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Bipartisan policy insights and political intelligence

The Long Term View: An MLA Public Policy Update on Long-Term Services and Supports

Posted in Health Policy

By Dennis Smith

Two hundred years ago last month, President Madison fled Washington as British troops invaded the Nation’s Capital. The White House and the Capitol were burned on August 24. A few weeks later, the bombardment of Baltimore would inspire Francis Scott Key to write the “Star Spangled Banner.” Because our young nation further removed itself from British and French influences, the War of 1812 has been called our second war for independence.

The push for independence is underway today in the long term services and supports (LTSS) part of Medicaid. One of the purposes of Medicaid is enable “… each State, as far as practicable under the conditions in such state, to furnish … rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care …”.[1]

Properly understood, Medicaid is not “a” program, it is several programs serving different populations with very different needs. Most individuals enrolled in Medicaid today are healthy (children represent about half of the Medicaid population) and millions, in a better economy, would not be on the program because they would be enjoying a higher level of income. Millions are on Medicaid because of an unexpected turn of events – divorce, loss of a job, loss of income, or an unintended pregnancy. Many families who are on Medicaid today will not be on Medicaid five years from now.

But a senior citizen on Medicaid or an individual with a disability on Medicaid, will likely rely on the program for the rest of his/her life. The LTSS part of Medicaid is, in large part, about how and where that senior or individual with a disability will live. Approximately two-thirds of Medicaid spending is made on behalf of low-income seniors and citizens with disabilities.  Approximately one-third of Medicaid spending is for LTSS, which goes nearly exclusively to people with disabilities and seniors.

As states struggle with the cost of their Medicaid programs and seek to improve how to deliver services, two models are emerging in the delivery of LTSS. One model relies on health plans to merge LTSS with acute care benefits, now referred to as “managed” LTSS or MLTSS. According to the June 2014 Report to the Congress on Medicaid and CHIP by the Medicaid and CHIP Payment and Access Commission (MACPAC), 16 states now employ a MLTSS model, covering 389,000 individuals.  Earlier this month, the Center for Health Care Strategies released Key Attributes of High-Performing Integrated Health Plans for Medicare-Medicaid Enrollees, which describes “… a framework [that] can help guide states and health plans in defining essential elements for high-performing integrated health plans …”.[2]

The other model allows the individual to “self direct” his/her LTSS services. The National Council on Disability (NCD) calls self-direction a “game changing strategy.” Last year, NCD released, The Case for Medicaid Self-Direction: A White Paper on Research , Practice, and Policy Opportunities, which, among other things, “… recommends strategies for improving the accessibility and quality of self-directed Medicaid services and supports.”[3]  As the report explains, self-direction has also been called consumer direction or participant direction.  The role of the consumer may be as comprehensive as taking complete authority over a budget under which the consumer purchases LTSS goods and services and acts as the employer. At a minimum, self-direction means that the individual is allowed to hire and fire individuals who provide personal care services.

These two resources will be helpful to states, individuals, and their families as together they explore the future of their Medicaid LTSS programs. The LTSS part of Medicaid is about personal independence, liberty, and freedom as much as it is about access to medical care.

Health Insurance Exchanges: State of the States

Posted in Health Policy

By Cindy Gillespie

Health Insurance Exchanges: State of the States update is our weekly report on Health Insurance Exchange developments.

This week, HHS Secretary Sylvia Burwell announced that Access Health CT CEO Kevin Counihan will fill the Marketplace Chief Executive Officer position and the board for the Washington Health Benefit Exchange approved a $59.2 million budget for 2015.

Weekly Health Care Wrap-Up

Posted in Health Policy

By Cindy Gillespie

Weekly Health Care Wrap-Up  is our weekly look at developments affecting health care at the federal and state levels.

This week, the Congressional Budget Office released an update of its Budget and Economic Outlook, projecting that Medicare and Medicaid spending over this period will be $89 billion less from 2014-2024 and CMS approved Governor Tom Corbett’s Medicaid waiver to use private managed care companies to cover anyone up to 138 percent of the federal poverty level.

