The Patient Protection and Affordable Care Act will improve the health care of nearly 30 million women in the U.S., according to an issue brief published by The Commonwealth Fund.

By the time the law fully takes effect in 2014, up to 15 million uninsured women will be eligible for subsidized coverage, and an additional 14.5 million insured women will see improved coverage and/or reduced premiums.

Low-income women will especially benefit from the law, the issue brief states.

President Obama signed the Patient Protection and Affordable Care Act this past March as part of his administration’s effort to enact national health reform.

Implications for Direct-Care Workforce

Perhaps the most significant provision of the act will be an expansion of Medicaid eligibility to cover adults earning up to 133 percent of the federal poverty level (currently about $14,400 for a single adult).

An estimated 8.2 million uninsured women between the ages of 18 and 64 will be eligible for Medicaid when that provision takes effect in January 2014, The Commonwealth Fund report found.

A significant number of these millions of uninsured women are members of the direct-care workforce, which is 90 percent female, PHI research (pdf) suggests.

Approximately one out of four direct-care workers is uninsured, and many of them would be eligible for Medicaid under the new eligibility rules. The median annual income of direct-care workers is just $17,000; personal and home care aides make an average of $12,000 a year.

PHI has compiled a chart (pdf) on other health-reform provisions that will affect the direct-care workforce.

More Helpful Provisions

The Commonwealth Fund’s issue brief details several other provisions that will benefit women.

Beginning September 23, 2010

• Health plans will be required to cover a wide variety of services without requiring cost-sharing. Those services include screenings for breast cancer, and cervical cancer, as well as osteoporosis screenings for women age 65 and older.

Beginning January 1, 2014

• Insurance companies will be required to accept every individual who applies for coverage, and will be forbidden from charging higher premiums based on gender or pre-existing medical conditions.
• Health plans sold through state insurance exchanges will be required to cover maternity and newborn care.

– by Matthew Ozga

The Federal Medical Assistance Percentage (FMAP) increase is expected to be extended, since the U.S. Senate has voted to pass it.

Without the FMAP extension, many states were planning to cut or even eliminate health care programs serving poor and elderly residents.

The Senate voted on August 5 to pass the federal state-aid package that includes $16.1 billion to extend the FMAP increase through 2011.

First the Senate had to surmount a Republican filibuster — an outcome that seemed unlikely by all accounts just one week ago. Once the Senate voted on August 4 to end the debate, the bill headed to the Senate floor where it passed, 61-39.

Calling Representatives Back for the House Vote

Members of the U.S. House of Representatives have already left for summer recess. However, in an uncommon move, House Speaker Nancy Pelosi (D-CA) called them back to Washington, D.C. to vote on the measure next week.

Once the measure is passed in the House, as expected, the bill will be sent to President Obama, who has been pushing for its passage.

Extension Will Prevent Layoffs and Service Cuts

The $16.1 billion FMAP increase is part of a larger, $26 billion state-aid package of which $10 million is targeted to prevent teacher and other public service worker layoffs due to shortfalls in state budgets.

The bill was tied up in the Senate until two Maine Republicans, Susan Collins and Olympia Snowe, joined with Democrats to end debate on the bill.

“At a time when our economy is still regaining its footing and state budgets are strapped, this FMAP extension is critical to maintaining services for elders and people with disabilities, as well as ensuring stability to the direct-care workforce that provides those services,” said Steve Edelstein, PHI’s national policy director.

“We applaud the Senate leadership and Senators Collins and Snowe for putting the needs of our most vulnerable citizens at the forefront and for refusing to let this vital legislation die.”

– by Deane Beebe

Congressional inaction may cost states up to $24 billion in additional Medicaid funding.

The future of the Federal Medical Assistance Percentages (FMAP) increase remains in doubt, despite pleas from governors, state legislators, AARP, and the 64-member Leadership Council of Aging Organizations, of which PHI is a member.

In June, the House dropped an FMAP increase extension from legislation that would prolong certain tax provisions and unemployment benefits.

Later that month, Senate Republicans defeated a severely scaled-down version of the FMAP extension that had been written into the Senate’s legislation extending jobless benefits.

Origins of the FMAP Extension

As part of the American Recovery and Reinvestment Act, Congress authorized a temporary increase in the rate at which the federal government matches state funding for various social programs, including Medicaid. This rate is known as FMAP.

The temporary FMAP increase was originally scheduled to last through the end of 2010. However, many governors have requested an extension in order to bring relief to their cash-strapped states.

