MEDICAID MATTERS Executive Director Association of Regional Center - - PowerPoint PPT Presentation
FACULTY DISCLOSURE I have no financial relationships to disclose. I have no conflicts of interest to disclose. I will not promote any commercial products or services. Amy Westling MEDICAID MATTERS Executive Director Association of Regional
Amy Westling Executive Director Association of Regional Center Agencies
I have no financial relationships to disclose. I have no conflicts of interest to disclose. I will not promote any commercial products or services.
The basics of federal Medicaid rules; Special Medicaid programs; and, How to advocate for essential Medicaid programs.
Basic Principles of Healthcare Delivery
Began in 1965 to "improve a wide range of health and medical services for Americans of all ages.”; Called “Medi-Cal” in California; and, State and federal funding partnership.
All states required to cover:
Families under the Federal Poverty Level (FPL); and, Individuals with disabilities on SSI.
Some states (including California) expanded and include:
Individuals up to 138% of FPL; and, Childless adults.
Federal Medical Assistance Percentages (FMAP) determine federal reimbursements. Different FMAPs for various programs incentivize behavior.
Each State Plan Amendments (SPA)
state provides. Centers for Medicare and Medicaid Services (CMS) approves, denies, or comments on SPA applications.
Statewide; Comparable; Reasonable promptness; and, Provider choice.
Different Mandatory Benefits for adults and children (under age 21); A specific list for adults; and, A more comprehensive scheme for children.
Early: Assessing and identifying problems early; Periodic: Checking children's health at periodic, age-appropriate intervals; Screening: Providing physical, mental, developmental, dental, hearing, vision, and
problems; Diagnostic: Performing diagnostic tests to follow up when a risk is identified; and, Treatment: Control, correct or reduce health problems found.
Inpatient/Outpatient Hospital; Nursing Facility; Home Health; Physician/Family Nurse Practitioner; Laboratory/X-Ray; Family Planning/Birth Center/Nurse Midwife/Tobacco Cessation; and, Transportation to Medical Care.
Optional Benefits are more comprehensive, but at each state’s discretion. Examples:
Prescription drugs; Physical, speech, occupational therapy; Rehabilitative services; Podiatry; Optometry/eyeglasses; Dental; Private duty nursing; Inpatient psychiatric services (under age 21 and over age 65); and, Hospice.
A Brief Seminar in Service to Special Populations
Personal care; Community First Choice Option - 1915(k); Case management; Services in an intermediate care facility for Individuals with Intellectual Disability; and, State Plan Home and Community Based Services - 1915(i).
Beginning in 1981, states could “waive” certain Medicaid requirements. Different rules apply to different waivers. 1915(c) allows the waiver of comparability and statewidedness to provide Home and Community-Based Services.
Allow for the provision of additional services; Must be cost-effective; Can cap enrollment; and, Are limited to one per person.
Continuously hospitalized from 4 months to age 3; Highlighted the need for reform; and, Established concept of “institutional deeming.”
A Practicum in Public Policy
Federal efforts aimed at Medicaid reform:
Block grants; and, Per person caps.
State Budget challenges and decisions
Disability advocates changed recent federal healthcare debate through:
Staying informed; Getting engaged; Telling their stories; and, Showing up.
Subscribe to relevant news updates; Find trusted sources; and, Don’t obsess, but don’t forget.
Know who your representatives are; Meet them before you need something; and, Call or write letters ahead of key votes.
Be short; Be clear; Be truthful; Be constructive; Be focused; and, Be memorable.
Go to hearings when you can; Watch for hearings outside of Sacramento/Washington D.C.; and, Find other public meetings or forums too.