For the complete power point presentation regarding the benefits of Medicaid Expansion or additional documents and information please visit the Center on Law and Povertys website:
www.nmpovertylaw.org
Friday, October 26, 2012
Center on Law and Poverty Medicaid Expansion presentation
The following informatio was shared with Tribal Governors and programs at a event hosted by AIPC and the Center on Law and Poverty.
For the complete power point presentation regarding the benefits of Medicaid Expansion or additional documents and information please visit the Center on Law and Povertys website:
www.nmpovertylaw.org
For the complete power point presentation regarding the benefits of Medicaid Expansion or additional documents and information please visit the Center on Law and Povertys website:
www.nmpovertylaw.org
NMICoA Health Committee comments for NCAI
October 23, 2012
NMICoA Health Committee commentary for Nation Congress of American Indians
The New Mexico Indian Council on Aging (NMICoA) Health Committee was develop by its late President, Archie Chavez of Sandia Pueblo, in 2008 to address Healthcare concerns of Pueblo Seniors. The Impetus of the Health committee formation was the institution of the Coordination of Long Term Services (CoLTS) program by the State of NM. The CoLTS program which served seniors eligible and enrolled in Medicaid had a mandate for seniors to be enrolled in a managed care program contracted by the NM Human Services Department, in order to receive medically associated services and benefits in a more coordinated fashion. The implementation of CoLTS for NM Native American (NA) seniors brought many problematic issues with outreach and education of the program, as well as, with service coordination, delivery, utilization, and reimbursement. The CoLTS implementation experience was the second that Native Americans had with Managed Care and now NM is planning to implement Centennial Care to replace the many Medicaid programs. The NMICoA Health Committee has been following the implementation of Patient Protection and Affordable Care Act (PPACA) and Medicaid Reform in NM, and has the following comments for consideration.
There is a Government to Government Relationship that exists between the Tribes, States and the Federal Government. There has been a serious lack of true Consultation and Collaboration between Tribes and the State of NM Human Services Department (HSD). The State of NM by law has mandated that all State Agencies must consult with Tribes on any issue will affect Tribal Communities. The Federal Government also has many rules and regulations governing consultation with Tribes. It is the opinion of the NMICoA Health Committee that the State of NM has not achieved true consultation with Tribes.
NM HSD 1115 Waiver “Centennial Care” while has many merits and improvements to the Medicaid program, is opposed by all Tribes in NM due to:
Medicaid Expansion for the State of NM would be a great economic boost to NM and Tribal Communities. The decision whether or not to accept the Expansion of Medicaid from CMS solely belongs to Governor Martinez office. Given the Government to Government relationship between the States Tribes and Federal Governments:
NM Health Insurance Exchange (NMHIX) while is an important component of the PPACA, is not ideal as a means health care delivery for Native Americans. The Snyder Act of 1921 obligated the Federal Government to provide the Tribes with Housing, Education, and Healthcare. Forcing the Tribes to “buy in” or purchase health insurance, while has some advantages, takes the burden of obligation to provide healthcare off the Federal Government. This will also continue to erode tribal sovereignty in that Managed Care Plans and Private Health Insurance Plans do not share the same Government to Government relationship. Here in the state of NM there has still been no formal consultation between Tribes and the State on NM regarding the development and implementation of a Health Insurance Exchange.
Respectfully Submitted by
Dr. Ron Lujan
Committee Member
NMICoA Health Committee
NMICoA Health Committee commentary for Nation Congress of American Indians
The New Mexico Indian Council on Aging (NMICoA) Health Committee was develop by its late President, Archie Chavez of Sandia Pueblo, in 2008 to address Healthcare concerns of Pueblo Seniors. The Impetus of the Health committee formation was the institution of the Coordination of Long Term Services (CoLTS) program by the State of NM. The CoLTS program which served seniors eligible and enrolled in Medicaid had a mandate for seniors to be enrolled in a managed care program contracted by the NM Human Services Department, in order to receive medically associated services and benefits in a more coordinated fashion. The implementation of CoLTS for NM Native American (NA) seniors brought many problematic issues with outreach and education of the program, as well as, with service coordination, delivery, utilization, and reimbursement. The CoLTS implementation experience was the second that Native Americans had with Managed Care and now NM is planning to implement Centennial Care to replace the many Medicaid programs. The NMICoA Health Committee has been following the implementation of Patient Protection and Affordable Care Act (PPACA) and Medicaid Reform in NM, and has the following comments for consideration.
There is a Government to Government Relationship that exists between the Tribes, States and the Federal Government. There has been a serious lack of true Consultation and Collaboration between Tribes and the State of NM Human Services Department (HSD). The State of NM by law has mandated that all State Agencies must consult with Tribes on any issue will affect Tribal Communities. The Federal Government also has many rules and regulations governing consultation with Tribes. It is the opinion of the NMICoA Health Committee that the State of NM has not achieved true consultation with Tribes.
NM HSD 1115 Waiver “Centennial Care” while has many merits and improvements to the Medicaid program, is opposed by all Tribes in NM due to:
Centennial Care will mandate that all NA will be enrolled into a Managed Care Organization (MCO) this will take the coordination of care out of the hands of Tribal programs and place it with an undetermined urban based MCO.
The Elimination of the “opt out” category for NA enrolled in Medicaid. Since the 1990s NA have had the option of on obtaining Medicaid Services through a “Fee For Services” category, and today approximately 80% of NA still are opt out of managed care.
