Living Independently

Passive Enrollment discussed at CPWD

Teri Bolinger of HCPF

CPWD held a Medicaid forum to hear directly from the state of Colorado about the Medicaid and Medicare Dual Eligibility Demonstration. The state is looking for ways to cut costs around this group of beneficiaries because they see the cost to the state as disproportionately high.

The most controversial point of the dual eligibility demonstration was the proposal to “passively enroll” people into the program. A letter would be sent to dual eligible beneficiaries that they must act on or they will be enrolled in the program. A beneficiary must actively respond to the letter to “opt-out” and keep services untouched.

Ian Engle, the CPWD Executive Director, pointed out the contradiction of passive enrollment with the Independent Living philosophy. He said that the Center promotes an informed individual to actively chose and direct their care. CPWD works so people decide and select services and supports so that they may take ownership and responsibility for the decisions they make.

Passive enrollment happens regardless of a choice and often without either clear knowledge or desire. An individual is forced to respond in order to opt-out of the program. Typically knowledgeable people act in their self-interest and those that do not act miss-out on the benefit. However, the state looks to turn this around so that the uninformed will be enrolled.

The state contends that someone may choose to opt-in or opt-out to the program at anytime and to be consistent with the current Colorado legislation they believe that passive enrollment is the only way to currently proceed. Teri Bolinger from the Colorado Health Care Policy and Finance Department was clear that passive enrollment was the only method on the table. Colorado citizens would have to demand a change for the state to consider another form of enrollment.

We asked the state to make the case why an individual would want to opt-into the program, but they could only repeat the advantages to the government agencies and providers. They implied that people would benefit from a more centralized control of programs and services and it is easy to see how this would benefit the state and possibly save money; but from the perspective of an individual recipient, there is no advantage.

I believe it is reasonable to opt-out until the state can show that their demonstration will actually work for you. It is essential that even creating an efficient and effective system that those impacted are informed and understand the services provided by the state.

People at CPWD Medicaid Forum

Around Colorado, Independent Living HCPF, Medicaid

Colorado ADAPT demands Governor Hickenlooper and CMS move to apply for the Community First Choice Option

(DENVER, January 13, 2012) Colorado ADAPT visited the Colorado Governor’s office and demanded Gov. Hickenlooper order the Department of Health Care Policy and Finance to begin now to work on getting the federal enhancement for the Community First Choice Option. ADAPT also went to the local Center for Medicare and Medicaid Services (CMS) office to demand Jeff Hinson urge the federal agency to complete the final regulations that will allow Colorado to apply for Medicaid enhanced funding.

Colorado ADAPT meets with CMS

Contacting him in route to the CMS Baltimore office, Jeff Hinson agreed to give the message to Marilyn Tavenner the CMS Administrator today and the Governor, who was out of town, will be responding to ADAPT next Tuesday at 3:30, after speaking with the department over the holiday weekend.

“I promise you that I will stop by her office today and tell her,” said Mr. Hinson on the phone with Colorado ADAPT from Maryland, “and send her a note if she is not in.”

In Denver, Colorado ADAPT continued to meet with the CMS Regional Administrator about what they could do to ensure that the Community First Choice (CFC) Option did not miss Colorado. States that apply for the “enhanced match” will get more federal Medicaid funding. The Community First Choice Option is a program that was developed to help states reduce Medicaid spending by allowing citizens to choose to live or remain in their own home or the community rather than expensive institutions and nursing homes.

“Richard, you know we have never come to the department asking for money,” said Dawn Russell of ADAPT to the Associate Regional Administrator, Richard Allen; “we haven’t come to rob your bank, ADAPT always brings money and savings to the table.”

CFC is part of the Affordable Care Act and although some states like New York have already applied for the expanded funding, most states like Colorado are waiting for a final version of the CFC regulations before putting in their applications. ADAPT is asking the governor to start now and direct HCPF to begin to develop the implantation council that is part of the CFC regulations, and to prepare to apply for the funds when the final regulations are published.

Colorado ADAPT in the Governor's Office

“We saw what happened in 2006 when our state failed to apply for the Money Follows the Person grant,” said Dawn Russell. “Not only did we miss out on millions of federal dollars, but our state lagged behind in building the infrastructure to save millions. It wasn’t until last year that the feds opened the program again and Colorado got $22 million.  We are asking the governor to be proactive and create the implementation council. Colorado cannot afford to watch HCPF fail to apply again.”

