MEDICAID & HOME AND COMMUNITY-BASED SERVICES
Medicaid & HCBS Policy Documents
Statewide Transition Plans:
ACCSES expects Congress and the Administration to continue to push expansion of Medicaid managed care (MMC) and other delivery reforms, including implementation of these changes for individuals with developmental and intellectual disabilities. There is an emerging interest within the Centers for Medicaid and Medicaid Services (CMS) and the states in the use of Accountable Care Organizations (ACO) as a service delivery model. Implementation of the Affordable Care Act (ACA) will also continue at an exceptional pace, as the U.S. Department of Health and Human Services (HHS) oversees the activities of the health insurance exchanges and states consider, prepare for, and implement a significant expansion of the Medicaid program.
Congress continues to struggle with long-term care policy. Medicaid provides the bulk of the country’s long-term services and supports (LTSS), and some policymakers are looking to either establish a new entitlement program for LTSS or to add a new LTSS benefit to Medicare, similar to how a hospice benefit was added to the program.
Many states have opted to provide LTSS in the home and community under Medicaid waivers. States also have participated in a number of Medicaid demonstrations aimed at caring for people in their home and community. For example, the Money Follows the Person Demonstration, first authorized by Congress as part of the Deficit Reduction Act of 2005 and then extended in 2010 through the ACA, is designed to transition people living in long-term care institutions into the community and to change state policies so that Medicaid funds for long-term care services and supports can “follow the person” to the setting of his or her choice.
In 2012, the Administration combined multiple agencies: The Office on Aging, the Administration on Intellectual and Developmental Disabilities and the HHS Office on Disability, which ran the Community Living Initiative tasked with expanding home and community-based services for people with disabilities, into one agency called the Administration on Community Living (ACL). The ACL continues to become more involved in HCBS issues and provides another venue from which to communicate more effectively with CMS on HCBS issues.
With the economy under great pressure, and as the demographics of an aging population drives demand while resources are stretched, changes in the long-term care system may result in unintended consequences. For individuals with intensive support needs, including 24-hour supervision and professional services like nursing care, adequate care options must continue to be available including appropriate settings where high level-of-care needs can be met.
ACCSES will defend individuals’ access to the services and supports they need to live, work and play in their communities. We will not allow the federal government and states to balance their budgets by eliminating life giving services and supports that individuals with disabilities rely on.
ACCSES will protect Medicaid programs for people with disabilities, and will fight attempts to reduce services and hurt people in MMC programs that are driven by corporate profits and supported by the short-term thinking of some politicians.
ACCSES will work to ensure that any efforts to include people with disabilities in managed care arrangements, particularly with respect to Medicaid long-term services and supports, adequately address concerns with a state’s ability and capacity to serve people with disabilities and maintain the types of Medicaid benefits currently available under Medicaid waivers and demonstration projects.
ACCSES will monitor the development and utilization of the ACO model and disseminate relevant information to the field.
ACCSES will defend individuals with disabilities access to Medicaid and will oppose federal or state proposals to eliminate or reduce support for Medicaid by decoupling the federal entitlement, capping the federal share of Medicaid costs, block-granting the program, or repealing the Medicaid expansion, and other mechanisms that seek to reduce the federal commitment to Medicaid services for people with disabilities.
ACCSES will ensure its members are a recognized part of care coordination efforts by HHS, along with the medical community. ACCSES will highlight the cost-effectiveness of its services, as opposed to expensive interventions such as the emergency room.
ACCSES will ensure that the regulations and sub-regulatory guidelines implementing the Medicaid HCBS program are clarified to enhance the full array of service options consistent with informed choice and person-centered planning.
ACCSES will assess each new step of implementation of the ACA, including benefits coverage by qualified health plans and Medicaid alternative benchmark plans, for the benefit of coverage of home and community-based benefits and habilitation benefits, and lead opposition to potential threats to optional services under Medicaid waivers.
ACCSES will promote independent, community living by developing relationships with ACL staff and political appointees and commenting on agency programs.
ACCSES will ensure that an appropriate array of long-term care services, supports and settings are adequately funded and available to meet the needs and choices of individuals, including those who require intensive levels of care.
ACCSES will monitor and support the efforts of CMS and state programs that offer funding for assistive technology that help individuals transition from institutions and into the community.
ACCSES will monitor implementation of the ACA employer shared responsibility provisions, advocate for appropriate regulations that impact ACCSES members as employers and provide ACCSES members with guidance on compliance with the regulations.