Lack of meaningful consultation and collaboration with NM HSD and Medical Assistance Division (MAD), in documents submitted with the Centennial Care Waiver to CMS tribal statement comments and participation were misrepresented. Consultation with all Tribes was not achieved and not all information discussed and presented to HSD was included.
Due to these issues the Tribes and Pueblos of NM are unified in their opposition to the State of NMs imposition of Centennial Care on Tribal peoples.
Medicaid Expansion for the State of NM would be a great economic boost to NM and Tribal Communities. The decision whether or not to accept the Expansion of Medicaid from CMS solely belongs to Governor Martinez office. Given the Government to Government relationship between the States Tribes and Federal Governments:
By law before any decision is made regarding the use of Federal funding that will have a significant impact on Tribal Governments or Programs all State and Federal Agencies must consult with Tribes. Does the decision to Expand Medicaid require consultation due to the Federal Funding attached to the Medicaid program?
If the State of NM decides not to expand Medicaid for the Non Native population can the Governor make this decision on behalf of Tribes. This is a question of Tribal Sovereignty.
If the States and Tribes do not agree on Expansion of Medicaid will CMS grant a Waiver to Tribes to expand their programs independent of the States?
NM Health Insurance Exchange (NMHIX) while is an important component of the PPACA, is not ideal as a means health care delivery for Native Americans. The Snyder Act of 1921 obligated the Federal Government to provide the Tribes with Housing, Education, and Healthcare. Forcing the Tribes to “buy in” or purchase health insurance, while has some advantages, takes the burden of obligation to provide healthcare off the Federal Government. This will also continue to erode tribal sovereignty in that Managed Care Plans and Private Health Insurance Plans do not share the same Government to Government relationship. Here in the state of NM there has still been no formal consultation between Tribes and the State on NM regarding the development and implementation of a Health Insurance Exchange.
Respectfully Submitted by
Dr. Ron Lujan
Committee Member
NMICoA Health Committee
Converting Medicaid to Block Grants
From the National Committee to Protect Social Security and Medicare (NCPSSM)
Santa Fe New Mexican Article "Extending Medicaid is an opportunity for New Mexico"
Extending Medicaid is an opportunity for New Mexico
Nick Estes | MyView
Posted: Saturday, October 20, 2012 - 10/20/12
Posted: Saturday, October 20, 2012 - 10/20/12
The Santa Fe New Mexican has urged the governor and Legislature in an editorial to take the federal government up on the incredible opportunity to expand Medicaid coverage to 150,000 or more low-income, uninsured New Mexicans under the Affordable Care Act. That editorial is spot-on.
This is an incredible deal for the state. The federal government will pay 100 percent of the costs for the first three years and then phase down the percentage over three years, but never lower than 90 percent.
This summer, Gov. Susana Martinez said she was worried about how much this would cost the state, but it turns out that the deal is even better than she expected. That’s because new state tax revenues generated by the Affordable Care Act will more than cover even the modest state costs. The state’s Insurance Premium Tax will apply when the Medicaid program buys insurance for newly covered individuals. Other state taxes will be generated as these individuals obtain health care and the spending circulates in the rest of the economy. Thousands of new jobs will be created.
The Legislative Finance Committee staff recently concluded that, during the first seven years, the state general fund would actually come out ahead expanding Medicaid — by $341 million. At the same time, we will improve our economy by thousands of jobs and significantly improve the health of 150,000 or more New Mexicans. This is truly a win-win proposition.
After 2019, the state will have to pay 10 percent of the cost for these newly eligible individuals. But new state tax revenues from Medicaid federal funds, plus the federal subsidies to individuals who buy health insurance in the new exchange, should continue to equal or exceed the state’s share of expanding Medicaid.
Cost to the state is simply not a factor in deciding whether to extend Medicaid to some of our most vulnerable citizens.
These individuals are mostly the “working poor” — people who have jobs that don’t provide health insurance. Some of these individuals are uninsured veterans, one-half of whom are counting on getting care through the Affordable Care Act, including the Medicaid expansion, according to a report by the Urban Institute. These folks deserve health coverage.
Perhaps for the first time in their lives, 150,000 of our fellow citizens will be able to get medical care outside the emergency room. They will get regular checkups and preventive services, as well as follow-up care and prescription drugs. Besides, the state and counties pay a lot of these costs already — costs that will be mostly covered by the federal government when we extend Medicaid and implement the rest of the Affordable Care Act. It will also help reduce the “cost shift” onto those who have insurance, which amounts to $2,300 per year per family in New Mexico (the highest rate in the country).
Because “Obamacare” is law, implementing the Medicaid expansion will keep the New Mexico dollars paid in federal taxes in the state, where they will benefit New Mexicans. Many other states will choose to expand Medicaid and will use our tax dollars to do so if we don’t act.
More recently, the governor has asked the federal government if she can delay coverage to some poor New Mexicans or leave them out of the Medicaid expansion altogether and force them into the health insurance exchange, where they would likely not be able to afford coverage. Failing to fully expand Medicaid would not only be fiscally unwise but incredibly unfair to some of our lowest-income neighbors and friends. Leaving them out would leave a huge gap in health insurance coverage in New Mexico and burden emergency rooms again.
We hope that Gov. Martinez and the Legislature will take this opportunity to improve our citizens’ health and our economy at the same time.
Nick Estes is a deputy policy director at New Mexico Voices for Children, a statewide child advocacy organization.
Native American Subcommittee of the MAC comments
The following is a description of the Native American Subcommittee of the MAC by Mr Greg Ortiz:
Following is a brief report of the "Native American Subcommittee of the MAC" which was held at the
Los Griegos Center, 1231 Candelaria Road NW, Albuquerque,NM, 1:00pm-4:00pm.
