“Premium Assistance,” People with Disabilities, and Medicaid Expansion Via Insurance Exchanges. Information Bulletin #379 (4/2013) Do you reside in a State that has not agreed to expand Medicaid under the Affordable Care Act (ACA) to all persons whose incomes are under 138% of the federal poverty level? Has your Governor talked about using Medicaid’s “premium assistance” plan to purchase a health plan via an “Exchange” for people under 138% – the “Arkansas model”? This Information Bulletin attempts to clarify some of these concepts, particularly as they apply to people with disabilities. 1.The normal way most States are implementing the ACA Medicaid expansion is to provide all persons with incomes under 138% with defined Medicaid benefits delivered through one Medicaid system. The “Arkansas model” is different and is the outlier. It uses Medicaid funds as “premium assistance” payments with which a State will purchase a private health plan, through the health insurance exchange being created for each state under the ACA (run either by the state or by the federal government). This private health plan will be limited to specific covered health benefits and services. Based on the proposed federal regulations and guidance from the federal Medicaid agency, CMS, the additional benefits covered under Medicaid, and the cost-sharing protections under Medicaid, must still be provided, these are likely to be very difficult to access. However, absent a special waiver, with premium assistance payments, a State cannot mandate that anyone under 138% receive Medicaid expansion services via the private insurance market; they must all be offered the choice of traditional Medicaid. 2. There is one possible way your State may try to get around this prohibition on mandatory enrollment in premium assistance. The State may apply to CMS for a section 1115 demonstration waiver to provide premium assistance to purchase a health plan on an Exchange and to make participation mandatory. What is critical for people with disabilities to know is that, under such a waiver, “A State may not require an individual to obtain [Medicaid services and health care] benefits through enrollment” with premium assistance payments if the person fits into one of the following five categories. If you are in one of these categories, the State cannot force you into a private health plan even through a 1115 waiver. Instead, the State must provide the traditional Medicaid benefits and services that current Medicaid recipients who are disabled are eligible for and receive, and deliver them in the traditional manner. The exempted categories are: 1. Blind and disabled persons (or persons “being treated as being blind or disabled) without regard to whether the individual is eligible for supplemental security income benefits …on the basis of being blind or disable. Nationally, we estimated that 2,665,407 people with disabilities are in this category. See Information Bulletin #369 (1/2013) or http://stevegoldada.blogspot.com/ for a State-by-State breakdown. 2. Dual eligibles – i.e., persons who receive both Social Security disability and Supplemental Security Income benefits. 3. Persons institutionalized in a “nursing home, an intermediate care facility for the mentally retarded, or other medical institution, and required, as a condition of receiving services in such institution under the State plan, to spend for costs of medical care all but a minimal amount of the individual’s income required for personal needs.” 4. “Medically frail and special medical needs individuals,” (as identified in accordance with regulations of the Secretary). 5. Persons who qualify for long-term care services. “The individual qualifies based on medical condition for medical assistance for long-term care services,” including Home and community-based services furnished under a 1915 waiver. These exempted categories are critical. These people are entitled to all of the Medicaid services and benefits currently available to existing Medicaid recipients who are disabled, through the existing delivery system. 3. Do you reside in a State that is considering using premium assistance payments for people on Medicaid? If you do, please make sure your State is fully aware that it will have to run two separate programs for the Medicaid 138% expansion population, even with a waiver allowing it to force some Medicaid enrollees into premium assistance. One Medicaid program will provide all the components in the State’s existing benefits and services for people in categories ## 1 -5 above, and for others who opt out of premium assistance if there is no waiver. A second and separate Medicaid expansion program will use premium assistance payments for people not exempted under a waiver, or who have not opted out if there is no waiver. We expect that most States using premium assistance without a waiver will try to convince people in categories ## 1-5 to receive services through private insurance in the Exchange paid with the premium assistance. Don’t do it! You are exempted from mandatory enrollment. Why are we so emphatic? There is no way a private insurance company that is paid to provide “Exchange” health services will provide the long-term care Medicaid services that people in categories ##1-5 need to live independent, integrated lives in their homes and apartments. Congress did not even require Exchanges to include long-term care services or benefits, and you can bet they will not. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

