1. Keeping and Seeking Opportunities for AT in Today’s Medicaid Programs Deb Parker Wolfenden, M.Ed. CCC-SLP Policy Director ATAP NATTAP Conference June 13, 2006

2. Topics Covered What is a Medicaid Waiver? Potential positive impacts for AT P.L. 109-362 (a.k.a. The Deficit Reduction Act of 2005) –Benefit or Beast? –Advocacy Strategies

3. CMS- Approved Waivers Allows state to operate outside the specified Federal mandates Allows state to experiment with innovative service delivery models Allows state to extend or expand coverage for specified populations

4. 3 Most Common Waivers Freedom of choice (1915 (b) waiver) HCBS waiver (1915 (c) waiver) Demonstration waiver (1115 waiver)

5. Requirements for HCB Waivers Risk of institutional level of care Cost neutrality Waive income and resources requirements of legally responsible spouses or parents

6. HCB Waiver Services Case Management Homemaker services Home health aid services Personal Care Services Adult day health Habilitation Respite Partial hospitalization “Other” services approved by CMS as cost effective and necessary to avoid institutionalization

7. Getting invited to the “table” Know how your state program is organized, managed and what the input points are Have an AT point person on the inside Have well prepared, data driven talking points - KISS Network

8. Staying at the “table” Bring a wealth of information, technical assistance and resources in an area where it is lacking Cost saving benefits –AT Demonstration Centers –Reutilization –Decrease in levels of abandonment –Expand provider base - AT Assessments

9. Deficit Reduction Act

10. Cost Sharing Provisions Comparability is no longer required States can impose premiums and copays States can impose premiums for any type of service Children, elders and people with disabilities are all affected by these changes.

11. Advocacy Implications Provide state officials with literature documenting that even small copayments and other forms of cost-sharing result in low income people foregoing necessary health care or loss of Medicaid eligibility due to cost of premiums (Leighton Ku and Victoria Wachino (7/05), (Samantha Artiga & Molly O’Malley (5/05)

12. HCBS provisions Home and Community Based Alternatives to Psychiatric Residential Treatment for Children (§6063) Money Follows the Person (§6071) Expanded Access to HCBS for Elderly and Disabled (§6086) Self-directed Personal Assistance Services (Cash and Counseling) (§6087)

13. Advocacy Strategies Submit comments to proposed draft regulations when they are published Advocate for oversight (legislative, consumer, P&A) –Initial and any future changes in eligibility –Individuals who loose eligibility under the adjusted eligibility criteria are grandfathered completely –Broad eligibility criteria includes cognitive, neurological and mental health disorders –Inappropriate care includes overly restrictive care

14. Bibliography: J. Perkins, The Deficit Reduction Act of 2005: Implications for Advocacy (April, 2006) This is available at www.healthlaw.org Neighborhood Legal Services, Resources for 2006 Annual Conference of AT Act Programs (June, 2006)