ADAPT is also demanding that Jeff Hinson contact Marilyn Tavenner the new Administrator of CMS to get the CFC regulations finalized and to meet with ADAPT. The regulations were originally scheduled to be completed last October.

ADAPT, Around Colorado, System Change CFC, Colorado ADAPT, Community First Choice Option, Medicaid

Photos from the march and rally.

Senator Aguilar of Colorado District 32

Over 100 people marched from 6th Street and Grant to the steps of the Colorado Health Care Policy and Finance building where they rallied with the direct message: “My Medicaid Matters.”

The march and rally were organized by Colorado ADAPT to send the message to Washington DC and the Deficit Reduction Super Committee that Medicaid is an essential federal program. ADAPT has proposed cost saving Medicaid reform for Congress to consider that will continue to support people with disabilities in the community and still save tax dollars. Generally the ADAPT proposal is to expand the use of community-based services as an option to expensive institutions, to de-medicalize services, to expand consumer directed options and to eliminate wasteful bureaucracy.

“This Super Committee holds our very lives in their hands,” said Anita Cameron of ADAPT and one of the organizers of the march. “Their vote could send millions of people with disabilities and seniors around the country into nursing facilities, which actually costs states more money. Our very lives and freedom are on the line.”

Before noon about 100 activists gathered at 6th and Grant to start the march. Morris Price, Rep. Diana DeGette’s District Director addressed the crowd before the march. Rep. DeGette is in Washington.

The Denver Police stopped traffic for the march, as the long line made its way mostly uphill on Logan and past the state Capitol to the HCPF office building on Grant. Along the way, the marchers chanted “My Medicaid Matters,” following someone shouting out a focus to the Medicaid program including: Independence, family, jobs and community.

Colorado ADAPT My Medicaid Matters March

At the rally, Dawn Russell of ADAPT began with a little history of the My Medicaid Matters campaign and what ADAPT had accomplished with Money Follows the Person and the Community First Choice Option.

“It was no surprise yesterday when news reports announced it is likely that the Super Committee will fail to reach a debt deal,” said Ms Russell. “Many believe their plan is to kick the can down the road, extend the deficit reduction problem to the next administration. Because of the Super Committee impotence How long will we wait for ADAPT’s proposals for REAL Medicaid reform?”

Senator Aguilar of Colorado District 32, Carol Meredith, Mark Stallman, James Tucker, Julie Reiskin and Anita Cameron all spoke at the rally to reinforce the message that “my Medicaid matters.”

ADAPT, Around Colorado, System Change March, Medicaid, Rally

By Steve Gold

Steve Gold

The American Health Care Association, the national trade organization for the nursing home industry, and the Alliance for Quality Nursing Home Care have been on You Tube with a “Care Not Cuts” campaign. These two organizations have mounted a sophisticated campaign on behalf of nursing homes and against cut-backs for their clients - the nursing homes. . Their common thread: Medicaid reductions have hurt nursing homes.

What they do not state is the average Medicaid per diem expenditure continues to increase significantly. What they do not tell you is what your State spends to keep people institutionalized.  They also do not tell you that each State could save a bundle of money by moving people into the community.

In 2009, Medicaid nationally spent more than $50 billion on nursing home care.

The state-by-state data below is from an AHCA report.  It provides the average Medicaid expenditure your State spent per person per day for nursing homes in 2010.  (This data may not even include additional Medicaid expenditures other than what was paid to the nursing homes.)

A number of States did not provide the information and are not included below.

We also calculated the percentage increase from 2006 to 2010 for the average Medicaid expenditure per diem per person for each State.

If you multiple the 2010 per diem amount by 365 days, you’ll compute the average annual MA expenditure in your State per person in a nursing home.  Yes, it’s a big business and the elderly and disabled are the cash cows that keep the Medicaid funds flowing.

Where is the home-care industry’s campaign?  What are the elderly and disabled advocates doing to counter the misinformation that the nursing home industry is putting out?  Who is mounting a campaign “Care In My Home - Not Nursing Homes”?

Steve Gold, The Disability Odyssey continues

To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100.

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects.  Information Bulletins are also be posted on my blog located at http://stevegoldada.blogspot.com/

ADAPT, Around Colorado, Around the country, System Change Medicaid, Nursing Home, Steve Gold