The Affordable Care Act: Opportunities for States to Increase Home- and Community- Based Services in Medicaid Dee Mahan, Families USA October 7, 2010

LLCP HEALTH CARE MANAGEMENT, LLP A TRAINING INSTITUTE ADVOCACY SUPPORT RECOGNITION SPONSORS THIS PPT DEMONSTRATION: THE MATERIALS IN THIS PPT DEMONSTRATION IS FOR EDUCATIONAL EMPHASIS IN SUPPORT OF THE AFFORDABLE CARE ACT DEMONSTRATED AS A LEARNING AND EDUCATIONAL TOOL. AS PART OF THE ADVOCACY FOR THIS INITIATIVE STUDENTS AND AGENCY PROVIDERS ARE ENCOURAGED TO SUPPORT THE BACK TO HOME PERSON-CENTERED PROGRAMS AND BECOME A VOICE FOR THEIR OWN STATE PLANS FOR COMMUNITY CHOICE PROGRAMS LINDA R SMITH, CEO/PRESIDENT LLCP HEALTH CARE MANAGEMENT LLP & TRAINING INSTITUTE RESEARCH INITIATIVES FAMILIESUSA.ORG SEND ALL RESPONSES TO CARE OF

The Affordable Care Act: Several options for states to expand home- and community-based services in Medicaid State Balancing Incentive Payments Program Change to Money Follows the Person Community First Choice Option Changes to the existing state plan option, 1915(i) 3

Supporting systems balancing: State Balancing Incentive Payments Program 4-years starting October 2011, $3 billion available Incentives for states to make administrative changes Eligible states – Spent less than 50% of total Medicaid long-term services dollars on non-institutional care in FY 2009 – Must agree to administrative changes – Must submit a plan for expanding community-based care 4

Required administrative changes No wrong door/single entry point system Conflict free case management services Uniform core assessment tool for establishing eligibility for home- and community-based services 5

Other state requirements Collect service, quality, and outcomes data Use added funds to expand non-institutional services in Medicaid Maintain eligibility for non-institutional services at December 31, 2010 level 6

Spending targets and FMAP increases HCBS spending as % of total Medicaid LTC spending, FY 2009 Target HCBS spending percentage FMAP increase Less than 25 percent25 percent5 percentage points 25 percent but less than 50 percent 50 percent2 percentage points 7

State Balancing Incentive Payments Program: Opened questions How can states count non-institutional spending? Six month timeframe and administrative changes: how far along do they need to be? What if targets are missed? 8

Extending Money Follows the Person Extends to 2016, with added $2.25 billion Reduced institutional residency requirement Proposals from new states due January 7,

New state plan option: Community First Choice Option New personal attendant benefit Must be: statewide; provided without regard to age, type of disability, or form of community- based services and supports needed States taking up option receive 6 percentage point FMAP increase One year maintenance of effort requirement 10

Eligibility and Services Two eligibility tiers –Medicaid eligible, up to 150% FPL –State option to extend to income level for institutional care; individuals must meet institutional level of care criteria Covers support with activities and instrumental activities of daily living, health related tasks Option to cover some transition costs, added services 11

Community First Choice: Advocating for expansion Consider how the program will work with existing programs in your state Option does not sunset—could use Balancing Incentive Program to help set up systems to support moving forward with this new program 12

Changes to 1915(i) Changes to the existing state plan option for community-based care for people not meeting institutional level of care requirement –States given greater flexibility in benefits offered –More protections for program enrollees –Must be statewide, no caps, no waiting lists –Can be targeted 13

Advocating for Change Use state data, personal stories Expanding community-based care is politically popular Evaluate which options your state could best pursue now and push for those Keep the drumbeat going for broader change 14