Health Insurance Exchanges: State of the States

Posted in Health Policy

By Cindy Gillespie

Health Insurance Exchanges: State of the States update is our weekly report on Health Insurance Exchange developments.

This week, Covered California disclosed that it was reaching out to 100,000 California enrollees to have them verify their immigration and citizenship status and Your Health Idaho expressed optimism that it would receive a data file from CMS with data on its 76,000 enrollees in early September that it could use for reenrollment purposes.

Weekly Health Care Wrap-Up

Posted in Health Policy

By Cindy Gillespie

Weekly Health Care Wrap-Up  is our weekly look at developments affecting health care at the federal and state levels.

This week, a report by the Treasury Inspector General for Tax Administration found that the ACA’s medical device tax was bringing less revenue than projected and an audit by the U.S. Department of Health and Human Services’ Office of Inspector General determined that Illinois repeatedly overdrew Medicaid funds from its Payment Management System from FY 2010 to 2012.

Health Insurance Exchanges: State of the States

Posted in Health Policy

By Cindy Gillespie

Health Insurance Exchanges: State of the States update is our weekly report on Health Insurance Exchange developments.

Health Insurance Exchanges: State of the States update is our weekly report on Health Insurance Exchange developments. This week, CMS updated its solicitation to hire the next government contractor to continue building the HealthCare.gov IT system and Connect for Health Colorado informed its board that CMS had formally approved the exchange’s request for a No Cost Extension to spend their exchange establishment grants into 2015.

Weekly Health Care Wrap-Up

Posted in Health Policy

By Cindy Gillespie

Weekly Health Care Wrap-Up  is our weekly look at developments affecting health care at the federal and state levels.

Weekly Health Care Wrap-Up is our weekly look at developments affecting health care at the federal and state levels. This week, CMS sent letters to about 310,000 exchange enrollees requesting additional documentation to verify their eligibility for subsidies and an annual survey found that most large employers expect health costs to rise by an average of 6.5 percent in 2015.

Mark Burkhalter Authors Atlanta Business Chronicle Article

Posted in Tax Policy

MLA’s Mark Burkhalter authored the article, “Viewpoint: To create jobs, attract and retain business with corporate tax cuts,” featured in the Atlanta Business Chronicle.

A favorite argument among government bureaucrats is that corporations aren’t people. Tell that to the employees who put in at least 40 hours a week to keep a company profitable in hopes that there will be a raise or bonus come year end.

But when government sees companies as nothing more than a name, employees suffer. Such is what is happening to American workers. Taxes on American corporations are the highest in the developed world. When companies have high taxes, there is less money for expansion, hiring, to invest in employees and pay shareholders.

Now, a flood of American companies have discovered a way out of paying the highest corporate tax rate in the developed world — 39.1 percent in state and federal taxes. And that doesn’t include the burden of taxes and penalties levied by the Affordable Care Act and other regulations of the past six years.

Dozens of U.S. corporations are taking their headquarters offshore or merging with foreign businesses, primarily in Europe, to reduce their tax burden.

Click here to read the full article.

Stefan Passantino Quoted in The National Law Journal

Posted in Political Law

MLA’s Stefan Passantino was quoted in The National Law Journal’s article, “Lobbyists Regain Seat At the Table.”

The suggested revision is intended to resolve the case, which the lobbyists brought in 2011 alleging the ban infringed their constitutional right to petition the government. Praised by good-government organizations and scorned by the lobbying community, Obama’s directive has barred federal agency heads from appointing federally registered lobbyists to hundreds of advisory boards and commissions.

“It’s clearly a revision whose time has come,” said McKenna Long & Aldridge partner Stefan Passantino, who leads his firm’s political-law team and represents lobbyists.

————

In addition to a lawsuit, several lobbyists serving on advisory panels started to report that they were no longer lobbying after 2009. More than 20 members of 16 Industry Trade Advisory Committees deregistered following Eisen’s announcement, The Hill reported in February 2012.

“It was good politics,” Passantino said of the ban. “But it wasn’t good policy.”

Click here to read the full article.