Committee members present at this meeting: Julie Weinberg (Director, HSD-Medical Asstnc.Div), Dave Antle,
Adm.Richie Grinnell (Regional Director Albuquerque Area IHS), Floyd Thompson (Navajo Area IHS), Suzie (Behavioral Health Dir.-Eastern Navajo IHS),
Theresa Belanger (Tribal Liaison HSD-Medical Asstnc.Div).
Agenda:
1.) Introductions: Ms.Weinberg opened and facilitated the meeting. Self-introductions of committee members and audience.
2.) Organizational items:
a.) Define subcommittee's mission: Ms.Weinberg inquired from the members about 'who and how' does this committee communicate with Pueblos, Tribes and Nations? What are the best methods of communication? 'How' does this committee want to organize themselves?
*Ms.Weinberg stated that this is a "new" committee (sub-committee of a sub-committee) and this is her first time creating such an organization/committee which is a second attempt to engage the indigenous Pueblos, Tribes and Nations in more appropriate, proper "Tribal Consultation" per Native American recommendations.
-There was mention of a "Native American Advisory Council" which is a committee to directly engage with the MCO's and a Native American person is a member of this committee(?). Identity of the person was not revealed.
-There may still be some confusion about roles and membership of the: Native American Subcommittee of the MAC, Native American Advisory Council and
this "new" Committee. She will take the input of this "new" committee as her guidance.
*Ms.Weinberg comments and recommendations: use of the RAM meetings for training, i.e. IHS, others(?);
waive any cost-sharing for Native Americans (Sec. 115 says cost-sharing would not apply to Native Americans);
"Presumptive Eligibility" allows temporary eligibility (60 days) for services to persons presenting themselves as Native American.
-This is in answer to Adm.Grinnell's question about "how" they (State) will determine 'who' is an Indian and thus eligible for services.
She also hopes the MCO's will rely on local Native American workers, organizations, etc. to aid in the distribution of services and/or health care On-Rez/Off-Rez.
*Ms.Weinberg wants a smooth transition into Centennial Care and calendar year 2013 will be the ramp-up to the January 1st 2014 target date of implementation.
Other dates given: November 20(?), 2012 = Proposals Due; January 7, 2013 = Contracts Awarded
*Ms.Weinberg advises members (audience?) to read the RFP on-line at either:
HSD website: http://www.hsd.state.nm.us or MAD website: http://www.hsd.
b.) Other organizational items as suggested by Committee:
Floyd Thompson: recommends the Contractors be a part of this discussion so they will be made aware of what is required for outreach to rural communities, i.e. language, cultural competence, transportation.
Adm.Richie Grinnell: re-emphasizes the necessity of knowing and having specifics and the Contractors present as part of the meeting (committee?) without which this committee is greatly hampered. He also questions 'how' the State will determine 'who' is an Indian.
Suzie: notes the importance of having the Contractors make actual visits to the Native communities served so they will know first-hand the challenges providers may encounter as well as the challenges of the patients in their given community locations.
3.) Identify Readiness Year Issues and Concerns the Subcommittee will work on.
4.) Other topics
5.) Next Meeting(s), Frequency and Locations: December 2012 = Date/Time/Location to be determined.
6.) Public Input:
Mr.Eric Lujan: comments to Ms.Weinberg that he has repeatedly informed her how to communicate and engage tribal leaders and organizations and what defines bonafide "Tribal Consultation" and that this meeting should not be considered or recorded as "Tribal Consultation".
Summary: There was a noticeable absence of genuine recognized tribal leaders: Pueblo Governors, Presidents, Chairmen or Tribal Councilmen who appropriately should be at the table. *Ms.Weinberg said she sent letters to AIPC, So.Gov.s, 8NIPC, Apache, Navajo and others(?). I do not know if the letter was an invitation to participate as a member of this committee or as an attendee to the meeting. After the meeting I spoke with some committee members and the consensus is that this seems to be another attempt to place 'Tribal Consultation" on the record, which in my opinion, it is not.
Lastly, as of this note, I am not aware if Ms.Weinberg has made actual visits or had face-to-face discussion with tribal leaders On-Reservation/Off-
I would like to thank Mr Ortiz from Acoma for Sharing these comments so that I could post them for your information.
My other Comments were along the lines of: How are we (Tribes) suppose to take you (NMHSD) seriously now when you say that "we (NMHSD) are interested in best practice on cultural competency, outreach education, and how to engage Tribes both on the governmental and community level"? In the past 9 months I have and others have told you the wheres who's and hows of engaging Tribal Programs, we have told you over and over what we think of Centennial care both in person and in response commentary papers at consultations, and nothing of what we (Tribal people) want or think is included in the Centennial Care Waiver.
Friday, October 19, 2012
Medicaid Expansion meeting Recap
Good Afternoon everyone,
I would first like to Thank the All Indian Pueblo Council and the Center on Law Poverty for hosting this important meeting.
I think it was a success, there was alot of vital information that was distributed regarding the Expansion of Medicaid in NM. As was presented by the Center on Law and Poverty there is an overwheming argument supporting the Expansion of Medicaid. I will make the presentation available asap.
I would also like to Thank Jemez HHS staff for presenting on what to expect when your Healthcare Facility decides to accept CMS Funding and contracting with MCOs. April Wilkinson extended a welcome to any other Tribal program who is interested in touring JHHS, and is interested in learning more about best practices at Jemez, her email address is lwilkinson@jemezpueblo.org
I am glad that Through Lt Governor Gilbert Suazo's (Pueblo of Taos) request that AIPC is going to develop a resolution supporting Medicaid Expanson or a Seperate "Waiver for NA" to expand Medicaid on each individual Tribal Community. I am trying to organize a meeting of the "Kewa Workgroup" for the last week of October so that we can help formulate the resolution for AIPC.
details to follow
I would first like to Thank the All Indian Pueblo Council and the Center on Law Poverty for hosting this important meeting.