What are the Religious Communities doing in your State Re Medicaid Expansion? Information Bulletin # 377 (4/2013) Have the various religious communities in your State taken a public position with regards to Medicaid expansion for residents whose incomes are less than 138% of the federal poverty level? Last week in Pennsylvania, 1,350 Roman Catholic nuns, priests, and brothers, representing 19 different religious congregations, were individually identified, by name and religious affiliation, in a letter written to the Pennsylvania Governor in which they urged him to accept federal Medicaid funds to expand coverage to nearly 700,000 residents who lack coverage. These religious leaders noted that their “faith, tradition and justice teaching call us to advocate for the right of all human beings to have access to the basic necessities that enable them to live productive lives with dignity. Among those is the right to affordable health care.” They stated that a failure to accept these funds by the Governor would “breach the moral duty to those who are on the margins of society.” They requested a meeting with the Governor. These leaders pointed out the health benefits, cost savings on uncompensated care to hospitals, and economic stimulus which will occur with the Medicaid expansion. These religious leaders concluded that their “faith calls us to respond to the needs of the disabled, the impoverished, and the downtrodden. The Medicaid expansion is an unparalleled opportunity to provide affordable health insurance for uninsured Pennsylvanians.” In every State there are coalitions of religious congregations – Protestant, Evangelical, Jewish, Catholic, and others. Have they taken a public position regarding Medicaid expansion? Have they written to the Governor and state legislators? Have you asked them to? What have they done in North Carolina, South Carolina, Georgia, Alabama, Mississippi, Texas, Oklahoma, Nebraska, Iowa, Tennessee, Virginia, West Virginia, Kansas and Utah? Surely there are religious leaders and coalitions who recognize Medicaid expansion as a “moral duty.” Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

One Strategy to Increase Monthly Income for Disabled Persons – Corrected!!!!!!. Information Bulletin #376A (3/2013) [Introduction – I apologize. In the above Information Bulletin, I made an error that a few people pointed out to me. The correction below regarding Medicare and Medicaid will significantly benefit people who apply, so I am rewriting this Bulletin with the corrections and thank all of you who pointed out my error. On a personal note, it is really gratifying that people actually read the Information Bulletin to the end. I must admit that I am never confident how many people read these, or do they float away in outer space. Thanks. Steve] There are more than 7 million persons who are disabled and who receive Supplemental Security Income because they have a disability. This Information Bulletin is addressed to a subset those 7 million -- whose disability began before they were 22 years old and whose parents receive or were entitled to receive Social Security retirement benefits. This Information Bulletin is to remind and or inform this subset of 7 million SSI recipients of a potential federal financial benefit that could increase their monthly incomes. This subset of 7 million disabled persons’ living arrangements differ: some live independently on their own; some live in group homes or with roommates; some are married and live with their spouses; and some still reside with their aging nondisabled parents. Some have physical disabilities, some intellectual and some mental disabilities. Some were born with their disability and some acquired their disability before age 22. If you are one of these 7 million or know people who are, you and they might be eligible to receive “Child’s benefits” – under the Social Security retirement system - based on the “earning record of an insured person,” your parent(s) Social Security retirement benefits, whether or not your parents are still alive. What this means in nontechnical terms is: 1.Is either parent receiving Social Security retirement benefits, Social Security Disability benefits, or has either parent died? If one of your parents has died, you may be eligible to receive benefits on his/her account if s/he had a history of working. 2.Don’t be misled by the term “child.” It does not mean your age, but refers to your relationship to your parent. For example, a 45 year old recipient of SSI has a 67 year old parent who collects S.S. retirement benefits. The 45 year old may be entitled to “child’s benefits” based on his parent’s earning record. 