1. 1 Health Reform Key Issues, Concerns and Opportunities for MIGs and Medicaid

2. 2 Brief History  Senate Finance Committee Released a “Call to Action” (11/08) and a Series of White Papers Outlining Reform Proposals (4/09-5/09);  Senate Health, Labor, Education and Pensions Committee Released Draft Bill to Overhaul Healthcare System (06/09);  House of Representatives Introduces Comprehensive Bill (07/09) – Bill is divided and sent to 3 committees;  Senate Finance Committee Introduces Legislation (10/09).

3. 3 Current Status  House bill has been amended in committee, recombined and reintroduced to the full chamber;  Senate Finance bill and HELP bill both cleared their committees and are currently being combined by Senate leadership;  Floor debates expected to extend well into December, if not 2010;  Still in contention – debates about policy are ongoing.

4. 4 Key Components of the Bill(s)  Medicaid Changes: ◙Expand Medicaid to everyone under 133% (Senate) or 150% (House) of FPL; ◙Current eligibility levels, procedures and methodologies are frozen with no sunset date indicated (House) or until 7/1/2013 (Senate); ◙Restructures income calculation for many Medicaid beneficiaries (Senate) to IRS calculation – Elimination of income disregards; ◙Mandatory increase to the provider rates Medicaid pays; ◙Creates offices and demonstrations to increase coordination of care between Medicaid & Medicare.

5. 5 Key Components of the Bill(s)  Medicaid (continued): ◙Removes asset test for many Medicaid categories, but not SSI, MBI, 1915(c), Medicare Savings (House); ◙Removes asset test for people who have their income determined by IRS standards (Senate); ◙Provides increased FMAP for long-term care expansion/restructuring;  CLASS Act (House + Senate): ◙Creates a national, premium-funded, opt-out Long- Term Care insurance program. ◙Eligibility for LTC Services done by ADLs, not income; ◙Benefits provided in “Cash & Counseling” style.

6. 6 Key Components of the Bill(s)  Private Insurance Reforms: ◙“Community Rating” – no more than 2:1 (house) or 6:1 (senate) variation in premiums for 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).

7. 7 Key Components of the Bill(s)  Individual mandate to buy insurance;  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  Public Plan/Co-ops ◙Establishes public option (House/possibly Senate) or co-ops (Senate) to compete with private insurance.

8. 8 Potential Impact to People with Disabilities  Positives: ◙Greater availability of services in the private sector. ◙No preexisting condition exclusion, denial of coverage or termination of coverage. ◙Less premium variation. ◙CLASS act – LTC without income/asset test. ◙New Medicaid coverage for low-income people, including those with serious conditions that don’t meet SSA listings.

9. 9 Potential Impact to People with Disabilities  Concerns: ◙Eliminating income disregards; ◙Emphasis on acute care & individuals accessing private plans in the exchange; ◙Impact of mandatory expansion on optional Medicaid services/eligibility; ◙Reduction in “DSH” – Many States use DSH to help support care for people with Mental Illness; ◙Large expansion may cause access issues.

10. 10 For More Information:  Center for Workers with Disabilities ◙National Association of State Medicaid Directors ◙1133 19 th Street NW, Suite 400 Washington, DC 20036  Staff contacts: ◙Nanette Relave, Director ◘nrelave@aphsa.orgnrelave@aphsa.org ◘(202) 682-0100 x241 ◙Damon Terzaghi, Policy Associate ◘dterzaghi@aphsa.orgdterzaghi@aphsa.org ◘(202) 682-0100 x265