I think it was a success, there was alot of vital information that was distributed regarding the Expansion of Medicaid in NM. As was presented by the Center on Law and Poverty there is an overwheming argument supporting the Expansion of Medicaid. I will make the presentation available asap.
I would also like to Thank Jemez HHS staff for presenting on what to expect when your Healthcare Facility decides to accept CMS Funding and contracting with MCOs. April Wilkinson extended a welcome to any other Tribal program who is interested in touring JHHS, and is interested in learning more about best practices at Jemez, her email address is lwilkinson@jemezpueblo.org
I am glad that Through Lt Governor Gilbert Suazo's (Pueblo of Taos) request that AIPC is going to develop a resolution supporting Medicaid Expanson or a Seperate "Waiver for NA" to expand Medicaid on each individual Tribal Community. I am trying to organize a meeting of the "Kewa Workgroup" for the last week of October so that we can help formulate the resolution for AIPC.
details to follow
NM HIX Native American Work group meeting schedule change
REMINDER TO RSVP
The NA Work Group was scheduled to meet beginning in December, but it has been decided to move the dates of the Work Group to begin sooner.
With this in mind, the dates the Native American Work Group will be held are now:
October 23, 10:00 – noon – meeting will be held at Plaza San Miguel, 729 St. Michaels Drive, Room 33, Santa Fe, NM (Plaza San Miguel is between Payne’s Nursery and Daniels Insurance, across the street from Smith’s, near the corner of Pacheco and St. Michaels Drive).
November 7 – Time and location to be announced
November 28 – Time and location to be announced.
December 4 – Time and location to be announced
Attached is a copy of the ‘Premier’ and the agenda with call-in instructions for those who wish to participate but cannot attend in person.
Please RSVP for these meetings to Priscilla Caverly (Priscilla.caverly@state.nm.us
Priscilla Caverly, Tribal Liaison / HSD Office of the Secretary
PO Box 2348 / Santa Fe, NM 87504 / Phone 505-476-7203
These meetings are open to the Public, I encourage anyone who works is interested in learning more about the NM Health Insurance Exchange to attend
Erik
Native American Subcommittee of MAC details
I encourage Everyone who has a stake in Medicaid to attend this meeting
NATIVE AMERICAN SUBCOMMITTEE OF THE
MAC
October 22, 2012
1:00-4:00
Los Griegos Center
1231 Canderlaria Road NW
Albuquerque, NM 87107
Agenda
1. Introductions
2. Organizational Items
a. Define subcommittee’s mission
b. Other organizational items as suggested by Committee
3. Identify Readiness Year Issues and
Concerns the Subcommittee Will Work On
4. Other topics
5. Next Meetings-Frequency and
Locations
6. Public Input
Thursday, October 11, 2012
Letter from Rep Heinrich to HHS Sec. Sebilius
This is a Letter from Representative Martin Heinrich's office to HHS Secretary Sebelius regarding Tribal Consultation in NM
Monday, October 8, 2012
NMICOA Quarterly Meeting details
NMICOA
Meeting October 25, 2012 Acoma Community Center
9
am Acoma Color Guard, Opening Prayer, and Welcome Roll Call and Introduction of Special Guests
9:30
New Mexico and Medicaid Changes in Plain English
Roxanne
Bly (Laguna), Laguna Health Committee and Rainbow Board President
10:15
Update on Social Security in Plain English
Gene
Varela, AARP (AARP Requested presentation)
11 Update
from the Title VI--Ray Espinosa
11:15
Generational Abuse with the emphasis on Elder Abuse:
A
personal perspective
Christine
Lowery, Professor in Social Work
11:35
Acoma Head Start Dancers
12
Lunch
1:15
NMICOA Business Meeting (Roll Call, if needed)
Review
of Proposed Bylaws and vote
Review
of Proposed Bylaws and vote
ELECTIONS
FOR PRESIDENT AND SECRETARY
Please
have your nominations ready
3
p.m. Adjourn
ABQ News Artilce "Editorial: N.M. Should Embrace Medicaid Expansion"
Editorial: N.M. Should Embrace Medicaid Expansion
It is time for New Mexico to bite the Medicaid expansion bullet.
Contrary to what advocates argue, this isn’t a no-brainer game-changing panacea. It’s just that after weighing the pros and cons, the scales come down on the side of doing it.
As a result of the U.S. Supreme Court affirmation of the Affordable Care Act of 2010, states have the option of expanding Medicaid. The federal government has promised to pick up the lion’s share of the cost.
The ACA — aka Obamacare — would extend Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level. If that happens, about 170,000 New Mexicans could be added to the state’s Medicaid rolls.
Medicaid, which currently pays health care costs primarily for low-income children, the elderly and disabled people, is jointly financed by the federal and state governments. It currently covers about one-fourth of New Mexico’s population, or about 550,000 people, most of them children. At this time the feds pay about three-fourths of the state’s roughly $4 billion program annually.
Proponents say that in addition to increasing the number of people who have health care coverage, the expansion will inject billions of dollars into the state economy, develop a more robust health care infrastructure especially in rural areas and create thousands of jobs in the health care industry and in other businesses as a result of the increased economic activity.
