1. Disability Policy Seminar February 15, 2011

2.  Challenges ◦ State budget deficits ◦ Push for flexibility ◦ Potential for major structural changes as part of deficit reduction ◦ Getting implementation done right  Opportunities ◦ Expansion of coverage ◦ New options for home- and community-based services

6.  Cuts inevitable but some deeper than needed: ◦ Rainy day funds still available in some states ◦ Lack of a balanced approach  Pressure to repeal maintenance-of-effort provision ◦ AZ waiver request ◦ Repeal would have significant impact on people with disabilities

7.  New Medicaid waiver requests could include: ◦ Block grant waivers would cap state and/or federal spending on the program ◦ Requests to increase cost-sharing and premiums above Medicaid limits ◦ Requests to limit benefits for certain groups

8.  Senate bipartisan negotiations  Leading proposals would cap federal spending as share of GDP  “Look Ma, No Hands” Approach  Connecting the dots leads to Medicaid Block Grant

9.  Biggest challenge is playing defense and offense at the same time  Need for strong messages on value of Medicaid  Maintain focus on implementation ◦ Benefit packages for Medicaid ◦ Eligibility determination process ◦ Consumer support and education