Medicaid Basics 2010 National Conference to End Homelessness  Martha Knisley The Technical Assistance Collaborative www.ta...
Overview <ul><li>The Basics—Medicaid 101 </li></ul><ul><li>Challenges and Opportunities </li></ul><ul><li>Case examples: M...
The Basics <ul><ul><li>Medicaid is a federal and state funded medical insurance program </li></ul></ul><ul><ul><li>Federal...
The Basics <ul><li>Federal Policy: </li></ul><ul><li>Statewideness </li></ul><ul><li>Comparability of Services </li></ul><...
The Basics <ul><li>Federal Financial Participation (FFP) matches “state” funding—based on formula—FFP goes as high as 72% ...
The Basics <ul><li>Each state has its own Medicaid State Plan that defines: </li></ul><ul><li>Access and “Medical Necessit...
Challenges   <ul><li>Medicaid is an entitlement  </li></ul><ul><li>Medicaid covers the person not the place, not the progr...
Challenges <ul><li>There are incentives for states to expand coverage for people coming out of institutions </li></ul><ul>...
Opportunities <ul><ul><li>States can change their Medicaid state Plan </li></ul></ul><ul><ul><li>Persons who are homeless ...
Opportunities <ul><ul><li>Opportunities to shift from grant funded services to Medicaid are desirable when: </li></ul></ul...
Opportunities and Challenges: PPACA  <ul><li>15 million single adults living at or below 133% of poverty will be eligible ...
Matching-Up Medicaid with Supportive Housing—Services   <ul><li>Targeted Case Management (MH/PH) </li></ul><ul><li>Rehabil...
Matching-Up Medicaid with Supportive Housing—Services <ul><li>Section 6044 of the Deficit Reduction Act (DRA) (MH/PH/DD) <...
Matching Up Medicaid with SH  Medicaid Clinical treatment – MH and SA Primary health and chronic health care Rehabilitatio...
Services Not Covered <ul><li>Room and Board </li></ul><ul><li>Education </li></ul><ul><li>Watchful Oversight  </li></ul><u...
State Case Studies <ul><li>Indiana </li></ul><ul><li>New Mexico </li></ul><ul><li>Louisiana </li></ul><ul><li>Common appro...
Common Approaches (cont.) <ul><li>Same crosswalk approach used for cost analysis  </li></ul><ul><li>Single portal for hous...
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5.10 Using Medicaid for Housing (Knisley)

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Medicaid is a government health insurance program that can be used to offer services in supportive housing programs. Under the new Health Care Reform law, virtually all homeless people will be eligible, and can benefit from configuring supportive housing services to take advantage of Medicaid reimbursement. Consideration will be given to the administrative and data burdens inherited when a housing provider becomes eligible for reimbursement from Medicaid/medical assistance, as well as the benefits of delivering a flexible array of supports to maintain persons in their homes.

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5.10 Using Medicaid for Housing (Knisley)