With the feds picking up virtually 100 percent of the cost for the first three years of expansion starting in 2014 — although the state Human Services Department says it could be 97 percent — and 90 percent thereafter through 2020, what’s not to like?
A lot. A good argument can be made that it’s bad policy for the country. All this infusion of cash comes from the federal government, which doesn’t have any. So this is borrowed money.
And for New Mexico, at some point we need to be good at something other than poverty as a way of generating economic activity.
Plus, the state will have to cough up a larger share — an estimated additional $320 million to $500 million for 2014 through 2020.
Ultimately it’s up to Gov. Susana Martinez to decide whether the state takes the federal government up on its offer. But either way, New Mexicans’ federal taxes will go into a pot to pay for Medicaid expansion in the states that participate.
A sticking point is that adding upward of 170,000 eligible New Mexicans to the program is going to slam the state’s already burdened health care system that is desperately short, especially in rural areas, of medical personnel — up to 600 primary care physicians and 1,000 nurses.
That will require a sea change in how services are delivered. Instead of automatically seeing a primary care doctor, patients might see a nurse practitioner or a physician’s assistant, or have their meds prescribed by a pharmacist. More thought might go into what medical services are really necessary. Large providers have already started gearing up for the influx of new patients.
Some prognosticators say having more people with access to routine and preventative care should help dampen costs overall by decreasing the use of emergency rooms for nonemergencies. And some say having nearly everyone covered for medical services will keep costs down in the long run for those who have insurance, as providers will no longer have to make up for people who don’t pay their bills by raising the premiums of the insured. Time will tell whether any of that is true. While advocates say this will keep people out of hospitals, UNMH is already citing the expansion as one reason it needs more acute care hospital beds.
While polls show America is divided on the Affordable Care Act as a whole, it is clear that opting out will do nothing for New Mexicans. Although it will increase the amount of money spent on health care in the state budget, New Mexico can’t afford to walk away from the federal government’s offer — and the expansion is aimed at people in need.
Martinez has shown real compassion on public safety net issues before, and this is a chance — not a sure bet — to offer more New Mexicans a healthier future.
She should sign New Mexico up.
This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.
Kaiser Health News Article "How Will The Election Change Medicaid?"
How Will The Election Change Medicaid?
The future of Medicaid -- the state-federal workhorse of the nation's health system that provides health coverage to the poorest and sickest Americans -- hangs in the balance on Election Day.
President Barack Obama and Republican nominee Mitt Romney have vastly different approaches to the program. Medicaid is the backbone of the 2010 health law -- considered Obama's signature legislative achievement -- which, starting in 2014, expands coverage to 30 million uninsured Americans. As many as 17 million of those newly insured citizens will be on Medicaid. Romney would turn over much control of the program to states and give them new powers to tailor benefits and eligibility to their own budget needs. Romney says such a move would begin saving $100 billion per year by 2016.
The following list of "frequently asked questions" provides more details on the presidential candidates' plans for Medicaid.
What is Medicaid?
Created in 1965, Medicaid is jointly financed by the federal government and the states. States administer the program but the federal government sets minimum income and eligibility thresholds, targeting low-income children and their parents, the elderly and people with disabilities. It also sets minimum benefits that state Medicaid plans must provide. States can build on these requirements and, as a result, eligibility rules vary widely. The program now covers about 60 million Americans, of which about half are children. Medicaid pays for nearly two-thirds of nursing home residents and about 40 percent of births.
Medicaid is an open-ended entitlement program in which the federal government matches state spending on health insurance. Match rates range from 50 percent to 73 percent, depending on a state's per capita income, with poorer states receiving higher rates. The average federal match is 57 percent.
How does President Obama's health care reform law change Medicaid?
The 2010 law eliminates varying eligibility rules and, starting in 2014, provides Medicaid coverage to everyone with incomes less than 133 percent of the federal poverty level, which today is nearly $31,000 for a family of three.
This expansion could add as many as 17 million people to Medicaid over the next decade if all states adopt the change. Most of the newly eligible would be adults without children who currently are not covered in most states.
The Supreme Court ruling which upheld the health care reform law made this expansion optional for states. Several Republican governors have already said they would not take the extra federal money to expand the program.
Under the law, the federal government pays the full cost for those newly eligible for Medicaid from 2014 to 2016, then states have to begin to contribute to the cost but no more than 10 percent by 2020. States will receive their current federal funding match rate for people currently eligible.
What has Mitt Romney proposed for Medicaid?
Romney wants to overturn the health law and the Medicaid expansion. Instead, he proposes converting the program into a block grant to states -- a fixed annual allotment of money. Payments from the federal government would grow at 1 percentage point above inflation a year, which would slow funding, in exchange for fewer federal rules on how states can use the money.
According to the Romney campaign, the block-grant approach will save an estimated $100 billion per year by 2016.
Repealing the health care reform law would reduce Medicaid spending by $618 billion over the next 10 years, according to the Center on Budget and Policy Priorities and Romney's additional cuts would mean a total of at least $1.4 trillion in cuts over a decade.
Such a cut would be even more than the plan for Medicaid that passed the U.S. House of Representatives, a bill that was authored by House budget chairman and vice presidential nominee Rep. Paul Ryan.
The House plan to block grant Medicaid would curtail Medicaid spending by $810 billion over 10 years, according to the Congressional Budget Office. In 2022, federal Medicaid funding would be about 34 percent less than states would receive under current law, according to an analysis by the Center on Budget and Policy Priorities. Under Ryan's block grant proposal, between 14 million and 27 million fewer people would be covered in 2021 than under Medicaid as it currently exists, according to an Urban Institute analysis. With less money, states are certain to reduce benefits and ask recipients to pay more for care, among other changes.
