Kronick, R., & Gilmer, T. (2012). Medicare and Medicaid spending variations are
ID: 450968 • Letter: K
Question
Kronick, R., & Gilmer, T. (2012). Medicare and Medicaid spending variations are strongly linked within hospital regions but not at overall state level. Health Affairs, 31(5), 948–955.
Mann, C. (2003). The flexibility factor: Finding the right balance. Health Affairs, 22(1), 62–76.
In these articles pertaining to the politics of Medicare or Medicaid. Use the following as a guide to develop a report on the selected issue: Explain the main points of the articles. Explain in detail the issue as it pertains to the politics of Medicare or Medicaid. Discuss the impact of the issue relative to the provisions for services to Medicare or Medicaid recipients.
In a Microsoft Word document, create a 2- to 3-page report on your analysis of the selected issue.
Support your responses with examples.
Cite any sources in APA format.
Explanation / Answer
Medicaid is an important source of health insurance coverage for people with disabilities. This issue brief explains how Medicaid eligibility and benefits for people with disabilities are affected by the Affordable Care Act (ACA) rules as of 2014. Marketplace rules are discussed to the extent that they relate to Medicaid eligibility determinations for people with disabilities.
Medicaid Eligibility Pathways for People with Disabilities
In states that implement the ACA’s Medicaid expansion, more people with disabilities may qualify for Medicaid based solely on their low income status, which enables them to enroll in coverage as quickly as possible, without waiting for a disability determination. As of 2014, the ACA expands Medicaid eligibility up to 138% of the federal poverty level (FPL, $16,104 for an individual in 2014), although implementation of the expansion is effectively a state option. In states that are not implementing the ACA’s Medicaid expansion, people with disabilities can qualify for Medicaid based solely on their low income status if they fit into a coverage group, such as parents and other caretaker relatives, pregnant women, or children, and meet the state’s income limit associated with that group.
People with disabilities can qualify for Medicaid at somewhat higher incomes, up to state-established ceilings, if they also meet disability-related eligibility criteria. Eligibility determinations for disability-related coverage groups continue to be based on existing rules and are not affected by the ACA’s 2014 eligibility and enrollment changes.
People with disabilities who qualify for Medicaid based solely on their low income status can enroll in coverage on that basis and start receiving benefits while their disability-related Medicaid eligibility is being determined. In addition, people with disabilities who do not qualify for Medicaid based solely on their low-income status can enroll in Marketplace coverage with subsidies, if eligible, while their disability-related Medicaid eligibility is being determined.
Medicaid Benefits Packages for People with Disabilities
States must provide alternative benefit plan (ABP) coverage to adults newly eligible for Medicaid. A state’s new adult ABP may not necessarily include all Medicaid state plan benefits, although states can choose an ABP that does so.
In states that do not fully align their new adult ABP with their state plan benefits, a beneficiary’s eligibility pathway determines the contents of her benefits package. Certain populations, including many people with disabilities, must have access to Medicaid state plan benefits, even if they are eligible for Medicaid through the new adult expansion group.In addition, beneficiaries who qualify for Medicaid in both the new adult expansion group (which offers ABP benefits) and a disability-related coverage group (which offers state plan benefits) can choose to enroll in the disability-related coverage group so that they can access the benefits package that best meets their needs.
Identifying Applicants with Disabilities
A key function of the application form is to identify people who may be exempt from ABP enrollment or who may be eligible for Medicaid in a disability-related coverage group because these characteristics can affect the benefits package that a beneficiary receives. Because some people may be reluctant to self-identify as having a disability, it will be important for applicants to understand that answering the disability screening questions can affect the contents of their benefits package. For people applying for coverage through a Marketplace that assesses potential Medicaid eligibility (rather than determining final Medicaid eligibility), there are additional application questions that can affect the type of Medicaid eligibility determination and consequently the benefits package that they receive
Eligibility Renewals
As of 2014, there are new streamlined renewal and reconsideration procedures for poverty-related coverage groups that states also can opt to apply to disability-related coverage groups.
Application Accessibility and Assistance
State Medicaid agencies must ensure that their services are accessible to people with disabilities. For example, state Medicaid agencies must provide auxiliary aids and services at no cost to applicants and beneficiaries; provide information and assistance with the application process in a way that is accessible to people with disabilities; and use accessible applications, forms, and notices. Marketplaces are similarly prohibited from discriminating on the basis of disability and must ensure that their services are accessible to people with disabilities.
The Affordable Care Act (ACA) makes several changes to Medicaid eligibility and enrollment rules that may affect people with disabilities. While the ACA’s adult coverage expansion is effectively a state option, other changes apply to all state Medicaid programs as of 2014, including simplified eligibility determination procedures with a new income counting methodology and increased reliance on electronic data matching; modernizations to the application and renewal processes; and coordination with other insurance affordability programs, including the new Marketplaces that offer qualified health plans (QHPs) and administer advance payment of premium tax credits (APTC) and cost-sharing reductions.
The Centers for Medicare and Medicaid Services (CMS) has finalized regulations1 that implement many of the ACA’s changes. The Department of Health and Human Services (HHS) also has released the single streamlined application that the Secretary was required to develop for use in all insurance affordability programs beginning in 2014.2 This issue brief explains Medicaid eligibility and benefits rules as they pertain to people with disabilities, including relevant changes as of 2014.
Medicaid’s Role for People with Disabilities
While Medicaid often is regarded as a source of health insurance for people with low incomes, the program also provides important primary or supplemental coverage for people with disabilities. This is true in part because health insurance typically is offered as an employment benefit, making it inaccessible to people with disabilities who are unable to work entirely or to work full-time. In addition, the type and scope of benefits offered by Medicaid include many services essential to people with disabilities that are frequently not covered by private insurance at all or are covered insufficiently to meet the needs of people with disabilities. For example, Medicaid is the primary payer for long-term services and supports, including nursing facility and home and community-based services
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