In their FY2011 budgets, approximately 30 states have assumed that the enhanced FMAP rates will be extended through the entire fiscal year, which ends next June 30.

Inaction Would Harm States

If the FMAP increase is not extended through the end of the 2011 fiscal year, states will be forced to reconcile roughly $24 billion in missing Medicaid funding.

Analysis from the Center for Budget and Policy Priorities shows exactly how each state will be affected if Congress fails to extend the FMAP increase.

“Without continued federal support, long-term care services could be seriously jeopardized,” said Carol Regan, PHI government affairs director. “Elders and people with disabilities could go without services, workers could face reduced hours and income, and family members will be forced to make even greater sacrifices to care for their loved ones.”

Medicaid currently pays for half of all long-term care spending in the country, costing over $100 billion annually.

Organizations Speak Out

Numerous organizations have urged Congress to extend the enhanced FMAP rates through June 30, 2011.

On July 21, the Leadership Council of Aging Organizations sent a letter (pdf) to Senate Majority Leader Harry Reid (D-NV) asking the Senate to approve the FMAP extension “without delay.”

Additionally, the American Health Care Association and the National Center for Assisted Living have teamed up to launch “Driving for Quality Care,” an RV tour through 40 states intended to drum up support for FMAP extension.

– by Matthew Ozga

A provision in the health reform law extends the Money Follows the Person (MFP) Rebalancing Demonstration program for another five years, until 2016.

The Centers for Medicare and Medicaid Services (CMS) sent a letter (pdf) to state Medicaid directors in an effort to get states to participate. To make it easier for the 29 states (and the District of Columbia) that took part in the original MFP demonstration to do so again, the agency has streamlined the enrollment process significantly.

States that did not participate in the initial MFP demonstration can apply for the second phase. CMS plans to post guidelines later in July on how these states can apply, and will select states on a competitive basis.

The MFP demonstration program provides funding to states to facilitate the development of community-based long-term care programs instead of institutional care to provide services and supports to elders and people with disabilities who receive Medicaid.

Benefits to States that Participate

In late June, CMS sent a letter to state Medicaid directors to highlight the advantages of participating in the extended MFP program, including:

• enhanced Federal Medical Assistance Percentage rate for qualified services;
• national technical assistance and supplemental services;
• full reimbursement for some administrative costs; and
• reimbursement of home and community-based services and demonstration services at an enhanced rate.

Congress authorized the MFP program to be extended until 2016 and provided $2.25 billion. The initial five-year MFP demonstration had a $1.75 million budget and was set to expire in 2011.

Inside Health Policy reports that the MFP program made it possible for 6,000 people to move from institutional to community-based care by 2009.

PHI Provides Technical Assistance to MFP Program

“We were very pleased that Congress decided to extend the MFP demonstration program in health reform,” said PHI National Policy Director Steve Edelstein. “MFP has been an important vehicle not only for expanding home and community-based services but also for states to pursue initiatives for support and an adequate and stable workforce to provide those services.”

For the past year, PHI has been providing technical assistance on workforce issues to a number of state MFP grantees through the Direct Service Workforce Resource Center. The PHI policy team has been helping with workforce data collection and monitoring, providing guidance on procurement and incentive payment polices, and providing support for entry training programs.

PHI National Director of Curriculum & Workforce Development Peggy Powell is working with MFP demonstration staff in the District of Columbia, by assisting in the development and implementation of a values-based pilot training program for community-based, direct-support workers and other provider agency staff.

The goal of the training is to increase the trainees’ understanding of a person-centered approach in meeting the needs and preferences of their program participants and supporting fuller community integration.
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Powell noted, “During our recent interviews with community residence and day program staff, we consistently heard them express how important it is to provide this opportunity and choice for consumers, and the need to help direct-support staff develop the knowledge and skills necessary to achieve MFP’s vision for full community integration.”

– by Deane Beebe

Dr. Donald Berwick

PHI has joined 28 other members of the Leadership Council of Aging Organizations in supporting Dr. Donald Berwick’s nomination as Administrator of the Centers for Medicare & Medicaid Services (CMS). Read the full story

Helen Hanson, Home Care Worker

Direct-care worker Helen Hanson, a long-time friend of PHI, wrote about planned federal spending cuts — and how they will affect Maine’s direct-care workforce — in a recent issue of The Times Record in Maine. Read the full story