Which states have the most to gain under the Obama administration's Medicaid plans?
Florida, Texas, Mississippi and other states that have traditionally had the tightest eligibility for Medicaid and a large percentage of uninsured citizens have the most to gain under the federal health law. But these states are among those saying they won't expand Medicaid because they don't think they'll have money to pay their share starting in 2017. They also worry that the health law would increase their Medicaid costs as people who were previously eligible but not enrolled would sign up. Under this scenario, the state would have to pay its share of the costs for these people because their eligibility does not result from the health law. States such as Vermont that already cover residents up to 133 percent of the federal poverty level in Medicaid would not gain much new funding.
What would states do with more flexibility if, as Romney wants, Medicaid becomes a block grant?
In tough economic times -- when Medicaid is most needed but when state revenues are squeezed -- states could be expected to tighten eligibility or reduce benefits. The Obama administration has given states the ability to cut optional Medicaid benefits such as vision and dental services and prescription drugs. But the administration has been reticent to allow states to shift higher costs on Medicaid recipients or force them to pay premiums or large-co pays for services. If the program turned into a block grant, states would likely have more freedom to shift higher costs onto recipients or make it harder for them to sign up.
Are there enough doctors to handle 17 million more Medicaid recipients under the health care reform law?
The safety net would feel some strain, though it still has a few years to get ready as not everyone would sign up immediately. Today, approximately 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study by the Centers for Disease Control and Prevention. New Jersey had the nation's lowest rate at 40 percent, while Wyoming had the highest, at 99 percent.
To increase the number of providers the health law does two things: It spends $11 billion to expand community health centers, which provide primary care to millions of Medicaid recipients. The law also gives a pay raise to primary care physicians treating Medicaid patients. In 2013 and 2014, primary care physicians would be paid at Medicare rates, which equates to about a 30 percent average pay hike nationally.
How much will it cost to add 17 million to Medicaid and how can the nation even afford it?
The Medicaid expansion makes up a big chunk of the health law's $930 billion price tag over the next decade, according to the Congressional Budget Office. But the money won't increase the federal budget deficit because the law is being funded by new taxes and penalties. These include a new excise tax on high-premium insurance (Cadillac) plans, equal to 40 percent of premiums paid on plans costing more than $27,500 annually for a family, starting in 2018; an increase in Medicare payroll taxes on couples with income of more than $250,000 a year; and new fees on insurance companies, pharmaceutical companies and medical device manufacturers.
Why can't states experiment with new health care delivery methods with Medicaid now?
Actually, they can and they are. Dozens of states in recent years have hired private managed care firms such as Aetna or United Healthcare to cover millions of Medicaid recipients, and the trend is expected to continue regardless of who wins the election. States are also experimenting with such things as bundling payment to hospitals and doctors, establishing medical homes where doctors' offices are paid to coordinate patient care for those with chronic illnesses and forming accountable care organizations that allow providers to share in savings if they can meet certain quality measures. While the federal government has to approve state experiments, what often hinders their efforts is getting consensus from stakeholders such as nursing homes, hospitals, physicians and consumer advocates.
Why should those who don't know anyone on Medicaid care about the candidates' positions?
No one knows when they will lose their job and health benefits and have to rely on Medicaid for themselves or their children. While the program pays for 60 percent of nursing home residents, most of them only become eligible after depleting their savings to pay for the care. Most hospitals are also heavily reliant on Medicaid funds so their ability to remain financially healthy depends on the program. Medicaid is also an economic engine in most states as the money goes to doctors, device makers, durable medical equipment makers and others.
Why is Medicaid such a hot issue this year?
Medicaid costs have risen markedly in the past several years due largely to the economic downturn, and the program is in the crosshairs of Capitol Hill deficit hawks. At the state level, Medicaid is usually the first or second costliest program and many governors have been asking for more flexibility to rein in spending. Since 2009, when Congress gave states billions dollars of extra Medicaid funding in the federal stimulus law, the federal government has required states to maintain current eligibility levels. The provision was continued in the 2010 federal health law, though it expires in 2014
The future of Medicaid -- the state-federal workhorse of the nation's health system that provides health coverage to the poorest and sickest Americans -- hangs in the balance on Election Day.
President Barack Obama and Republican nominee Mitt Romney have vastly different approaches to the program. Medicaid is the backbone of the 2010 health law -- considered Obama's signature legislative achievement -- which, starting in 2014, expands coverage to 30 million uninsured Americans. As many as 17 million of those newly insured citizens will be on Medicaid. Romney would turn over much control of the program to states and give them new powers to tailor benefits and eligibility to their own budget needs. Romney says such a move would begin saving $100 billion per year by 2016.
The following list of "frequently asked questions" provides more details on the presidential candidates' plans for Medicaid.
What is Medicaid?
Created in 1965, Medicaid is jointly financed by the federal government and the states. States administer the program but the federal government sets minimum income and eligibility thresholds, targeting low-income children and their parents, the elderly and people with disabilities. It also sets minimum benefits that state Medicaid plans must provide. States can build on these requirements and, as a result, eligibility rules vary widely. The program now covers about 60 million Americans, of which about half are children. Medicaid pays for nearly two-thirds of nursing home residents and about 40 percent of births.
Medicaid is an open-ended entitlement program in which the federal government matches state spending on health insurance. Match rates range from 50 percent to 73 percent, depending on a state's per capita income, with poorer states receiving higher rates. The average federal match is 57 percent.
How does President Obama's health care reform law change Medicaid?
