Thank-you Kathy. I hope your planning retreat goes well!

 

 

 

There has been a great deal of activity recently so I’ll provide just a few highlights!

 

Operational:

If you have reimbursement requests for 2016, please submit them to Annie by December 16 so then can be paid for this year.

 

The staff and Nurse Consultants are having a planning retreat Monday afternoon. I’m looking forward to new ideas as we think about Ctrl Alt Believe – Rebooting the Association (don’t tell them but they get to do the foil activity also!!)! Our office will be closed for this event.

 

The MHCA office will be closed Dec 23 and 26 for the holiday. Annie and I are also taking some PTO at the end of the month so the office will be “lightly staffed” some of the days.

 

Advocacy:

The Legislative Team continues to focus on the approved legislative priorities, and as we expected the LTC Imperative agenda includes a couple of items that apply to home care. We met with them and we are continuing to participate in discussions around EW Waiver and the potential impact on our members. Their workforce priorities are complementary to our initiatives and we will be supporting that legislation.

 

There is much consternation and many unknowns around federal legislation and regulations. Attached are the slides from a conference call the Council of States had yesterday, related to federal policy and the new Administration.

 

The high level overview is that the Republicans appear to be headed toward an early January repeal of the ACA and it is anticipated that they will be open to hearing about policies that are “overburdening,” such as F2F. We have been repeatedly advised to watch for Block Grants being a strong possibility for home care. The Government Relations Counsel has a connection with a member of the Trump Transition Team and will be crafting a letter for the Council to send regarding our priority issues/concerns.

 

Also, below is an email regarding Medicaid reform that you may be interested in.

 

On the state level, DHS held a meeting to review their recommendations for more stringent service documentation regulations for the waivers programs that do not currently meet the CMS standards. The more targeted areas include adult day programs, transportation and medical equipment. . We will provide input to DHS on what we view as overly strict and cumbersome language.

 

Membership:

I have contracted with Elaine Weber Nelson to provide some membership support while we continue our search for PT membership staff. Elaine will be focused on developing membership messaging for the various member segments, developing a more enriched recruitment plan and recommending marketing materials. She will be joining the Membership Team and gathering additional insights from them December 21. In the meantime, staff has been working to spread the word about the value of membership and are seeing from fruits from our labors.

 

The small “dues” group met and is recommending a revised proposal that minimizes the ‘sticker shock’ for members. It will be presented to the Membership Team in December and then on to the board in January. The group consisting of Jay, Jan, Andrea and 2 Membership Team members felt that the agreement reached is more amenable.

 

 

Attached are the slides from a conference call we had today, related to federal policy and the new Administration.

 

 

 

 

 

Dear Medicaid Partnership Member-

 

Please find below a timely piece relating to the ongoing discussions within the Trump transition team concerning Medicaid reform.  Although this article certainly reveals the broad range of opinions that continues to swirl around this important issue, it also underscores the premium (no pun intended!) that will be placed on reforms which can achieve improved efficiency without harming Medicaid’s vulnerable beneficiaries.  As such, our group’s reform deliberations (including but not limited to the HomeFirst concept) increasingly look to us to be very well-positioned. 

 

As an aside, the Liberty Partners team has long been on very good terms with the Heritage scholars noted below, and we’re also working closely with Ron Pollack and his Families USA team on an unrelated project, so we look forward to utilizing those contacts in addition to those within Team Trump when our PMHC policy ideas are finalized and approved for external discussion.

 

 

Inside Health Policy

Heritage Foundation Pushes For Premium Support In Medicaid Overhaul

 

Heritage Foundation policy director Nina Owcharenko, who has joined President-elect Donald Trump's HHS transition team, advocates for premium support of Medicaid in a policy brief that lays out the group's recommendations for Medicaid reform. Advanceable tax credits would fund the premium support for able-bodied adults and their children, Heritage Senior Research Fellow Edmund Haislmaier told Inside Health Policy, while federal block grants would pay for the elderly and disabled.

 

"It would probably involve converting Medicaid into a supplemental, refundable tax credit approach," Haislmaier said.

 

The incoming Trump administration will focus on Medicaid reform, Indiana governor and Vice president-elect Mike Pence said in a televised interview Sunday (Dec. 4) with George Stephanopoulos on ABC. "With regard to Medicaid, there's a real opportunity as we repeal and replace Obamacare to do exactly what the president-elect also said on the campaign, and that is block-granting Medicaid back to the states," he said.

 

Pence also referenced Indiana's Healthy Indiana Plan ("HIP") and HIP 2.0 expansion demonstrations that were architected by Trump's pick for CMS head, Seema Verma. The state designed HIP 2.0 through the Affordable Care Act's expansion. "We actually have people on Medicaid for the first time in the history of the program that actually have to make a monthly contribution to a health savings account to receive full benefits," he said, referring to the state's programs.

 

Meanwhile, the House Republican budget plan for fiscal 2017 proposed to cut federal Medicaid funding by $1 trillion--or nearly 25 percent--over 10 years, relative to current law, according to the National Health Law Program.

 

Haislmaier called Medicaid the single largest welfare program with a big cliff, and argued that an earned income tax credit would move beneficiaries to self-sufficiency. "What you want to do, instead of an all-or-nothing defined benefit package, is to convert that into contributions that taper off as you go up the income scale," he said.

 

Thirty-one states have used 1115 waivers to tailor Medicaid with CMS approval. Trump's CMS nominee, Seema Verma, designed the Health Indiana Plan that introduced co-pays and HSAs under Pence's administration, for example. The Arkansas waiver gives beneficiaries funds to pay for exchange plans.

 

A health policy analyst said the Arkansas waiver still backs beneficiaries' health policies with Medicaid benefits. If an exchange plan imposes higher co-pays than Medicaid or adds restrictions that Medicaid doesn't, the patient will ultimately get the Medicaid benefit as a program beneficiary.

 

The Arkansas demonstration has not shown budget neutrality, as is required for demonstrations, the analyst said, because it has run on the private exchange market. While Owcharenko's policy brief for the Heritage Foundation says that private subsidies are more efficient than Medicaid's, the analyst said the Arkansas demonstration has shown this isn't the case. Medicaid's lower payment rates--which have been pared back to the bare minimum after deep program cuts--requires efficiency that the market doesn't.

 

Haislmaier said he wants privatization at the federal level rather than see Medicaid expansion continue as it has under the Affordable Care Act. "Prior to the ACA, you were not allowed as a state to cover able-bodied adults without children without a waiver," he said. "But the ACA wanted to assure coverage for those people."

 

Legislators have used waivers to overhaul Medicaid in their states, Haislmaier added, but block grants would leave states attached to strings in federal government hands.

 

Haislmaier also said Medicaid has an access problem largely due to states' failure to reimburse providers. Leonardo Cuello, health policy director for the National Health Law Program, said the access problem is due to the steady tightening of funds.

 

"States have chosen to keep the program lean and tight as possible to keep it going," Cuello said. "It may create access problems, but that's a decision states have made. The way extreme premium support models such as those Heritage seems to be recommending is not by providing equivalent care through private companies. It's by cutting care dramatically."

 

Ron Pollack of Families USA said policy must be based on an understanding of Medicaid's beneficiaries. "They are people who have very low incomes, and who do not have disposable income that enables them to purchase health insurance," he said. "Creating a premium support system that requires low income people to pay out of pocket for premiums that they will find unaffordable is a very cruel hoax." -- Susannah Luthi

 

 

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