MaineCare Today and a Look Ahead. Chris Hastedt, DrewChristopher Joy, Kathy Kilrain del Rio

Transcription

1 MaineCare Today and a Look Ahead Chris Hastedt, DrewChristopher Joy, Kathy Kilrain del Rio

2 Maine Equal Justice Partners Maine Equal Justice Partners (MEJP) is a nonprofit legal aid provider. We find solutions to poverty and improve the lives of people with low income in Maine.

3 Maine Equal Justice Partners Direct Service Community Organizing Litigation Public Policy

4 Maine Equal Justice Partners mejp.org

5 Medicaid Expansion How did we get here? Where are we now? Where are we going?

6

7 Medicaid Expansion: The History Passed by the legislature 5 times Vetoed by Gov. LePage each time November 2016: Signatures collected by hundreds of volunteers throughout the State to put expansion on the ballot November 7, 2017 Maine becomes the first State in the Nation to expand MaineCare by ballot initiative winning by a margin of nearly 20% and bringing health care coverage to 70,000 Mainers at or below 138% FPL

8

9 The ballot initiative was not the end of this story and we won t let up until people have health care

10 Lawsuit Legislature Passes Funding Gov. LePage Veto Court Orders State to File State Plan Amendment (SPA) Lawsuit Continues

11 Eligibility: Who should be covered under expanded MaineCare? ~70,000 Mainers are newly eligible for MaineCare under expansion, including: Individuals with household incomes up to 138% of the Federal Poverty Level (FPL) Parents with incomes between % FPL People with disabilities who are not eligible for Medicare with incomes between %, or with assets over the limit for MaineCare in the disability category

12 Eligibility Guidelines Individuals are eligible if they meet all of the following criteria: Are between 21 through 64 years old Are not eligible for Medicare Household income does not exceed 138% FPL 2018 Monthly Income Limits $1,397 $1,893 $2,390 $2,

13 What income counts? Income is calculated using MAGI (Modified Adjusted Gross Income). MAGI = Taxable income (AGI), plus: o Nontaxable Social Security, o Excluded foreign income, and o Tax exempt interest Uses point in time income Assets do not count 2018 Monthly Income Limits $1,397 $1,893 $2,390 $2,887 13

14 How to Apply for MaineCare Online mymaineconnection Paper Application Print a paper application: Mail applications to: DHHS, 114 Corn Shop Lane Farmington, ME Or, fax to: In person Apply at any DHHS office. Find your local DHHS office at: hhs-apps/office_finder/ 14

15 APPLY Protect your right to coverage! Help is available through MEJP or CAHC APPEAL Use our online form or submit a letter More information at mejp.org DELAY Continue to protect your right to coverage Mail or fax a reply to the Hearings Officer More information at mejp.org

16

17 Screening Tool Provides a rough estimate of your eligibility Visit mejp.org Medicaid Expansion Guide How to apply Tips for success Answers to Frequently Asked Questions Pledge to Take Action

18 mejp.org

19 Call Our Hotline ext. 208

20

21 mejp.org/content/medicaid mainecare expansion guide

22

23 Key Tips!

24 Is funding needed NOW to implement Expansion? NO! There are sufficient funds available in the current Medicaid budget to cover expansion until at least the beginning of June, We expect the Court will confirm this soon. The new legislature will have plenty of time to assess what s needed and make an appropriation if necessary when the arrive in January Here are estimate from : Maine DHHS; The Legislature s Office of Fiscal and Program Review (OFPR); and The Manatt LLP engaged by Maine Health Access Foundation.