The 2010 law eliminates varying eligibility rules and, starting in 2014, provides Medicaid coverage to everyone with incomes less than 133 percent of the federal poverty level, which today is nearly $31,000 for a family of three.
This expansion could add as many as 17 million people to Medicaid over the next decade if all states adopt the change. Most of the newly eligible would be adults without children who currently are not covered in most states.
The Supreme Court ruling which upheld the health care reform law made this expansion optional for states. Several Republican governors have already said they would not take the extra federal money to expand the program.
Under the law, the federal government pays the full cost for those newly eligible for Medicaid from 2014 to 2016, then states have to begin to contribute to the cost but no more than 10 percent by 2020. States will receive their current federal funding match rate for people currently eligible.
What has Mitt Romney proposed for Medicaid?
Romney wants to overturn the health law and the Medicaid expansion. Instead, he proposes converting the program into a block grant to states -- a fixed annual allotment of money. Payments from the federal government would grow at 1 percentage point above inflation a year, which would slow funding, in exchange for fewer federal rules on how states can use the money.
According to the Romney campaign, the block-grant approach will save an estimated $100 billion per year by 2016.
Repealing the health care reform law would reduce Medicaid spending by $618 billion over the next 10 years, according to the Center on Budget and Policy Priorities and Romney's additional cuts would mean a total of at least $1.4 trillion in cuts over a decade.
Such a cut would be even more than the plan for Medicaid that passed the U.S. House of Representatives, a bill that was authored by House budget chairman and vice presidential nominee Rep. Paul Ryan.
The House plan to block grant Medicaid would curtail Medicaid spending by $810 billion over 10 years, according to the Congressional Budget Office. In 2022, federal Medicaid funding would be about 34 percent less than states would receive under current law, according to an analysis by the Center on Budget and Policy Priorities. Under Ryan's block grant proposal, between 14 million and 27 million fewer people would be covered in 2021 than under Medicaid as it currently exists, according to an Urban Institute analysis. With less money, states are certain to reduce benefits and ask recipients to pay more for care, among other changes.
Which states have the most to gain under the Obama administration's Medicaid plans?
Florida, Texas, Mississippi and other states that have traditionally had the tightest eligibility for Medicaid and a large percentage of uninsured citizens have the most to gain under the federal health law. But these states are among those saying they won't expand Medicaid because they don't think they'll have money to pay their share starting in 2017. They also worry that the health law would increase their Medicaid costs as people who were previously eligible but not enrolled would sign up. Under this scenario, the state would have to pay its share of the costs for these people because their eligibility does not result from the health law. States such as Vermont that already cover residents up to 133 percent of the federal poverty level in Medicaid would not gain much new funding.
What would states do with more flexibility if, as Romney wants, Medicaid becomes a block grant?
In tough economic times -- when Medicaid is most needed but when state revenues are squeezed -- states could be expected to tighten eligibility or reduce benefits. The Obama administration has given states the ability to cut optional Medicaid benefits such as vision and dental services and prescription drugs. But the administration has been reticent to allow states to shift higher costs on Medicaid recipients or force them to pay premiums or large-co pays for services. If the program turned into a block grant, states would likely have more freedom to shift higher costs onto recipients or make it harder for them to sign up.
Are there enough doctors to handle 17 million more Medicaid recipients under the health care reform law?
The safety net would feel some strain, though it still has a few years to get ready as not everyone would sign up immediately. Today, approximately 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study by the Centers for Disease Control and Prevention. New Jersey had the nation's lowest rate at 40 percent, while Wyoming had the highest, at 99 percent.
To increase the number of providers the health law does two things: It spends $11 billion to expand community health centers, which provide primary care to millions of Medicaid recipients. The law also gives a pay raise to primary care physicians treating Medicaid patients. In 2013 and 2014, primary care physicians would be paid at Medicare rates, which equates to about a 30 percent average pay hike nationally.
How much will it cost to add 17 million to Medicaid and how can the nation even afford it?
The Medicaid expansion makes up a big chunk of the health law's $930 billion price tag over the next decade, according to the Congressional Budget Office. But the money won't increase the federal budget deficit because the law is being funded by new taxes and penalties. These include a new excise tax on high-premium insurance (Cadillac) plans, equal to 40 percent of premiums paid on plans costing more than $27,500 annually for a family, starting in 2018; an increase in Medicare payroll taxes on couples with income of more than $250,000 a year; and new fees on insurance companies, pharmaceutical companies and medical device manufacturers.
Why can't states experiment with new health care delivery methods with Medicaid now?
Actually, they can and they are. Dozens of states in recent years have hired private managed care firms such as Aetna or United Healthcare to cover millions of Medicaid recipients, and the trend is expected to continue regardless of who wins the election. States are also experimenting with such things as bundling payment to hospitals and doctors, establishing medical homes where doctors' offices are paid to coordinate patient care for those with chronic illnesses and forming accountable care organizations that allow providers to share in savings if they can meet certain quality measures. While the federal government has to approve state experiments, what often hinders their efforts is getting consensus from stakeholders such as nursing homes, hospitals, physicians and consumer advocates.
Why should those who don't know anyone on Medicaid care about the candidates' positions?
No one knows when they will lose their job and health benefits and have to rely on Medicaid for themselves or their children. While the program pays for 60 percent of nursing home residents, most of them only become eligible after depleting their savings to pay for the care. Most hospitals are also heavily reliant on Medicaid funds so their ability to remain financially healthy depends on the program. Medicaid is also an economic engine in most states as the money goes to doctors, device makers, durable medical equipment makers and others.
