Steve Gold’s “Treasured Nuggets of Information”
Steve Gold is very informed and active regarding issues of Medicare, Medicaid and Home Health Care. Steve is a treasure trove of information, and we strongly suggest that you take the time to view his website. Steve’s comments can be found at http://www.stevegoldada.com. In a February 2009 issue of “Treasured Nuggets of Information”, Mr. Gold provides a roadmap for holding your state accountable after it receives The Stimulus Act money:
The Stimulus Act and Medicaid Services. Information Bulletin #276 (2/19/09)
Is your State crying lack of Medicaid funds? Threatening to reduce Medicaid waivers? Already reduced Medicaid programs? Telling the press that Medicaid funds must be reduced because of a state budget crisis? Here are some possible answers:
You’ve read about the recently enacted Stimulus Act. It has an entire section regarding “FMAP” the “Federal medical assistance percentage,” i.e., the federal money used to match your state’s funds for Medicaid programs in your state.
The FMAP has been significantly increased. States’ Medicaid programs will have a large increase in federal funds without having to increase their state funds whatsoever.
- The Stimulus package provides states with enormous FLEXIBILITY. Each state can decide how to allocate this new Medicaid funds. The federal statute imposed virtually no requirements.
Therefore, how your State spends its new Medicaid funds depends on political decisions at your State level – not because of the Stimulus package. If your state tells you that it must spend its Medicaid funds on certain programs or cannot do other programs, they’re selling you a lemon!
Advocates must ensure that Stimulus funds increase integration of people with disabilities in the community and do not increase the institutional biases. This is a great opportunity to “End the Waiting Lists” and to move people from institutions to the community.
You must know how your Medicaid office, Governor, and Legislature want to allocate these funds. IF there is a potential ADA violation, it should be stopped, either by direct actions and court orders.
- A state is NOT eligible for increased FMAP if any of the increased federal funds will go “directly or indirectly” to “any reserve or rainy day fund of the State.”
- With regards to the “eligibility” of persons and “methodologies or procedures” under a state’s Medicaid plan, any person who was eligible on, as well as Medicaid programs’ methods and procedures in effect on, July 1, 2008, must be maintained in order for your state to be eligible for the increased FMAP.
This is a very important handle. IF your state has imposed restrictive eligibility criteria since July 1, 2008, or changed its Medicaid programs’ methods and procedures since July 1, 2008, and IF your state wants to receive the increased FMAP, then eligibility, methodologies, and procedures must be reinstated to what they were on July 1, 2008. Therefore, if your state has, since July 1, 2008, restricted eligibility of programs or changed Medicaid programs’ procedures, hold them accountable.
- States can increase eligibility to persons whose incomes are higher than the income standards [sometimes known as “medically needy”] and receive increased FMAP for these people.
An update of a previous story from our December 2007 newsletter . . .
The Centers for Medicare & Medicaid Services (CMS) has released a study of states’ participation in the Money Follows the Person (MFP) Demonstration program. MFP is a federal program that has authorized $1.75 billion to support state efforts to move people currently residing in institutions back into their communities and to rebalance their long-term care systems to emphasize home and community-based services rather than institutional placement. (See our article about states’ non-participation in MFP in the December 2007 newsletter.) This study chronicles the efforts of the 30 states and the District of Columbia that are participating in MFP. You can find out what your state is doing under MFP (or if it one of the 20 states that have spurned participation in the program) by going to http://www.cms.hhs.gov/DeficitReductionAct/20_MFP.asp.
There is a small mystery regarding the MFP Demonstration program. On its website CMS says that $1.436 billion in MFP grants have been made to the various states. However, Congress appropriated $1.75 billion for the program. This leaves $314 million unaccounted for. If anyone can help with this enigma, please send us an e-mail with the answer. We will let our readership know in the next newsletter.
. . . As well as from the September 2005 newsletter.
The U.S. Department of Transportation (DOT) has spent over four years issuing regulations implementing the Air Carrier Access Act (ACAA). DOT published a Notice of Proposed Rulemaking (NPRM) on November 4, 2004, to revise its ACAA regulations in 14 Code of Federal Regulations, Part 382 to make foreign air carriers operating to and from the United States subject to most of the disability-related requirements currently applicable to U.S.carriers. DOT issued further NPRMs on September 7, 2005, (to provide greater accommodations for travelers with respiratory disabilities) and February 23, 2006, (to provide additional accommodations for air travelers who are deaf, hard of hearing or deaf-blind). The three now-consolidated rulemakings have been completed. The new regulations will be effective May 13, 2009. We will provide a full update of the new regulations in our next newsletter.