1. MA Reform Waiver David Godfrey Medicaid Director Minnesota Department of Human Services December 5, 2011

2. Minnesota Medicaid Reform Medicaid waiver reform language: “The Commissioner shall develop a proposal…which shall include any necessary waivers, state plan amendments, requests for new funding or realignment of existing funds, and any other federal authority that may be necessary for the projects…”

3. Medicaid Reform Work Plan Work groups: – Redesign long-term care (CC Administration), Loren Colman Reform benefit sets Consumer directed services Complex and high cost individuals – Employment supports (CC and CMH Administrations), David Godfrey – Housing supports (CFS and CMH Administrations), David Godfrey

4. Medicaid Reform Work Plan (cont.) Work groups (cont.): – Enrollee cost sharing/incentives (HCA Administration); Scott Leitz – Dual eligible planning grant (HCA Administration); Scott Leitz – Mental Health Reform (CMF Administration); Maureen O’Connell

5. Medicaid Reform Work Plan (cont.) Agency-wide collaboration and work group stakeholder involvement Policy development/timing constraints Budget neutrality requirement

6. Key Dates Completed: 10/01/11 – Duals financing model Letter of Intent submitted 10/21/11 – Interagency Agreement between MDH and DHS signed for DPP 11/28/11 – Level of Care Section 1115 waiver issued for public comment

7. Key Dates (cont.) Anticipated: 12/21/11 – Proposals identified by work groups for legislative report – 12/22/11 – Submit State Plan Amendment for Health Care Delivery System HCDS demo and Hennepin Health Demo 1/1/12 – Submit Level of Care Section 1115 waiver 1/15/12 – MA reform waiver report submitted to Legislature 2/15/12 – Work groups finalize MA Reform Waiver proposals

8. Key Dates (cont.) 3/15/12 – Submit Duals Planning Demo final report/begin negotiations on the financing model – 3/15/12 – Issue MA reform waiver draft for public comment 4/15/12 – Submit MA reform waiver –Negotiate waiver and other federal authority 4/15/12 to 11/30/12 – Negotiate Waiver with CMS 1/1/13 – Implement Duals integrated financing model 1/1/13 – Complete waiver legislative and budget proposals

9. HCA Reform Provisions Improve integration of Medicare and Medicaid for duals Health care delivery demonstration projects Individual and group/community incentives for to encourage healthy behavior and prevent chronic disease Encourage utilization of high quality, cost effective care through cost sharing Eligibility limits on Adults without Children

10. Medicaid Reform LOC Provision Nursing facility level of care (LOC) – Changed in 2009 for sustainability due to demographic pressure – Impacts admission of public pay consumers to nursing homes and waiver benefits – Federal MOE blocked implementation by ARRA and ACA

11. Medicaid Reform LOC Provision (cont.) If Minnesota does not get federal approval to implement the level of care criteria changes, an additional 1.67 percent rate cut will be applied to: – All waiver services – Alternative Care – Nursing and home health, private duty nursing – PCA services and supervision – Day training and habilitation – Grants Reduction is effective July 1, 2012, and expires Dec. 31, 2013.

12. Questions? David Godfrey Minnesota Department of Human Services (651) 431-2319 david.godfrey@state.mn.us