Why is Medicaid such a hot issue this year?
Medicaid costs have risen markedly in the past several years due largely to the economic downturn, and the program is in the crosshairs of Capitol Hill deficit hawks. At the state level, Medicaid is usually the first or second costliest program and many governors have been asking for more flexibility to rein in spending. Since 2009, when Congress gave states billions dollars of extra Medicaid funding in the federal stimulus law, the federal government has required states to maintain current eligibility levels. The provision was continued in the 2010 federal health law, though it expires in 2014
MEDICAID EXPANSION: What would it mean for Tribal health care services?
MEDICAID EXPANSION: What would
it mean for Tribal health care services?
The All
Indian Pueblo Council, the Leadership Institute and the New Mexico Center on
Law and Poverty have joined together to present information about the Medicaid
expansion which is authorized in the Affordable Care Act (ACA. Obamacare). Although the ACA contains a mandate requiring
the states to expand the Medicaid program to cover low-income uninsured
persons, the Supreme Court recently ruled that states cannot be penalized if
they do not expand the Medicaid program.
The decision to expand the program to cover the multitudes of low-income
uninsured citizens is left to the discretion of states’ governors and legislatures. In New Mexico the decision will be made by
Governor Susana Martinez.
Medicaid revenues are extremely
important to the operation of not only tribal and off-reservation health care
facilities but to Indian Health Service as well. The Service recovers about 60%
of payments that are billed under the Medicaid program. Medicaid payments are a significant portion
of the revenues tribal and off-reservation facilities need to maintain
services. The likelihood that
Congressional appropriations for Indian Health Service will be increased to
respond to the actual health care needs of Native Americans is not bright and
it is incumbent upon existing facilities to take advantage of all resources
available. Currently in our state, there
are 23,000 adult Native Americans eligible for Medicaid but not enrolled and
there are 13,000 Native American children who are eligible but not
enrolled. Working together, what can we
do to assure that our people receive the health care they need? Please join these discussions and bring your
knowledge and expertise to address this vital concern.
The All Indian Pueblo Council, the Leadership Institute and the
New Mexico Center on Law and Poverty invite you to
a Convening to discuss
MEDICAID EXPANSION: What would
it mean for Tribal healthcare services?
October 18, 2012 – Silver Room at the Indian Pueblo Cultural Center
9:00am to 1:00pm
AGENDA
MEDICAID
EXPANSION: What would it mean for Tribal
healthcare services?
October 18, 2012 –
9:00am to 1:00pm at the Indian Pueblo Cultural Center, Silver Room
2401 Twelfth Street
NW – 505-843-7270
Opening Prayer
Moderator: Evelyn
Blanchard, CLP Community Organizer
9:00am Welcome
Randall Vicente, Chairman, All
Indian Pueblo Council
Regis Pecos, Founder/Director,
The Leadership Institute Kim Posich, Executive Director, New Mexico
Center on Law and Poverty
9:30am Overview of Medicaid opportunity
Sireesha
Manne, J.D. and Kelsey Heilman, J.D. CLP
Healthcare Team Attorneys
New Mexico has reached a critical
moment—the state must decide whether or not to provide Medicaid healthcare
coverage to over 150,000 adults whose incomes fall under 138% of the poverty
level, starting in 2014. Of the 150,000
uncovered persons are approximately 24,000 adult Indian people and 13,000
Indian children. Currently, most adults
do not qualify for Medicaid unless they are pregnant, disabled or seniors. Although federal law requires states to
provide this new Medicaid coverage, the Supreme Court recently ruled that
states cannot be penalized if they do not comply with the law. As a result, some states are now refusing
this opportunity. Governor Martinez
remains undecided. In this presentation,
CLP attorneys will discuss the Medicaid opportunity, how it could benefit
uninsured residents and Native American communities, and its financial impact
on the state and healthcare sectors.
10:15am Question
and answer
10:30am The Benefits and Challenges of Tribal Contracting
with an MCO
April
L. Wilkinson, Program Specialist, Jemez Pueblo and Staff
Jemez Pueblo personnel will
describe the process through which the Pueblo contracted with Indian Health
Services to provide healthcare services to its people and what the Pueblo has
done to piece together the funding necessary to its operation. Panelists will discuss the interface that has
been established to be able to assure payments are received from MCOs. The information provided will introduce
tribes to the various considerations involved in contracting for services and
the retrieval of monies from MCOs and other sources of revenue.
11:15am Question
and answer
11:30am Break
11:45am Medicaid expansion and its implications for Indian healthcare
systems: Building our Expertise
Anthony Yepa, Management Analyst,
Kewa Pueblo Health Corporation Erik Lujan, Volunteer,
New Mexico Indian Council on Aging, Health Committee Quela Robinson, J.D., CLP Healthcare
Team Attorney
Medicaid expansion will have a
significant impact on Indian healthcare systems. From the perspective of their positions, the
panelists will discuss considerations and opportunities that can be realized
from the expansion and propose resources that need to be developed within
tribal/off-rez healthcare communities themselves to further the positive development
of Indian healthcare systems.
12:15pm Question
and answer
12:30pm Medicaid expansion: What can
tribal officials and native people, on and off-reservation, do to help 23,000
adult Indians and 13,000 eligible Indian children to secure healthcare coverage?
Randall Vicente,
Chairman, All Indian Pueblo Council
Regis Pecos, Founder/Director, The Leadership Institute
Kim Posich, Executive Director, New Mexico Center on Law and Poverty
Audience
response.
1:00pm Closing
prayer
Subscribe to:
Posts (Atom)