Medicaid Benefits We Could Lose Under Caps or Cuts
from The Arc of the US:
Congress is moving fast to deeply cut and cap Medicaid. The
proposed cuts are putting Medicaid’s “optional” and “waiver” benefits at risk.
Medicaid law requires that all states provide services such as
doctor visits, hospitalization, nursing home care, and others. Other critical
services for people with disabilities are not required by law (i.e. optional
benefits) but are allowed if the state chooses to provide them and follows
federal requirements.
What are Optional Benefits?
The federal/state Medicaid program allows states to provide a
wide variety of optional services in addition to the mandatory services. Once a
state includes an optional service as part of its state plan, benefits must be about
the same, available throughout the state, and people get to choose their providers
and plans. States provide many different services and supports as optional
benefits, such as:
·
Prescription Drugs
·
Clinic services
·
Physical therapy
·
Occupational therapy
·
Speech, hearing and language disorder services
·
Respiratory care services
·
Other diagnostic, screening, preventive and rehabilitative
services
·
Dental Services
·
Prosthetics
·
Eyeglasses
·
Private duty nursing services
·
Personal Assistance services
·
Case management
·
Services in an intermediate care facility for
Individuals with Intellectual Disability (ICF/ID) – This includes some large
institutions and many large and small group homes that meet federal
requirements.
·
“State plan” Home and Community Based Services - Typically includes services like
respite, case management, supported employment, and environmental
modifications. States using this option include:
California,
Colorado, Connecticut, Delaware, District of Columbia, Idaho, Indiana, Iowa,
Louisiana, Maryland, Mississippi, Montana, Nevada, Oregon, Texas, and
Wisconsin.
·
Self-Directed Personal Assistant Services - Provides personal care and related
services and participation in self-directed PAS is voluntary. Participants set
their own provider qualifications, train their PAS providers, and determine how
much they pay for a service, support, or item.
·
Community First Choice Option- Allows States to provide comprehensive
home and community-based services and supports under the State Plan as an
alternative to facility based care and receive increased federal matching
funds. States using this option are California, Maryland, Montana, Oregon, and
Texas.
What about “Waiver” Services? Are These Optional?
Waiver services are in a category of their own as states must
submit formal requests to have certain federal Medicaid requirements waived and
negotiate those changes with federal officials at the Centers for Medicare and
Medicaid Services. Waivers require periodic renewals which usually trigger new
negotiations.
While waivers offer states a lot of flexibility, they permit
states to limit services by permitting states to provide benefits only to
specific groups (for example, children with autism) and to cap enrollment (for
example, 200 children). This is why there are long waiting lists for many waiver
services in states throughout the country.
The most important waiver for people with I/DD is called the 1915(c) Home and Community-based Services Waiver. States have a variety of different
names for the waiver. States use this waiver to provide long term supports and services
in home and community settings rather than institutional settings. Waiver
services include:
·
providing direct support professionals to assist with meals,
bathing, dressing, and toileting
·
habilitation
·
communication support
·
assistive technology
·
supported employment
·
behavioral supports
·
services that may assist in diverting and/or transitioning
individuals from institutional settings into their homes and community
·
numerous other services.
The Bottom Line
Optional and waiver services would be under attack if Congress deeply cuts and caps Medicaid funding. This means that, depending on state responses to lost federal funding, people with intellectual and developmental disabilities (I/DD) are at risk for losing access to community-based supports and states may increase use of institutionalization.
Optional and waiver services would be under attack if Congress deeply cuts and caps Medicaid funding. This means that, depending on state responses to lost federal funding, people with intellectual and developmental disabilities (I/DD) are at risk for losing access to community-based supports and states may increase use of institutionalization.
6/15/17
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