Policy Update

Peter Notarstefano

Stimulus package to help states pay for Medicaid costs. The bad news is that the Senate failed to pass an economic stimulus package, so Medicaid help for the states is not going to happen until the new Congress reconvenes in January. The good news is that the congressional leadership plans to work on a stimulus package and on an omnibus fiscal 2009 appropriations bill, both of which could be ready for consideration sometime in January. So we could be seeing Medicaid assistance for supportive services, such as adult day services, several weeks earlier than we would ordinarily have expected.

Medicaid Regulations Likely to Be Withdrawn. The administration of President-Elect Obama is unlikely to move forward with a series of Medicaid regulations that would shift 18 billion dollars of Medicaid costs to the states. This cost shift could result in cuts in Medicaid payments to adult day providers and caps on the number of individuals eligible for adult day services. Of the seven regulations, six are subject to a congressional moratorium until March 31, 2009. The Obama administration will likely withdraw the regulations. If the rehabilitation option regulation is withdrawn, California, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Texas and Washington may be allowed to cover adult day health as an optional Medicaid service under the State plan. Maryland has already shifted adult day health to the waiver program.

How will the new President and Congress impact Adult day Services? With the election of incoming President Obama, Democratic initiatives in Congress will have an easier road to enactment. President-Elect Obama has said that seniors should have long-term care choices not biased toward institutional care. We now have 58 Democrats, 41 Republicans and two Independents in the Senate (the Senate race in MN is still being decided at this writing). In the House, there are 257 Democrats and 178 Republicans. There is no guarantee, however, that initiatives favored by either a Democratic President or a Democratic Congress will automatically find their way into law. The Senate Finance Committee held another hearing November 19 to pave the way for health care reform in the next Congress, and Rep. Charles Rangel (D-NY), chair of the House Ways and Means Committee, has said that his committee will work on health care reform as well. Former Senator Tom Daschle (D-SD), named as the incoming head of the Department of Health and Human Services, has a strong commitment to health care reform. In his book, What We Can Do About the Health Care Crisis, Sen. Daschle expressed his belief that long-term care should be covered either by Medicare or by a reformed health care system.

NADSA's Legislative Agenda for the 111th Congress. NADSA is advocating for the re-introduction of a number of bills that would benefit adult day service providers and the older adults and persons with disabilities that they serve. They include:

• The Community Choice Act, to allow nursing home eligible individuals to access community-based attendant services under Medicaid.
  
  
• The Empowered at Home Act,to improve Medicaid coverage of adult day services and other HCBS.
  
  
• Project 2020, which expands Older American's Act Nursing Home Diversion services.
  
  
• CLASS Act, which establishes a National Long-term Care Insurance Trust Fund. Funds could be used to pay for adult day services for individuals not eligible for Medicaid.
  
  
• Increased resources for the Older Americans Act programs that fund adult day services. NADSA is advocating for $361.348 million for Title III B Supportive Services and Centers and  $28 million for Choices for Independence activities (nursing home diversion, Aging and Disability Resource Centers, and evidence-based disease prevention).