3.Did your disability begin before you were 22 years old? Here is concrete example of how this system works. A.You became disabled before you were 22 years old. This could have been at birth or any time before you were 22. B.You receive SSI (although that is not a requirement). It does not matter where you reside or with whom you reside. C.What is important is that one of your parents receives Social Security retirement benefits (a/k/a Social Security “Old-Age” benefits), Social Security Disability Benefits, or if either parent has died and that parent had a work history that would have qualified him/her for Social Security retirement benefits. The dollar difference between your SSI monthly benefits and the “child’s benefits” based on your parents earning record could be significant. You may receive up to one-half of your parent’s full retirement benefit or disability benefit while your parent is still alive, and up to 75 percent of your parent’s Social Security benefit when s/he dies. You must apply to the Social Security Administration, which can be done in person, or by telephone or on-line. It is worth your effort to find out the monthly benefits you may be entitled to, whether or not you decide to actually apply, and compare that sum with your SSI. Two additional points: 1.Normally “child’s benefits” end if the person marries. However, if a person with a disability marries another disabled person who receives disability benefits, then you are still eligible for “child’s benefits.” 2. A big issue is health care coverage and benefits. On SSI, you receive Medicaid. In many States – not all – if your “child’s benefits” are less than 138% of the federal poverty level ($1,285 a month), you will still be Medicaid eligible effective 1/2014. In many States, you can become eligible for Medicaid under “spend down” requirements. If you start to receive your parent’s social security benefits because of your disability began before you were 22, you will also be eligible for Medicare benefits after you have been eligible for your parent’s benefits for 24 months. Check out how this issue will specifically apply to you. Also, in 1987, a federal law was enacted that says that if you are receiving Medicaid (maybe because you receive SSI on your own account), and then you start to receive Social Security benefits from a parent’s account, the amount of your parent’s benefit will not be considered when your State is deciding if you are financially eligible for Medicaid. For example, let’s say you are receiving $715 a month of SSI and also have Medicaid. Then your father dies and you become eligible for $1,000 a month in Social Security on your father’s account. Your State cannot count any of the $1,000 a month from your father’s Social Security when deciding if you are eligible for Medicaid. Here is the citation, 42 U.S.C. § 1383c, or http://www.ssa.gov/OP_Home/ssact/title16b/1634.htm (Determination of Medicaid Eligibility). Is the Social Security Administration motivated to provide the maximum amount of income to which people with disabilities are entitled to receive? The SSA knows each of the 7 million SSI recipients, their age when they became disabled and their parents’ status. It cannot be too difficult to at least notify them of these potential rights. In fact the Social Security Administration requires that you apply for benefits on your parent’s account if there is a chance you might be eligible, in part because SSI is a “payment of last resort.” There are a number of wrinkles which this Information Bulletin does not discuss. Telephone the Social Security 800 number and make an application. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

One Strategy to Increase Monthly Income for Disabled Persons. Information Bulletin #376 (3/2013) There are more than 7 million persons who are disabled and who receive Supplemental Security Income because they have a disability. This Information Bulletin is addressed to a subset those 7 million -- whose disability began before they were 22 years old and whose parents receive or were entitled to receive Social Security retirement benefits. This Information Bulletin is to remind and or inform this subset of 7 million SSI recipients of a potential federal financial benefit that could increase their monthly incomes. This subset of 7 million disabled persons’ living arrangements differ: some live independently on their own; some live in group homes or with roommates; some are married and live with their spouses; and some still reside with their aging nondisabled parents. Some have physical disabilities, some intellectual and some mental disabilities. Some were born with their disability and some acquired their disability before age 22. If you are one of these 7 million or know people who are, you and they might be eligible to receive “Child’s benefits” – under the Social Security retirement system - based on the “earning record of an insured person,” your parent(s) Social Security retirement benefits, whether or not your parents are still alive. What this means in nontechnical terms is: 1.Is either parent receiving Social Security retirement benefits or either parent died but would have been eligible to receive those benefits? 2.Don’t be misled by the term “child.” It does not mean your age, but refers to your relationship to your parent. For example, a 45 year old recipient of SSI has a 67 year old parent who collects S.S. retirement benefits. The 45 year old may be entitled to “child’s benefits” based on his parent’s earning record. 