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Letters from HHS Secretary and NASUAD Discuss New Federal Policy Directions

Recent letters issued by new U.S. Health and Human Services (HHS) Secretary Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, and by the National Association of States United for Aging and Disabilities (NASUAD), provide insights into new policy directions at the federal level and potential impacts on older adults and people with disabilities.

Letter from Price and Verma

Secretary Price and CMS Administrator Verma have released a letter to Governors outlining their priorities. The letter criticized the expansion of Medicaid coverage to non-elderly adults without children under the Affordable Care Act and promised to find a solution that “best uses taxpayer dollars to serve the truly vulnerable.”

The letter also identified the following areas of focus:

  • Providing states with more freedom to innovate and address health care needs;
  • Making available fast track approval of certain waiver applications and extensions;
  • Commencing a full review of managed care regulations;
  • Using 1115 waiver authority to increase employment and training;
  • Aligning Medicaid’s benefit structure and cost-sharing requirements with private insurance;
  • Providing waivers of presumptive eligibility, retroactive eligibility, and non-emergency transportation as a mandated benefit;
  • Extending the deadline for compliance with the HCBS Settings regulations and increasing engagement with states in assessing the compliance of various settings; and
  • Working with states to improve care for people struggling with addiction and providing a more streamlined approach to substance abuse treatment waivers.

The full text of the letter is available here

Letter from NASUAD

The National Association of States United for Aging and Disabilities (NASUAD) released a letter to Congressmen Paul Ryan and Greg Walden describing the potential impacts of the American Health Care Act (AHCA) on older Americans and people with disabilities. The AHCA is the bill under consideration in the House of Representatives to repeal and replace the Affordable Care Act (Obamacare). In particular, the letter points to challenges raised by the bill’s replacement of federal Medicaid matching dollars based on expenditures with per capita and aggregate caps on the federal share of state Medicaid spending. It notes that the per capita caps and aggregate caps on spending would pit each group of beneficiaries against one another, since an increase in spending on one group would need to be offset by the others. Because older adults and people with disabilities tend to need more services and consume a greater portion of Medicaid spending, they are likely to be targets for Medicaid cuts. Further, according to the letter, the caps will prevent states from targeting coverage to those most in need, in order to respond to reductions in federal reimbursement. Under the bill, if states seek to limit eligibility to individuals requiring higher levels of care, the per capita caps will not be adjusted to account for the higher acuity of the population.

The letter also discusses the bill’s failure to expand state flexibility to respond to these changes, its removal of the requirement that states provide three months of retroactive eligibility to Medicaid beneficiaries, its repeal of the increase in the home equity exclusion for Medicaid eligibility, its repeal of the enhanced federal matching rate for the Community First Choice Option (CFCO), and its repeal of enhanced federal matching funds for the Medicaid expansion for adults with incomes of up to 138 percent of the federal poverty level.

NASUAD is a bipartisan association of state government agencies and represents the nation’s 56 state and territorial agencies on aging and disabilities. A complete copy of the letter is available here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124