25 Funding Expansion: What will it cost? OFPR provided the following data showing the impact of expansion net of savings on the current Medicaid budget in State Fiscal Year 2019: End of Year balance When negative balance begins to accrue Current Budget no expansion (3.30M) June 26,2019 OFPR Estimate (34.25M) June 5, 2019 DHHS Estimate (61.84M) June 5, 2019 Manatt Estimate (33.83M) June

26 Questions

27 Enrollment & Engagement Project Enrollment Assistance Organize for more health care Be a health care voter!

28

29 Opportunities for Advocacy

30 How to Help Share information from our action alerts and social media Talk with your legislators Share your story or help connect us to others who are impacted by expansion

31 Southern Maine Workers Center Health Care is a Human Right Campaign our compass points to human rights

32 Health care systems should be based on human rights principles

33 Universal Publicly Funded Treated as a public good Accountable to the people it serves

34 Enough For All: A People s Report on Health Care

35 Key Findings:

36 THE SOLUTION:

37

38 Organizing Grassroots Opposition to the 1115 Waiver

39 Survey Collection / Story Sharing

40

41

42

43 I don t think that people don t work because they don t want to. There are very real reasons that people don t work It s hard to find good jobs, childcare costs a fortune. There are already enough things that keep people from getting ahead.

44 I was out of work when I had to get emergency surgery. I didn t have health care. Things went downhill quickly and I became homeless.

45 I d rather not work nights and weekends. It s hard to find childcare for my schedule. To work you have to sacrifice your family.

46 I do know people who game the system and it bothersmethattheygetafreeride.buti know many more people who have been hurt, are down on their luck, or have had bad times and our government should help them. Sometimes we don t know the whole story that keeps someone from getting work.

47 My daughter doesn t have health insurance. I pray she won t get sick. She is a childcare worker and doesn t have steady hours at her job.

48 I ve applied for about 20 jobs but I can t get over the threshold because I m homeless.

49 I can t get hired for work because I am legally blind, but I can t get approved for SSI. What about people like me who can t work? This is not right. If people can t work, they shouldn t be penalized.

50 Blanket requirements create cracks that are too big and people will fall through.

51 I was an engineer in my home country, but now I can only get jobs that I m way over qualified for and for low pay. It s clearly discrimination because I m an immigrant. I ve been working in Portsmouth and driving 4 hours every day from Lewiston.

52 Ican tgetajobthatoffers20ormorehours of work. I m discriminated against because of my juvenile record, which is from when I was 12 years old. I had a job, but lost it when they did the background check.

53 The 1115 Waiver ignores how difficult it can be to secure (20 hours a week of employment) especially with children or if you don t have transportation.

54 How are we supposed to get a job if we can t take care of our basic needs?

55 I lost my MaineCare when I went to the youth detention center. When you get out you have to reapply and I haven t been approved yet. I m working, but the only job I could find is under the table construction.

56 Sometimes I have to work four jobs because there aren t good jobs with steady hours where I live. Everything is seasonal.

57 I lost my MaineCare when I became a widow they said I made too much money because I began receiving survivor benefits from the Veterans Association. Now I have to paid $300 a month for health insurance, and between rent and everything else I can t afford it. I m currently unemployed and looking for work.

58

59 Medicaid Section 1115 Waiver A 1115 waiver is an application by a state to the Centers for Medicare and Medicaid Services (CMS) to waive certain Medicaid requirements. Maine s proposed 1115 waiver would impose new restrictions on tens of thousands of MaineCare enrollees and applicants. CMS has some discretion over which waivers to approve, but that discretion is not unlimited.

60 What changes would Maine s waiver make? Imposition of Time Limit/Work Requirement: So called able bodied adults age 19 through 64 must engage in work (minimum of 20 hours per week) or other approved activities in order to keep MaineCare coverage for more than 3 months, unless they are exempt.

61 Maine s proposed waiver changes, continued Premiums Charged: Imposes premiums on nondisabled adults between the ages of 19 64, beginning at incomes at half of the poverty level. (This includes parents, children ages 19 & 20, adults seeking family planning services, and former foster care children.) Premiums would range from $10 to $40 per month depending on income. If premiums are not paid by the last day of the final enrollment month, the member will lose MaineCare for 90 days or until the premium is paid.

62 Exemptions from: Work Requirements and Premium Payments People with disabilities, including those who are NOT receiving disability benefits unable to work at least 20 hours a week; Pregnant women; Parents with children under age 6; People living in residential facilities, including substance use treatment facilities; People providing care giving services for an incapacitated adult (caring for an incapacitated child over the age of 6 is not exempt.); People receiving TANF or unemployment benefits; American Indians and Alaska Natives who are members of federally recognized tribes exempt from premium requirement only.