3.Did your disability begin before you were 22 years old? Here is concrete example of how this system works. A.You were became disabled before you were 22 years old. This could have been at birth or any time before you were 22. B.You receive SSI (although that is not a requirement). It does not matter where you reside or with whom you reside. C.What is important is that one of your parents receives Social Security “Old-Age” insurance benefits, a/k/a Social Security retirement benefits, or either parent received those benefits before s/he died and would have been eligible for them now, were your parent alive. The dollar difference between your SSI monthly benefits and the “child’s benefits” based on your parents earning record could be significant. You may receive up to one-half of your parent’s full retirement benefit, or 75 percent of the deceased parent’s basic Social Security benefit. You must apply to the Social Security Administration, which can be done by telephone or on-line. It is worth your effort to find out the monthly benefits you may be entitled to, whether or not you decide to actually apply, and compare that sum with your SSI. Two additional points: 1.Normally “child’s benefits” end if the person marries. However, if a person with a disability marries another disabled person who receives disability benefits, then you are still eligible for “child’s benefits.” 2. A big issue is health care coverage and benefits. On SSI, you receive Medicaid. In many States – not all – if your “child’s benefits” are less than 138% of the federal poverty level ($1,285 a month), you will still be Medicaid eligible effective 1/2014. In many States, you can become eligible for Medicaid under “spend down” requirements. Unfortunately, you are not eligible for Medicare benefits based on your parent’s earning record. Check out this issue as it will specifically apply to you. Is the Social Security Administration motivated to provide the maximum amount of income to which people with disabilities are entitled to receive? The SSA knows each of the 7 million SSI recipients, their age when they became disabled and their parents’ status. It cannot be too difficult to at least notify them of these potential rights. There are a number of wrinkles which this Information Bulletin does not discuss. Telephone the Social Security 800 number and make an application. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

Why Private Employers Should Support Medicaid Expansion. Information Bulletin #375 (3/2013) Medicaid expansion is obviously critical for people whose incomes are less than 138% of the federal poverty level. However, the failure of States to expand their Medicaid program on January 1, 2014 will have disastrous impact on the private employers in your State. The Missouri Hospital Association recently released a report entitled “The Hidden Health Care Tax – How NOT Reforming Medicaid Could Lead to Cost Shifting.” www.missourihealthmatters.com/wp-content/…/Cost-Shift_Report.pdf This report presents data and arguments regarding how private employers will be negatively impacted if a State does not expand Medicaid and presents cogent arguments for advocates to use in urging Governors and State Legislatures to agree to Medicaid expansion. As you know from previous Information Bulletins, when Congress enacted the Affordable Care Act it significantly reduced the reimbursements that hospitals previously received uncompensated care the hospitals had been providing to low-income people. This reduction was because Congress had simultaneously mandated Medicaid expansion to all people who had been receiving this uncompensated care. With such expansion, the hospitals would receive regular Medicaid reimbursement for the newly Medicaid eligible people. Unfortunately, the Supreme Court invalidated the mandatory expansion, leaving States, hospitals and insurance companies with significant reductions in uncompensated care and no increase in Medicaid eligible persons. It has been reported that the growth of “uncompensated care is alarming,” from 2002 to 2011. Every State that does not expand its Medicaid program will suffer because the hospitals will continue to have high level of uncompensated care and no Medicaid dollars with which to pay for that care. Uninsured and uncompensated care account for a significant amount of costs hospitals must make up through other means. How will hospitals make up the lost Medicaid costs? Private commercial insurance payers will eventually (sooner than later) have to subsidize the cost of the loss in Medicaid reimbursements. The costs will be shifted from the loss of Medicaid patients to the private businesses that currently provide health insurance to their workers. This will happen regardless of their employees’ incomes. The above “The Hidden Health Care Tax” report presents the data quite starkly. The shifting of costs from uninsured/nonMedicaid low-income patients to employers of low-income workers are “hidden health care taxes” on commercial premiums and will increase what private employers will pay for the private health insurance of their employees. Otherwise, the hospitals will not be able to financially survive. Advocates: Has your State Hospital Association estimated the increase in costs to private employers’ health insurance premiums if your State does not expand Medicaid? Has your State Hospital Association publicly stated this increase? Has your Chamber of Commerce estimated this cost and the impact it will have on private employers’ insurance premiums? Are your Governors and legislatures aware of this ramification and increased costs if they refuse to accept 100% of federally reimbursed Medicaid expansion funds? Are your newspapers aware of these increased costs? Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.comor call 215-627-7100. Ext 227.

