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Hemi Tewarson Director, Health Division NGA Center for Best Practices
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About NGA About NGA
Conference of Governors The White House, 1908
Long Long Term Care Term Care Problems, Problems, Policies - - PowerPoint PPT Presentation
Long Long Term Care Term Care Problems, Problems, Policies - - PowerPoint PPT Presentation
Long Long Term Care Term Care Problems, Problems, Policies Policies and Prosp and Prospects: ects: Stat State e Perspective Perspective Beyond the ACA: Health Policy and Sustainable Health Spending Washington, D.C. July 18, 2017 Hemi
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Health Divis Health Division ion Guiding Principles Guiding Principles
The Health Division grounds all of its work in the following guiding principles:
- Helping Governors Succeed: Harnessing unbiased expertise to surface and disseminate the most
promising evidence-based practices that can assist governors as they strive to improve the lives of their residents
- Moving Beyond Theory: Moving beyond theory by breaking down complex challenges and translating
best practices into actionable steps governors can take to effectively and efficiently solve problems and create change
- Breaking Down Silos: Leveraging expertise across the NGA Center to help governors and their state
leaders break down silos and develop integrated, innovative, whole-person solutions that are sustainable over time
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Health Health Div Division Focus ision Focus Are Areas as
Health Systems Transformation Behavioral Health and Social Determinants of Health Medicaid and Health Insurance Workforce Public Health Data and Analytics
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“It is critical that any changes to Medicaid and the private health insurance market reflect states’ experience as major health care purchasers, regulators and administrators who will be responsible for carrying
- ut new reforms.”
- 2017 NGA LETTER TO CONGRESS
Governor Governors are s are Activ Activated on Health Reform ated on Health Reform
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Phase 1: Repeal and Replace Through Reconciliation Phase 2: Administrative Actions Phase 3: Other Legislative Action
Stated Path for Health Care Reform
Manager’s Amendments (3/20) CBO Score Released (3/13) AHCA Introduced (3/6) Updated CBO Score Released (3/22) Additional Amendments (3/23) AHCA Passes House (5/4) HHS/CMS Medicaid Letter to Governors (3/14) HHS 1332 Letter to Governors (3/14) BCRA Released by Senate 6/22 CBO Score of BCRA Released (6/26) Updated version of BCRA released (7/13)
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WY WI WV WA VA* VT* UT* TX TN SD* SC RI PA* OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN* MI MA ME LA KY KS IA IN IL ID HI GA FL DC DE* CT CO CA AR AZ AK AL
Governors’ Bipartisan Health Reform Learning Network
- Provides unbiased information
about health reform proposals and the state impact
- Offers a forum for states to engage
in dialogue with other state leaders and identify shared priorities for reform
- Released in June, Shared Priorities
from the Governors’ Bipartisan Health Reform Learning Network highlights priorities for Medicaid, private health insurance and public health
*Seven states are also participating in the MCH and Public Health Working Group
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Focus on C Focus on Cost Drivers
- st Drivers
- Pending federal health reform proposals have increased states’ focus on addressing significant cost
drivers in Medicaid, including LTSS
- Medicaid spending on LTSS was $152 billion in FY2014; 32% of total program expenditures
- Despite significant progress in many states to rebalance from institutional to home and
community-based services (HCBS), costs for LTSS populations remain high
- In addition to continued rebalancing efforts, states are exploring additional options to improve care
and control costs for LTSS, including:
- Innovative delivery models
- Managed care (MLTSS)
- Targeted solutions for unique populations (Duals, DD/ID, “at-risk,” etc.)
- Caregiver supports
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Bipart Bipartisan Health isan Health Reform Lear Reform Learning ning Network: Network: Prio Priorities rities for for LTS LTSS
Ad Addit itional
- nal flexibilit
ibility y and suppor port t for effor
- rts
ts to imp mprove e qua quality ty and value ue of LTSS Contin inued ed federal suppor port t and investmen estment for states es to mainta tain in and build d on paymen ent t and deliv ivery y reforms ms Flexibi ibility ty to cover er eviden ence ce-based ased services ces that imp mprove e health th outcom comes es and provide de ROI by addres essi sing ng social ial det etermi minan ants ts of health
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State State Exam Example: ple: Washingto Washington n
Recently approved 1115 Waiver established a new, limited LTSS benefit package for two key populations:
- 1. Medicaid Alternative Care (MAC): alternative limited LTSS benefit package (those selecting this package forgo
traditional LTSS services)
- Eligibility: Age 55+; Medicaid eligible (targeting those not currently using LTSS)
- Designed to support unpaid caregivers in continuing to provide quality care and delaying the need for more
intensive LTSS
- Beneficiaries may switch to the traditional LTSS benefit at any time
- 2. Tailored Services for Older Adults (TSOA): new eligibility group with access to limited LTSS benefit package only
- Eligibility: Age 55+; do not currently meet Medicaid financial eligibility (may have assets up to S51,000)
- Designed to support individuals who need LTSS and are at risk of spending down to Medicaid
Benefits
- Caregiver Assistance Services
- Caregiver Training and Education
- Specialized Medical Equipment & Supplies
- Health Maintenance & Therapies
- Personal Assistance Services (TSOA only)
Expected Enrollment and Savings
- State expects approximately 8,000
initial enrollment, with a majority in TSOA
- State legislature estimated up to $23
million in annual savings by year 4 Costs
- $550 PMPM, compared
with full benefit costs of $5,200 PMPM for nursing home, $2,000 PMPM for home care
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State Example: Virginia State Example: Virginia
Commonwealth Coordinated Care Plus (CCC Plus)
Statewide in 6 regions Required enrollment Duals/non-duals, children/adults, NF and 5 HCBS waivers Health plans may vary by region Coordination of Medicare benefits through companion D-SNP Continuity of care period is 90 days
Builds on Virginia’s Financial Alignment Demonstration, Commonwealth Coordinated Care (CCC)
Virginia is implementing a statewide Medicaid MLTSS program for over 213,000 individuals
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