Disabled workers move toward broader health benefits in current Medicaid expansion bill
Disabled workers move toward broader health benefits in current Medicaid expansion bill
Figuring out how to foot the bill is holding up congressional help for disabled employees trying to hang on to government health benefits.
The Work Incentives Improvement Act, which passed both houses of Congress this year by overwhelming bipartisan margins, broadens the availability of Medicaid and Medicare benefits for disabled people who go back to work. After House approval in October, congressional conferees began meeting to resolve differences in the scope of the expansions as well as strategies to make the expansions budget-neutral.
Medicaid is the chief stumbling block, says Andrew Sperling, director of public policy for the National Alliance for the Mentally Ill (NAMI) in Arlington, VA. The entire cost of the bill is roughly estimated at about $800 million over five years. Conferees have found offsetting savings for about three-fourths of those costs, he says. "Those offsets have to be found in order to bring this back to the House and Senate floor."
The legislation allows states to expand their Medicaid programs to working people between 16 and 65 years of age who otherwise would receive Social Security Disability Insurance (SSDI). Medicaid benefits, in the House version, would be available to persons under this option up to 250% of the federal poverty level; the Senate’s version of the program also allows Medicaid coverage for the disabled above 250% of the federal poverty limit.
Advocates had fought to eliminate the income cap, pointing out that under the Balanced Budget Act (BBA), states already can expand Medicaid up to 250% of poverty to working people with disabilities. However, two years after implementation of the BBA, notes a NAMI fact sheet, only a handful of state Medicaid programs have elected to pursue this option. (See related story, State Health Watch, January 1999, p. 1.)
Another argument for removing the cap, says Mr. Sperling, is that under section 1619 of the Social Security Act, some states already provide Medicaid to Supplemental Security Income recipients with incomes that meet or exceed 250% of poverty.
The legislation also makes available infrastructure grants to encourage states to offer Medicaid coverage to the disabled. The grants, tentatively set at a minimum of $500,000 each, would be used to help states establish and maintain the infrastructure for providing coverage and publicize the existence of such programs.
The version of the bill approved by the House sets aside $20 million for the infrastructure grants in fiscal year 2000 and increases the amount by $5 million for the next four years. Increases for the fiscal years 2005 through 2010 are tied to the Consumer Price Index. It is likely that the state infrastructure grants will survive as "mandatory" spending not subject to future congressional appropriations, says Mr. Sperling.
A proposed demonstration program would allow states to provide Medicaid to employed persons with a "potentially severe disability" in the hopes of preventing that person from turning to SSDI. Advocates say early Medicaid coverage could forestall medical complications and far greater expenditures for a wide range of conditions.
One of the issues being addressed in the conference committee is whether to require state Medicaid programs to implement the other Medicaid buy-ins to take advantage of the demonstration program. About eight to 10 Medicaid programs are seriously considering expanding Medicaid coverage under the Work Incentives Improvement Act, says Lee Partridge, staff director for the National Association of State Medicaid Directors. The most likely candidates are states that already have taken the plunge under the Balanced Budget Amendment, such as Wisconsin, Oregon, and Minnesota, and that their experience may inspire others to do so, she says. "None of [the enrollment] seems to be huge; they don’t seem to be flooded with hundreds of thousands of new potential eligibles."
Mr. Sperling says that getting Medicaid programs to take up the options offered under the work incentives legislation may be challenging in light of states’ responsibilities under the recent Olmstead decision. The U.S. Supreme Court in Olmstead broadened the duty of state Medicaid programs to offer home and community-based services to the disabled. (See related story, State Health Watch, August 1999, p. 1.)
"States are going to have to put a lot of resources into Olmstead compliance," he says, "but I would make the argument that the Work Incentives Improvement Act is completely consistent with Olmstead and that states ought to look at doing these Medicaid options as part and parcel of their Olmstead plans."
Contact Mr. Sperling at (703) 516-7222 and Ms. Partridge at (202) 682-0100.
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