  1. 1. Medicaid Basics 2010 National Conference to End Homelessness Martha Knisley The Technical Assistance Collaborative www.tacinc.org
  2. 2. Overview <ul><li>The Basics—Medicaid 101 </li></ul><ul><li>Challenges and Opportunities </li></ul><ul><li>Case examples: Medicaid as a core service for persons who are homeless </li></ul>
  3. 3. The Basics <ul><ul><li>Medicaid is a federal and state funded medical insurance program </li></ul></ul><ul><ul><li>Federal government sets broad policy and rules </li></ul></ul><ul><li>States administer the program </li></ul><ul><li>Medicaid operates as insurance: </li></ul><ul><ul><li>Covered lives </li></ul></ul><ul><ul><li>Covered “individual” benefits </li></ul></ul><ul><ul><li>Providers apply to be part of a service network </li></ul></ul>
  4. 4. The Basics <ul><li>Federal Policy: </li></ul><ul><li>Statewideness </li></ul><ul><li>Comparability of Services </li></ul><ul><li>Freedom of Choice of Provider </li></ul><ul><li>Equal Access </li></ul><ul><li>Amount Scope and Duration </li></ul><ul><li>IMD </li></ul>
  5. 5. The Basics <ul><li>Federal Financial Participation (FFP) matches “state” funding—based on formula—FFP goes as high as 72% down to 50% of payments </li></ul><ul><li>Federal rules and waivers administered by Centers for Medicare and Medicaid (CMS) </li></ul><ul><li>There are two broad categories of benefits: mandated and optional </li></ul>
  6. 6. The Basics <ul><li>Each state has its own Medicaid State Plan that defines: </li></ul><ul><li>Access and “Medical Necessity” </li></ul><ul><li>Individual Benefits (both mandated and optional) </li></ul><ul><li>Eligibility </li></ul><ul><li>Provider Qualifications </li></ul><ul><li>Rate Structure and Basis </li></ul>
  7. 7. Challenges <ul><li>Medicaid is an entitlement </li></ul><ul><li>Medicaid covers the person not the place, not the program </li></ul><ul><li>Not all housing supports can be covered by Medicaid </li></ul>
  8. 8. Challenges <ul><li>There are incentives for states to expand coverage for people coming out of institutions </li></ul><ul><li>Less incentive for people who are homeless: cost savings are marginal in Medicaid budget </li></ul><ul><li>Waiver programs are capped </li></ul>
  9. 9. Opportunities <ul><ul><li>States can change their Medicaid state Plan </li></ul></ul><ul><ul><li>Persons who are homeless can be enrolled in Medicaid </li></ul></ul><ul><ul><li>Their health and behavioral health care can be covered by Medicaid </li></ul></ul>
  10. 10. Opportunities <ul><ul><li>Opportunities to shift from grant funded services to Medicaid are desirable when: </li></ul></ul><ul><ul><li>There is an overlap between effective </li></ul></ul><ul><ul><li>interventions and “coverable” services </li></ul></ul><ul><ul><li>Providers can partner with Medicaid </li></ul></ul><ul><ul><li>providers or become qualified providers </li></ul></ul><ul><ul><li>Services are individualized </li></ul></ul>
  11. 11. Opportunities and Challenges: PPACA <ul><li>15 million single adults living at or below 133% of poverty will be eligible to enroll in Medicaid on January 1st 2014 </li></ul><ul><li>States can innovate through Waivers and other opportunities that can directly benefit people who are homeless </li></ul>
  12. 12. Matching-Up Medicaid with Supportive Housing—Services <ul><li>Targeted Case Management (MH/PH) </li></ul><ul><li>Rehabilitation Option (MH/SA) </li></ul><ul><li>Reinvesting MC Savings (MH/PH/DD/LTC) </li></ul><ul><li>Primary Health Care (FQHCs/HcH) </li></ul><ul><li>Home and Community Based Waivers (DD/PH) </li></ul>
  13. 13. Matching-Up Medicaid with Supportive Housing—Services <ul><li>Section 6044 of the Deficit Reduction Act (DRA) (MH/PH/DD) </li></ul><ul><li>Clinic based Services (MH/PH) </li></ul><ul><li>EPSDT for transition age youth </li></ul>
  14. 14. Matching Up Medicaid with SH Medicaid Clinical treatment – MH and SA Primary health and chronic health care Rehabilitation Option Tenancy supports and community integration
  15. 15. Services Not Covered <ul><li>Room and Board </li></ul><ul><li>Education </li></ul><ul><li>Watchful Oversight </li></ul><ul><li>Services provided in IMDs </li></ul><ul><li>Transportation </li></ul>
  16. 16. State Case Studies <ul><li>Indiana </li></ul><ul><li>New Mexico </li></ul><ul><li>Louisiana </li></ul><ul><li>Common approaches: </li></ul><ul><li>All state-local initiatives </li></ul><ul><li>Housing support and Medicaid covered services were matched through a cross- walking exercise </li></ul>
  17. 17. Common Approaches (cont.) <ul><li>Same crosswalk approach used for cost analysis </li></ul><ul><li>Single portal for housing and rehabilitation/ case mgmt. services; </li></ul><ul><li>most services are individualized; and </li></ul><ul><li>“ getting and keeping housing” included in service intervention and as outcome </li></ul>

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