Medicaid Restructuring Under the American Health Care Act and Nonelderly Adults with Disabilities | The Henry J. Kaiser Family Foundation

Medicaid covers more than three in 10 non-elderly adults with disabilities, providing a broad range of medical and long-term care services that enable people with disabilities to live and work in the community.

Source: Medicaid Restructuring Under the American Health Care Act and Nonelderly Adults with Disabilities | The Henry J. Kaiser Family Foundation

Key Takeaways
This brief describes Medicaid’s role for nearly 7 million nonelderly adults with disabilities living in the community to help inform the debate about the American Health Care Act’s proposals to end enhanced federal funding under the ACA and reduce federal Medicaid funding under a per capita cap.Medicaid covers more than three in 10 nonelderly adults with disabilities, providing a broad range of medical and long-term care services that enable people with disabilities to live and work in the community. 

  • Over half of nonelderly Medicaid adults with disabilities live below the federal poverty level, and nearly 85% have incomes below 200% of poverty ($24,120/year for an individual in 2017).
  • Nonelderly Medicaid adults with disabilities are four times as likely to receive nursing or other health care at home, more than 2.5 times as likely to have three or more functional limitations, and more than 1.5 times as likely to have 10 or more health care visits in a year compared to people with disabilities who are privately insured.

People with disabilities account for 15% of total Medicaid enrollment but 42% of program spending due to their greater health needs and more intensive service use.   

Medicaid spending per enrollee for people with disabilities is substantially higher than for those without disabilities, due to their greater health needs and reliance on Medicaid for expensive but necessary services, especially long-term care in the community and nursing homes, that are generally unavailable through private insurance and too costly to afford out-of-pocket.  Medicaid spending per enrollee for people with disabilities also varies substantially by state (from $10,142 in AL to $33,808 in NY in 2011).

Nonelderly adults with disabilities may be particularly affected by Medicaid changes in the American Health Care Act (AHCA), including the fundamental shift to per capita capped financing.

  • Most Medicaid disability-related coverage pathways and community-based long-term care services are provided at state option, making them subject to cuts as states adjust to substantial federal funding reductions under a per capita cap.  The CBO estimates that the AHCA will reduce Medicaid spending by $880 billion from 2017 to 2026.
  • The AHCA also would end enhanced federal funding for the ACA’s Medicaid expansion, which covers some nonelderly adults with disabilities, and Community First Choice attendant care services for people with disabilities, which could jeopardize states’ ability to continue to finance these options.

Well-being of Young Children after Experiencing Homelessness

“Compared to national norms, young children who have stayed in shelter have higher risk for developmental delays and higher rates of behavioral challenges”

Using data from the U.S. Department of Housing and Urban Development’s Family Options Study, Well-being of Young Children after Experiencing Homelessness (2017, OPRE Report No. 2017-06), examines the well-being of young children 20 months after staying in emergency homeless shelters with their families. The brief explores young children’s: pre-reading skills, pre-math skills, developmental delays, and behavior challenges. It discusses comparisons between children who experienced homelessness and national norms for children of the same age.

“Twenty months after staying in an emergency shelter with their families, children between 18 and 41 months were at somewhat higher risk for early developmental delays compared to national norms for children their age. They were at lowest risk for delays in their development of general activity and movement (although still at higher risk than national norms) and at highest risk for fine motor skill delays. Based on national norms, we would expect 84 to 88 percent of children to pass screening in all five domains assessed; however, only 77 percent of children who had been in shelter 20 months earlier passed all five domains.”2

Well-being of Young Children after Experiencing Homelessness HOMELESS FAMILIES RESEARCH BRIEF OPRE Report No. 2017-06 January 2017 by Scott R. Brown, Marybeth Shinn, and Jill Khadduri

Draft Principles for a Person-Centered Approach to Serious or Advanced Illness

Deadline: May 12, 2017

http://ltcombudsman.org/uploads/files/support/acl-person-centered-principles.pdf
ACL, in consultation with stakeholders from the aging and disability communities, has drafted a set of principles to guide their work, and to enhance existing programs and services related to serious or advanced illness for older adults and people with disabilities. ACL is now seeking input from the people they serve-older adults, people with dementia, people with all types of disabilities, and families and caregivers, as well as partners in the aging and disability networks.  The Draft Principles for a Person-Centered Approach to Serious or Advanced Illness is available here. Send your comments, by May 12, 2017, to AdvancedIllness@acl.hhs.gov.

Women’s Refugee Commission – Disabilities

Source: Women’s Refugee Commission – Disabilities

As many as 7.7 million of the world’s 51 million people displaced by conflict have disabilities. People with disabilities are among the most hidden and neglected of all displaced people, excluded from or unable to access most aid programs because of physical and social barriers or because of negative attitudes and biases. They are often not identified when aid agencies and organizations collect data and assess needs during and after a humanitarian disaster. They are more likely to be forgotten when health and support services are provided. Often, refugees with disabilities are more isolated following their displacement than when they were in their home communities.

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Medicaid Work Requirements – Legally Suspect

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Source: Medicaid Work Requirements – Legally Suspect

Executive Summary

Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why adding a work requirement to Medicaid is “legally suspect.” They explain that currently the Medicaid Act has four requirements that an individual must meet that do not include a mandatory work requirement. “A number of courts,” Perkins and McDonald write, “have recognized that states may not ‘add additional requirements for Medicaid eligibility’ that are not set forth in the Medicaid Act.” They also note that the purpose of Medicaid is to “furnish medical assistance to low-income individuals who cannot afford the costs of medically necessary services and to furnish ‘rehabilitation and other services to help [such individuals] attain or retain capability for independence or self-care. A mandatory work requirement is not medical assistance; it is not a service provided to Medicaid beneficiaries.”

Medicaid Work Requirements – Not a Healthy Choice

Executive SummaryIn an effort to win conservative members’ support for the Affordable Care Care Act repeal bill, House Republicans have added a work requirement for Medicaid to the measure. In this issue brief, NHeLP Managing Attorney of the DC office Mara Youdelman,  Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why such work requirements “run counter to the purpose of Medicaid.” They conclude, “Work requirements would stand Medicaid’s purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents.”DOWNLOAD PUBLICATION

Source: Medicaid Work Requirements – Not a Healthy Choice

Grants | Refugee Health Promotion

Source: Grants | Administration for Children and Families

Summary

Funding Oppportunity Title: Refugee Health Promotion
Funding Opportunity Number: HHS-2017-ACF-ORR-RX-1222
Program Office: Office of Refugee Resettlement
Funding Type: Discretionary
Funding Instrument Type: Grant
Announcement Type: Initial
CFDA: 93.576
Post Date: 03/14/2017
Application Due Date: 05/15/2017

Description

The Office of Refugee Resettlement (ORR) within the Administration for Children and Families (ACF) invites States to submit applications for Refugee Health Promotion (RHP) discretionary grant funds.  The purpose of the RHP grant is to support health and emotional wellness among refugees.  The program is designed to coordinate and promote local health and mental health services and education.  The funding should enhance access to health care services.  The RHP grant is intended to encourage partnerships with community-based organizations and complement existing care coordination and medical assistance programs such as Medicaid and Refugee Medical Assistance (RMA), which includes Refugee Medical Screening (RMS), and other ORR-funded social service programs, including Preferred Communities.