Proposed Medicaid Eligibility Changes Under the Affordable Care Act of 2010

Public Input Provided in 2011

Input provided to the Centers for Medicare and Medicaid Services

October 31, 2011

Administrator Donald M. Berwick
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Room 445–G, Hubert H. Humphrey Building,
200 Independence Avenue, SW.
Washington, DC 20201

Regarding: CMS–2349–P

Dear Administrator Berwick:

On behalf of the Texas Council for Developmental Disabilities we are pleased to submit comments to the Centers for Medicare and Medicaid Services (CMS) on the Notice of Proposed Rule Making (NPRM) regarding the Medicaid Program; Eligibility Changes Under the Affordable Care Act of 2010 (76 CFR 51148 – 76 CFR 51199).

TCDD is pleased to see the proposed rules issued to implement the expansion of Medicaid coverage required by the Patient Protection and Affordable Care Act of 2010 (ACA). We also appreciate and support the efforts by CMS to create a single, streamlined application process which ensures that eligible individuals receive coverage as quickly as possible. However, we have concerns regarding CMS’ interpretation of the ACA and its potential impact on people with disabilities and special health care needs. The interpretation of the ACA in the NPRM appears to block access by some working people with disabilities to services and supports necessary to remain in the workforce. Although a single streamlined application process will make it easy for most applicants and create administrative efficiencies for states, it has the potential to block access to vital services and supports for people with disabilities.

Individuals with disabilities who are currently receiving services to live independently in the community and who need access to long-term care should not be adversely impacted by ACA implementation. We are particularly concerned that people with disabilities who are not eligible for Supplemental Security Income (SSI) will lose access to Home and Community Based Services (HCBS), Medicaid Buy-In (MBI)1 and other long-term services and supports as a result of being placed in the new mandatory eligibility category created by the ACA (codified at section 1901(a)(10)(A)(1)(VIII) of the Social Security Act herein after referred to as the “Adult” category). Consequently, these individuals will become underinsured.

It is our understanding that the new benchmark plan required for the Adult group was intended to supplement the current eligibility groups by allowing previously uninsured low-income adults who might not be able to afford to purchase insurance. However, the draft rules as proposed would replace existing categories of eligibility or subsume other categories. Individuals with disabilities who are eligible for Medicaid should not be placed in the benchmark plan if doing so would result in a loss or reduction of services through Medicaid. Individuals incorrectly placed in a benchmark plan – or those who experience the onset of disability following an initial determination – with a need for long-term services and supports should be able to move to a different category of eligibility so that they can access those additional services.

We also recommend that people with disabilities be exempt from the Modified Adjusted Gross Income (MAGI) methodology and be able to make an informed choice about enrolling in the healthcare package that best meets their needs. Congress included a list of categories of individuals who are exempted from having the MAGI eligibility determination. This list includes individuals who qualify for medical assistance under a State Medicaid plan, or under any Medicaid waiver of the State plan, on the basis of being blind or disabled without regard to whether the individual is eligible for supplemental security income benefits (SSI) under Title XVI on the basis of being blind or disabled. Placing a person in the Adult category, as required by the interpretation of the proposed rule, would eliminate Medicaid Home and Community Based Services waiver services and other supports included in the service package specifically to support a working individual with a disability.

Finally, we encourage CMS to allow individuals with disabilities to work with community organizations to expedite eligibility for individuals who require a higher level of care than provided by benchmark plans.

TCDD appreciates the opportunity to respond to the proposed rules issued to implement the expansion of Medicaid coverage required by the Patient Protection and Affordable Care Act of 2010 (ACA).

Respectfully submitted,

Roger A. Webb
Executive Director