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The Importance of Medicaid

What is the value of the Medicaid program to people with disabilities?

Medicaid provides the necessary assistance that people with disabilities need to effectively live in their communities. This can include a number of support services that characterize community living such as money management, assistance with getting in and out of bed and getting dressed, arranging meals, taking prescription medication and more. With the federal government’s assistance, states have the responsibility to provide these services to recipients in a variety of settings within the community, at home or at a nursing home/developmental center. People with intellectual and developmental disabilities face high levels of unemployment, and are typically shunned from private health insurance plans due to high risk, or simply do not have the resources to pay for high premiums, therefore Medicaid is their only option. Medicaid acts as a primary health insurance plan as it covers all the necessary health services that people with intellectual/developmental disabilities need.

As declared in the 2013 National Disability policy, the numbers of people with disabilities in the United States have steadily increased over the past two decades, as well as the number of individuals enrolled in Medicaid managed care plans. Today, more than two-thirds of the 70 million Medicaid beneficiaries receive at least a portion of their services through a managed care plan. In addition, the number of states using Medicaid managed care for long-term services and supports (LTSS) jumped “from 8 in 2004 to 16 in 2012.”

2014

Managed Long-Term Services and Supports (MLTSS)-2014

As of 2014, New Jersey, is pursing the the shift to managed care in an effort to lower Medicaid costs and offer more flexibility in coordinating long-term services and supports. New Jersey will be starting up Managed Long-Term Services and Supports (MLTSS) programs on July 1 2014.The state received a waiver from the Centers for Medicare and Medicaid Services in 2012 to shift Medicaid beneficiaries (age 65+ and adults with physical disabilities) out of fee-for-service programs into Medicaid managed-care programs.

Managed Long Term Services and Supports (MLTSS) refers to the delivery of long-term services and supports through New Jersey Medicaid’s NJ FamilyCare managed care program.  MLTSS is designed to expand home and community-based services, promote community inclusion and ensure quality and efficiency.

MLTSS uses NJ FamilyCare managed care organizations (also known as HMOs or health plans) to coordinate ALL services. Currently, NJ FamilyCare members have their acute and primary health care services and their home and community based services coordinated by different care management agencies.  MLTSS provides comprehensive services and supports, at home, in an assisted living facility, in community residential services, or in a nursing home.

Beginning July 1, 2014, participants in the Medicaid waiver programs listed below will be automatically enrolled in the Managed Long Term Services and Supports (MLTSS) program through their current Medicaid managed care organization (MCO), also known as a health plan:

  • Global Options for Long-Term Care (GO);
  • AIDS Community Care Alternatives Program (ACCAP)
  • Community Resources for People with Disabilities (CRPD)
  • Traumatic Brain Injury (TBI) Waiver

Effective July 1, 2014, Managed Long Term Services and Supports (MLTSS) includes:

  • Personal Care
  • Respite
  • Care Management
  • Home and Vehicle Modifications
  • Home Delivered Meals
  • Personal Emergency Response Systems
  • Mental Health and Addiction Services
  • Assisted Living
  • Community Residential Services
  • Nursing Home Care

2013

Medicaid Accountability and Care Act

On May 7th, 2013, a bill (H.R. 1853), entitled the Medicaid Accountability and Care Act, was send to the House Committee on Energy and Commerce. This bill would revise the allocation of payments for Medicaid beneficiaries, in which federal expenditures for a quarter would reflect the base amount spent on each type of beneficiary (elderly, people with disabilities, children, and other adults). For example, if New Jersey’s residents average 350 dollars each quarter, then every individuals benefit would match this amount, rather than accounting for long term care, and other unique circumstances. Expenditures per state would be determined by elements known to influence each category’s cost of care, in which each category would have its own spending average that reflects a state’s demand of services.

Placing the solvency of Medicaid under a per person cap payment system would revoke the concept of individual entitlement to services, meaning that funding for Medicaid payments are not based on fixed or predetermined caps through the state. Moreover, it is likely for individuals, such as the elderly and people with disabilities, receiving long-term supports and services to surpass the average per person capitation.

This bill has the potential to create an overwhelming financial burden on both communities by redirecting a large portion of the costs to the beneficiary, which in turn, could reduce access to needed supports and services. Given that Medicaid spending is mostly comprised of health care costs for the elderly and people with disabilities, this bill could prevent many people from living independent and productive lives. Additionally, states may be forced to increase its share of spending, remove features of Long Term Services and Supports, reduce eligibility for coverage, lower provider rates and increase cost sharing.

The New American Movement opposes any bill that compromises the quality of life and health of people with disabilities and the elderly for a number of reasons: Medicaid is a lifeline for the disability community; it allows people with disabilities to live in their communities and out of institutions; it the most cost-effective method of providing long-term supports and services; cutting spending for Medicaid has the most damaging effect when compared to other state programs; Medicaid spending helps the economy; and reducing the scope of Medicaid will increase spending on emergency care. With that being said, the federal government must find other ways to reduce the increasing cost of healthcare without jeopardizing the efficiency of benefits received by the disability community.

Sources:
. “Medicaid and the Uninsured .” The Henry J. Kaiser Family Foundation. Kaiser Commission, n.d. Web. <http://www.kff.org/medicaid/upload/8312.pdf>.
. “Candidate Romne’ys Medicaid Reform Could Devastate Governor Romne’ys Health Care Reform.” . Think Progress, n.d. Web. <http://thinkprogress.org/health/2012/05/04/477881/romney-medicaid-romneycare/?mobile=nc>.

. “New Jersey Delays Shift to Medicaid Managed Long-Term Care Programs.” . Professional Healthcare Institute, 9 Jan 2014. Web. <http://phinational.org/blogs/new-jersey-delays-shift-medicaid-managed-long-term-care-programs>.

.”Medicaid Managed Long Term Services and Supports (MLTSS).” .Department of Human Services, n.d. Web. <http://www.state.nj.us/humanservices/dmahs/home/mltss.html>.

. “The Case for Inclusion-2014.” United Cerebral Palsy, n.d. Web. <http://cfi2014.ucp.org/wp-content/uploads/2014/03/Case-for-Inclusion-2014.pdf>.

“National Disability Policy: A Progress Report – October 2013.” National Council on Disability, 31 Oct. 2013. Web. <http://www.ncd.gov/progress_reports/10312013>.