Day in Washington Podcast #27 – (Medicaid Moratorium)
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Episode Summary: In this episode we will be will be reviewing and providing a summary analysis on three of seven Medicaid regulations that have been proposed by the Center on Medicare and Medicaid Services (CMS). The disability community has been very involved for the past few months in legislative efforts to create a Medicaid moratorium to prevent the finalization of these rules. Although the purpose of the regulations is stated as reigning in out-of-control health care costs and preventing fraud and abuse, the result of the language of these regulations will significantly negatively impact people with disabilities. Although we’ve been told that these proposals are “bad” in this podcast we will be analyzing them to understand what they will actually do.
Audio File: Day in Washington Podcast #27 – (Medicaid Moratorium)
Show Notes
- Introduction, Date of Podcast
- Analysis of the Medicaid Regulation Regarding Payments for Ancilliary Services Under Case Management Plans
- Analysis of the Medicaid Regulation Regarding Rehabilitation
- Analysis of the Medicad Regulation Regarding School Administrative Costs and Transportation
- What is this really about? Money
- Congressional Response
- Contact your Legislator
- Closing and Contact information
- Disclaimer
Day in Washington Podcast #27 (Medicaid Moratorium)
Welcome to a Day in Washington. Day in Washington is your disability policy podcast covering legislative issues of interest to the disability community. We also spotlight specific bills and other related news articles. I’m your host, Day Al-Mohamed working to make sure you stay informed. This is Podcast #27 originally scheduled for Monday, June 2nd, 2008. Over the next few months we’ll be experimenting with a new feedback system – in addition to being able to comment in the blog itself, you can call 206-279-9159 and leave either a voicemail message or send a fax. We do want to hear from you.
One of the issues that the disability community has been hearing about for the last few months has been the push to create a Medicaid moratorium to stop a set of seven Medicaid regulations that were put forward by the Center for medicare and Medicaid services (CMS).
The purpose of these regulations is supposedly to reign in the out-of-control healthcare costs and to stop state abuse of Medicaid. That is…that the states were supposedly inappropriately charging Medicaid for certain services. Now we’ve been told over and over how bad these regulations would be for people with disabilities and that they’ll take away funding for critical services, but I don’t think that we’ve really ever examined exactly what these regulations would do. Exactly how bad they would be. So let’s just take a look at them and analyze what the legalese translates to.
The first of these regulations was issued March of last year and would end payments for ancillary services provided under case-management plans as they are outside the scope of Medicaid. So what does that mean? Why should anyone with a disability care? Ancilliary services are pretty broad and can cover a lot of different things but they can mean the difference between living independently and being consigned to a nursing home. These services include things such as assistance finding housing, and we all know how difficult it can be finding accessible house. They also can include assistance in paying utility bills, which in today’s time of high gas prices will impact many people utilizing Medicaid.
CMS issued a Medicaid regulation on rehabilitation services. This proposal in particular was one that I found especially short-sighted. CMS stated that “the emphasis in covering rehabilitation services is on the ability to perform a function” and that restorative services are those that are “provided to an individual who has had a functional loss and has a specific rehabilitative goal toward regaining that function.” So these services are to help someone regain a function they have lost. That may sound fine but…one of the things I like to point out is that legislation and policy issues are detail oriented and wording makes all the difference.
As currently written these regulations would prevent people with cognitive or intellectual disabilities from utilizing rehabilitation services. This would include individuals with other conditions such as mental health conditions and autism. Why? Because they are not going to be cured, their cognitive impairment isn’t going to get better. They may learn to cope and better manage their disability but it doesn’t go away. That is no reason to deny them these services. In addition, psychiatric disabilities and those related to substance abuse are cyclical in nature with some periods of recovery and periods of relapse. If an individual regresses are they then prevented from further assistance? Or if they are doing well, don’t we want to continue with whatever care or services are working to PREVENT a relapse?
The CMS regulation on rehabilitation may save money but it is at the terrible cost of denying services to individuals who would need them to continue to not just live independently, but to remain healthy.
The third CMS regulation that has attracted a significant amount of attention is with regard to Medicaid reimbursement for school administration expenditures and costs related to transportation. Transportation may not sound like a big deal, that Medicaid is reimbursing the schools for, however, when you consider that the money saved remains in the school system and has been used in many districts to fund school nurses and school mental health programs the elimination of this reimbursement becomes a much bigger issue.
What also is a concern is the fact that this regulation says that Medicaid will no longer play for administrative expenditures related to school-based services such as outreach and enrollment for vulnerable kids into the Medicaid program. Basically, schools handling the paperwork and actuall getting out there and getting kids who really need it access to these programs.
It just doesn’t make sense when you look back and find that in 2000, the Department of Health and Human Services, the Department of Agriculture, and the Department of Education together published a guide to school-based health care outreach that basically said that schools represent “the single best link” for identifying and enrolling eligible low-income children in health coverage and encouraged state Medicaid agencies to provide schools with financial support for their outreach enrollment activities.
Schools are the best outreach. Almost every kid goes to school. We know our schools and our teachers. They are a part of a community. We trust them. Certainly more than we’d trust a Medicaid officer in some office in the next town over. It just doesn’t make sense.
Okay, now lets get down to the nitty gritty. What is this really about? Money. The elimination of these reimbursements means that the individual school districts would have to come up with the money, More than 3 and a half billion dollars over the next five years. As many of you know there has been no increase in funding for the Individuals with Disabilities Education Act (IDEA) that will enable schools and early childhood providers to make up for this. So basically, these kids will lose out.
I don’t want to go into all 7 Medicaid regulations but I think that gives you an idea of exactly what they will do. When you add it all up these regulations are supposed to save Medicaid over 20 billion dollars. Hear that 20 BILLLION dollars.
With regard to what is happening in Congress on these regulations, thankfully, I can say that Congress has been very responsive to community concerns with regard to these regulations. Last week, before adjourning for the Memorial Day recess, the Senate passed a domestic spending amendment to the supplemental war spending bill that included a one-year moratorium on all seven Medicaid regulations. Now this doesn’t solve the problem. A moratorium only delays these regulations but the assumption is that this will buy time for congress and researchers and others to review them and recognize that there are problems.
Of course, the fact that it is an election year and a moratorium will probably create a delay until a new administration is in place is also a factor. The Bush administration has repeatedly stated that the spending amounts in the domestic spending amendment to war supplemental are too high and that he will veto the bill. The administration has also commented specifically on the Medicaid regulations saying they were designed to stop waste and fraud in the program.
The Senate passed the amendment and bill with a veto-proof majority. Right before the vote, HHS Secretary Mike Leavitt offered to voluntarily delay two of the rules, however, advocates from a wide variety of groups: hospitals, disability groups, juvenile justice, child welfare, medical and health professionals refused to compromise. The bill with the moratorium has now been sent back to the House where it is expected to be voted on any day now.
So if you have the opportunity, call your Representative and tell them that they need to support keeping this in the bill. That these cost saving measures aren’t realisitic and come at too high a cost…sacrificing people with disabilities and children.
CLOSING
And that is it for this week’s edition of Day in Washington. For links to more information, please check the show notes. Please feel free to contact me at http://www.dayinwashington.com regarding comments or suggestions. I’d love to hear from you, but for now, this is your host, Day reminding you to stay well and stay informed.
EPILOGUE
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Any opinions and perspectives expressed in this podcast should not be taken as the official stance of any group or organization affiliated with the host. In addition, none of the facts, data, or grammar have been checked for accuracy.
Thank you for listening.
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