Medicaid 1115 Waivers and People With Disabilities. Information Bulletin #344 (11/1/11)
I will bet anyone out there a Philadelphia pretzel (with mustard) that over the next few years there will be major structural and funding changes in the Medicaid program. These changes will happen regardless of the recommendations of the Congressional “Super Committee” or who wins the 2012 Presidential election. States are pressuring for more flexibility to make changes in Medicaid. We have no doubt that these changes will determine who will be eligible for and will receive Medicaid services, how much and what services they get, and the way these services are delivered.
Many States are submitting or have already submitted what are called “1115 Medicaid waivers” to get out from under some of the existing federal Medicaid rules. (California is just the latest state getting their waiver request approved.)
Section 1115 of the Social Security Act allows the Secretary of the Department of Health and Human Services (HHS) to suspend certain federal laws or regulations that govern programs authorized by Medicaid and SCHIP, in the context of an alleged state “research and demonstration project.” A Section 1115 Medicaid and SCHIP demonstration project/waiver are supposed to “promote the objectives" of the Medicaid program.
Some 1115 Waivers are statewide, comprehensive demonstrations that affect the majority of people who receive Medicaid in the state. These include waivers that require people to enroll in a managed care plan or that expand coverage to all state residents with incomes below a certain level. Other demonstration projects are more limited in scope. Examples of these include waivers that provide family planning services to low-income women who would not otherwise qualify for Medicaid, or those that allow certain people with disabilities to manage their health care purchasing (e.g. Cash and Counseling waivers).
Section 1115 waiver projects are generally approved to operate for a five-year period and must maintain “budget neutrality.” The budget neutrality requirement means that the waiver program cannot cost the federal government more than would have been spent on Medicaid for people covered by the waiver if the waiver didn’t exist.
1115 waivers can be written in to resemble what we called “block grants”. Most Governors and their Medicaid Directors are looking for any way to control their Medicaid budgets and they see the 1115 waiver process as one way to make this happen. We can “hope” that the current Administration (HHS/CMS) would not approve any waiver that would harm people’s services. However in this economic and political environment nothing is certain.
Remember if in the November 2012 election change administrations, there will be a new Secretary of Health and Human Services who may be more open to more state flexibility and “block grant” proposals.
Another aspect of the current 1115 waiver process that should send up red flags in our community is the limited federal requirement for stakeholder/consumer input into the design of the waiver. Literally the state (Medicaid Director) can substantially change the way Medicaid services are funded and delivered without holding one public hearing (CMS has new rules in the process to change this but they are not yet final.)
We are very worried that people with disabilities, especially those with more severe disabilities – you know, expensive – will not have their needs adequately addressed. The ADA applies to States that apply for 1115 Waivers and also applies to private managed care agencies that may apply to administer the 1115 Waiver. For people with disabilities, living in “the most integrated setting” must continue as a priority!
The hell with: NOTHING ABOUT US WITHOUT US!
Suggestions of things we can do now:
1. In the follow up to the historic DC “MY MEDICAID RALLY, reach out to other organizations in your state who have members that would be effected if Medicaid funding is reduced or if the program was drastically restructured. Form a Medicaid Action coalition (Texas is starting a Texas - MY MEDICAID MATTERS Campaign);
2. Meet with your Medicaid Director and/or your Director of Health and Human Services and find out what plans your state has in regard to Medicaid and especially an 1115 Waiver application.
3. Demand that the state establish a statewide public input process BEFORE for any proposed 1115 waiver process begins;
4. Develop an Action plan through 2012 to include: monitoring Medicaid funding, cuts in services, all new waiver submittals and renewals, outreach to the community and educate folks on Medicaid issues, develop a media strategy, potential legal action and Direct Action activities.
“We must not fiddle while the sky is falling because we can’t put Humpty Dumpty back together again” I always get these sayings mixed up!!!
Don’t Mourn...ORGANIZE, REGISTER and VOTE
Steve Gold, The Disability Odyssey continues
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