Florida Opts Into Medicaid Expansion, Religious Leader, and 10 Year Data. Information Bulletin #373 (2/2013) This Information Bulletin deals with three aspects of the Medicaid expansion struggle: 1. Florida, 2. Religious leaders, and 3. Ten year data. 1.Another Republican Governor has announced his State will provide Medicaid services beginning January 2014 to all of its citizens with incomes under 138% of the federal poverty level. What should be a clear non-partisan issue, health care for the poorest people in a state, has unfortunately morphed into party politics. That’s one reason it is important that Florida’s Governor Rick Scott joined Republican Governors in Michigan, Ohio, Nevada, New Mexico, North Dakota and Arizona. Governor Scott had said quite emphatically that “Florida would not expand its program.” Why the reversal? What makes Governor Scott’s announcement particularly important is that he understood two points that many non-participating Governors apparently have ignored. First, Governor Scott said that “our options are either having Floridians pay to fund [Medicaid expansion] in other states while denying health care to our citizens or using federal funding to help some of the poorest in our state.” NYT, 2/20/13. Yes, if your State does not opt-in, your State’s taxpayers will be paying for health care for low-income people in participating States that have agreed to the Medicaid expansion. That’s neither a very smart business decision nor a sound policy decision. Second, “since Florida is legally allowed to opt out [of Medicaid expansion in the future], that’s the right decision for our citizens.” Yes, CMS has stated that a State that provides Medicaid expansion services can at any time decide to end its participation and there are no repercussions. Have you contacted your Governor? Will other Governors see the importance of these two points for their States? Will advocates follow the Florida advocates’ success? 2. Religious leaders are realizing the moral implications in Medicaid expansion. For example, the “Roman Catholic bishops of Salt Lake City and Little Rock, Ark., have urged state officials to expand Medicaid. “ NYT, 222/13. Sorry to add another item to your plates, but have you contacted religious leaders in your State? Are they doing anything to encourage recalcitrant elected officials to do the right and smart thing? 3. A separate third Medicaid expansion issue. In previous Information Bulletins and individual State Fact Sheets, we have provided (thanks to the Kaiser Commission) six year out data from 2014 through 2019 to show the amount of federal funds would be received by Medicaid expansion and the amount of money a State would have to spend as a match over the six years. A number of States are now arguing a longer time-frame, and they are suggesting/implying that over a longer than six years the federal funds may not be worth receiving. Therefore, we will provide for a period through 2022 (again thanks to Kaiser Commission) data for those states that have still not opted in to the Medicaid expansion. The results are the same as for six years. States make out like bandits!!!!! No business person in her or his right mind would turn down accepting the federal funds for the amount they must match over a ten year period. It makes no business sense. Isn’t it time that politics be put aside and rational business decisions take over? INCREMENTAL IMPACT OF MEDICAID EXPANSION 2013-2022 Federal funds and state matches over 10 years. Alabama $14,371 billion of federal funds with only a $1,081 billion Alabama state match. Alaska $1,458 billion of federal funds with only a $147 million Alaska state match. Arkansas $12,465 billion of federal funds with only a $922 million Arkansas state match. Georgia 33,711 billion of federal funds with only a $2,541 billion Georgia state match. Idaho $3,280 billion of federal funds with only a $246 million Idaho state match. Indiana $17,322 billion of federal funds with only a $1,099 billion In Diana state match. Iowa $3,909 billion of federal funds AND a $534 savings in Iowa state funds!!!!! Kansas $5,270 billion of federal funds with only a $524 million Kansas state match. Kentucky $17,832 billion of federal funds with only a $1,297 billion Kentucky state match. Louisiana $15,786 billion of federal funds with only a $1,244 billion Louisiana state match. Maine $3,124 billion of federal funds AND a $570 million savings in Maine state funds!!!. Mississippi $14,499 billion of federal funds with only a $1,048 billion Mississippi state match. Missouri $17,795 billion of federal funds with only a $1,573 billion Missouri state match. Nebraska $3,063 billion of federal funds with only a $250 million Nebraska state match. New Jersey $15,366 billion of federal funds with only a $1,492 billion New Jersey state match. North Carolina $39,638 billion of federal funds with only a $3,075 billion North Carolina state match. Oklahoma $8,561 billion of federal funds with only a $689 million Oklahoma state match. Pennsylvania $37,842 billion of federal funds with only a $2,842 billion Pennsylvania state match. Rhode Island $2,935 billion of federal funds with only a $250 million Rhode Island state match. South Carolina $15,827 billion of federal funds with only a $1,155 billion South Carolina state match. Soth Dakota $2,110 billion of federal funds with only a $157 million South Dakota state match. Tennessee $22,541 billion of federal funds with only a $1,715 billion Tennessee state match. Texas $65,619 billion of federal funds with only a $5,669 billion Texas state match. Utah $5,274 billion of federal funds with only a $364 million Utah state match. Virginia $14,665 billion of federal funds with only a $1,326 billion Virginia state match. West Virginia $8,744 billion of federal funds with only a $619 million West Virginia state match. Wisconsin $12,263 billion of federal funds AND a $248 million savings in Wisconsin state match!!!! Wyoming $1,353 billion of federal funds with only a $118 million Wyoming state match. Ten year data from Kaiser Commission, “The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis,” at Table 6 (November, 2012). Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