63 More Waiver proposed changes Co Payments for Use of the Emergency Department: DHHS would require a $10 co payment from MaineCare recipients who use the hospital Emergency Department (ED) for any one of dozens of diagnoses considered by DHHS to be non emergent. This co pay applies even if a reasonable person would go to the ED under the same circumstance, or if the person s medical provider advises the person to go to the ED. Elimination of retroactive eligibility: Current law allows MaineCare applicants to get coverage for the 3 month period prior to the month of application if they were otherwise eligible during that period. The waiver would eliminate retroactive coverage.

64 Background: CMS and Medicaid Waivers Under the Trump Administration On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director Letter providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as community engagement) in Medicaid as a condition of eligibility. This action reverses previous Democratic and Republican Administrations, which had not approved such waiver requests because such provisions are inconsistent with the program s purposes of promoting health coverage and access. Nevertheless today s CMS states that such waivers are designed to promote better mental, physical, and emotional health... And help individuals and families rise out of poverty and attain independence.

65

66 5 Things to Know About Work Requirements: The Evidence: Work Requirements Don t Work. Maine s own experience also shows that exemptions from work requirements are no safeguard they don t protect vulnerable families. Most Medicaid recipients already work, but often in unstable jobs with frequent spells of unemployment and irregular hours. Loss of coverage interrupts continuity of care; means worse health outcomes; makes it more difficult to find and maintain employment Medicaid itself is a strong work support. Strategies that provide support to working families are most successful at sustaining employment and reducing poverty.

67 Waiver Approvals and Court Action Waivers including work requirements have been approved for KY, IN, AR and NH. In June 2018, the DC federal district court issued a decision (Stewart v. Azar) voiding CMS s decision approving work requirements and other provisions that restrict eligibility and enrollment in the Kentucky HEALTH waiver approval. The court told HHS to reconsider whether the waiver would help furnish medical assistance consistent with Medicaid program objectives AND prohibited Kentucky from implementing waiver changes during this review.

68 Kentucky what now? Kentucky did not appeal this decision. Instead it issued a notice allowing the public to comment through August 18 on issues raised by the court s decision. In the space of about 4 weeks, thousands of comments were submitted. CMS must now determine, based on these new comments, whether: the potential coverage gains flowing from the experiment, as designed, appear to outweigh the risks of coverage losses (and their attendant effects) that the experimental population of non exempt, Medicaid eligible Kentuckians will experience, or not. A separate lawsuit by Kentucky s governor asking the court to determine the waiver legal was dismissed in late Augusta.

69 CMS Response Alex Azar, Secretary of Health and Human Services: We suffered one blow in a district court in litigation. We are undeterred. We are proceeding forward. We are fully committed to work requirements and community participation requirements in the Medicaid program. We will continue to litigate. We will continue to approve plans. Seema Verma, Administrator of the Centers for Medicare and Medicaid Services: It doesn t change our commitment to giving states flexibility and our commitment to helping people rise out of poverty.

70 More Work Waivers filed Arkansas waiver challenged in court In late August, South Dakota submitted a Medicaid work demonstration proposal; in early September, Alabama and Michigan joined the group. This brings to ten the total number of work demonstrations now pending. On August 14, lawyers from the National Health Law Program, Legal Aid of Arkansas, and the Southern Poverty Law Center went to court to challenge the HHS Secretary s decision to approve Arkansas work requirement. (Gresham V. Azar)

71 Are Work Requirements Effective in Helping Low Income People Get and Keep Jobs? Consider the evidence: ARKANSAS: Arkansas Medicaid rollout began in June enrollees lose coverage for the rest of the year if don t meet the requirement for any 3 months. Early estimates are that over one quarter of the total target population already is failing to meet the experiment s requirements 4,300 beneficiaries will lose coverage in October; another 11,000 are at risk of losing coverage in the next months. Many recipients face technological barriers, including a multi step process for creating an online account, followed by monthly online verification of their work hours or claims for exemptions. Urban Institute research confirms that many low income Medicaid beneficiaries have limited educational attainment, limited access to computers, and limited ability to navigate such systems. Means tested programs that link eligibility and enrollment to continual reporting have demonstrated an adverse impact on participation.

