid benefits.
 “Katie Beckett” option (TEFRA option)
 States also cover children in foster care.
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Ten Things to Know About Health and
Disability Policy
9. Fluctuations in state fiscal conditions
impact the ability of Medicaid to provide
services for individuals with disabilities.
 Rate of growth in Medicaid spending slowed
since 2000 and hit record lows in Fiscal Year 2006.
 States are improving program efficiency and
investing in new services, innovations, and
provider payment rates.
 Medicaid also must respond to rising health care
costs, erosion of employer-sponsored health
coverage, enrollment growth, and pressure to
increase provider rates.
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Ten Things to Know About Health and
Disability Policy
10. Demographic and enrollment trends are
impacting Medicaid programs.
 Aging population
 Growth in disability rolls
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Trend: Aging Population
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Trend: SSDI Enrollment, 1970-2005
Source: Annual Statistical Report on the Social Security Disability Insurance
Program, 2005 Social Security Administration, September 2006, Chart 2
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Challenges and Issues
 Some health services can only be obtained in the
home and not in the workplace.
 Complexity of work incentive programs.
 Barriers posed by asset limits.
 Number and scope of definitions of “work” and
“disability.”
 Sustainability of initiatives such as Money Follows the
Person and Demonstration to Maintain
Independence and Employment.
 Pressures on state budgets.
 Age of transition for youth with disabilities.
 Impending restrictions on targeted case
management and the rehabilitation option.
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For More Information
 APHSA web sites:
 Center for Workers with Disabilities:
http://cwd.aphsa.org
 National Association of State Medicaid
Directors: http://www.nasmd.org
 Contact:
 Martha Roherty, Director
(202) 682-0100 ext. 229
[email protected]
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