If Texas can organize to expand Medicaid, what about your State? Information Bulletin # 372 (2/2013) Like many Governors, Texas’ Rick Perry has not committed to expand Medicaid for low-income people whose incomes are under 138% of the federal poverty level. However, Texas advocates have been doing their homework and are organizing the Trade Associations to explain to their Governor and elected officials why it’s essential that Texas agrees to Medicaid expansion. What follows is an excerpt from a newspaper article that explains what’s happening in Texas. These same arguments in this article are applicable in every State that is still sitting on the fence. You have to get to your Trade Associations and form a coalition. Trade Associations Lend Support for Medicaid Expansion by Becca Aaronson, February 5, 2013, in The Texas Tribune. “Despite the resistance of Gov. Rick Perry and many other Republicans to expanding Medicaid in Texas under the Affordable Care Act, some momentum seems to be building from outside of the Capitol in support of the expansion. “Texas’ two largest health care trade associations, the Texas Medical Association and the Texas Hospital Association, have announced support for extending Medicaid coverage to low-income adults. But both organizations also say that in order for the plan to work in Texas, lawmakers here also must implement reforms that will contain costs and bring more doctors into the Medicaid program to provide care for the additional patients. “ ‘The most viable path is to try to work with [the federal government] to create a reformed program that does meet the needs of Texas better,’ said John Hawkins, senior vice president of government relations at the Texas Hospital Association. He said the plan to expand must be bipartisan. Democrats must be flexible in considering “personal responsibility” reforms, such as requiring some new patients under the expansion to pay co-pays. And Republicans, he said, must “play ball” because the current system is fiscally inefficient. “We’re still providing this care at the local government level, but we’re doing it in a fragmented way that actually costs more and has worse outcomes,” Hawkins said. For an additional investment of $15 billion over 10 years, Texas could draw down $100 billion in federal funding to insure two million more Texans through the state’s Medicaid program, according to a report by Billy Hamilton, a nonpartisan consultant who was previously the state’s chief revenue estimator. [We can provide a 10 year comparison for your State. Just email me below and tell me what State.] The Texas Medical Association, which represents physicians across the state, announced on Saturday that it would support the Medicaid expansion if lawmakers can devise a way to give Texas “the flexibility to change the plan as our needs and circumstances change.” “You have the two major entities that represent the delivery of health care in Texas saying this is something that we definitely need to look at,” said Dr. Carlos Cardenas, vice president of the TMA board of trustees, adding the organization recognizes “there are issues within the present Medicaid program and that the Legislature is in a position to come up with some reforms to shore up the system.” *** Perry, who has the power to veto an expansion plan approved by the Legislature, also reiterated in his state of the state address in January that Texas would not expand Medicaid. “Gov. Perry continues to believe that Medicaid is an unsustainable, broken program that needs to be reformed, and he does not support expanding it under Obamacare,” spokesman Josh Haven said in an email. *** “The more people and organizations that come on board, the more likely there is to be a strings-attached proposition for the Medicaid expansion,” said state Rep. Garnet Coleman, D-Houston. As a proponent of expanding Medicaid coverage, Coleman said he would accept some reforms offered by Republicans, such as co-pays for expansion enrollees. “It’s hard to turn down $100 billion, so the question is what can be agreed upon to accept the $100 billion. And we have not gotten there yet.” To work around Perry’s veto power, state Sen. Rodney Ellis, D-Houston, has proposed a constitutional amendment that would allow Texas voters to decide whether to expand Medicaid. “There is a lot of political posturing going on, but the bottom line is that it makes no sense to reject additional federal health aid,” Ellis said in an email. “I believe we do millions of Texans a disservice — at a real financial and human cost — if we dither and delay implementing this common sense reform.” Whether Medicaid expansion happens in your State is up to you. Sure, it is not easy, but its doable and its critically important. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.