72 Arkansas: Work Requirements do little to promote work

73 Evidence from Maine MAINE: Maine s Waiver proposal is modeled on our current SNAP time limit and work requirement. When that SNAP time limit was applied in 2015, here s what happened: In the first three months, 80% of those impacted (10,000 people) lost food assistance. For those terminated employment rates increased by only 4 percentage points in the next year (about the same as the overall increase in employment in that year for all Mainers); and Two thirds of those terminated remained unemployed at the end of that year with neither wages nor food assistance.

74 Maine s Medicaid Waiver the future: Legal Challenge: MEJP believes that most DHHS waiver proposals cannot legally be waived under federal law. We will challenge any decision by CMS allowing work requirements and several other of Maine s waiver proposals in federal court in D.C. using Kentucky/Arkansas arguments. We are prepared to seek a judgment in State court that the waiver cannot be implemented under Maine law unless it is first approved by the Maine Legislature. Potential that Waiver could be withdrawn: A new administration could withdraw the waiver request. A new legislature could pass legislation requiring withdrawal of the waiver.

75 How You Can Help Organizations can sign onto a letter opposing the waiver Talk to legislative and gubernatorial candidates about the harm that this waiver could do Identify potential plaintiffs and connect them to MEJP A Parent With ALL children over age 6 AND at least one child under age 18 NOT on TANF or receiving Unemployment benefits NOT working 20 hours or more per week NOT in school half time or more NOT volunteering 24 hours per month or more; OR

76 Proposed Changes to the Public Charge Public charge is a term used in immigration law to refer to a person who is likely to become primarily dependent on the government to meet his or her basic needs. Under the new proposed rule, the government now wants to redefine public charge more expansively, as an immigrant who receives one or more listed public benefits. PUBLIC CHARGE PSA Final Spansubs 1 1.mp4

77 Proposed Changes to the Public Charge If the rule is finalized in its proposed form, this would mark a significant and harmful departure from the current policy. For over a hundred years, the government has recognized that work supports like health care and nutrition help families thrive and remain productive. Entire households will be harmed, as there is no way to target individual immigrants without hurting children, families, and communities.

78 Proposed Changes to the Public Charge Public Benefit Defined As: Non Emergency Medicaid * SNAP Medicare Part D Low Income Subsidy Housing Assistance (public housing or Section 8 housing vouchers and rental assistance) * Note: Exception for certain disability services offered in school, and for Medicaid benefits received by children of U.S. citizens who will be automatically eligible to become U.S. citizens Public Benefit NOT Defined As: Disaster relief Emergency medical assistance * Entirely state, local, or tribal programs (other than cash assistance) Benefits received by immigrant s family members Any other benefit not specifically listed in the proposed rule * Note: DHS also asks for input on inclusion of CHIP, but the program is not included in the regulatory text we ve seen

79 Key Points to Remember Current policy has not yet changed. We have only seen a draft. The rule must be published, there will be a comment period, DHS must respond to comments, and there will be changes. It will take time for the new rule to go into effect. Not all immigrants are subject to the public charge test. The test looks at multiple factors in determining whether someone should be considered a public charge. The rule will not be retroactive. Immigrants who are concerned should talk with an immigration attorney to determine how this could affect their individual situation.

80 How You Can Help Share information to help immigrants understand what is proposed and the process and help non immigrants understand why this is an important issue. Comment! There will be a 60 day comment period once the proposed rule is published. We need as many people and organizations to comment as possible. Learn more at Share your story if you are able.

81 Questions

82 Contact Us Chris Hastedt, MEJP Drew Joy, SMWC Kathy Kilrain del Rio, MEJP Maine Equal Justice Partners mejp.org Hotline: Southern Maine Workers Center maineworkers.org SMWC (7692) Worker Support Hotline: