In 2011, the National Council on Independent Living joined a coalition of other groups in commenting on Centers for Medicare & Medicaid Services (CMS) rules related to implementing eligibility determinations under the Patient Protection and Affordable Care Act (PPACA). The comments related to concerns that people with disabilities might lose access to home and community based services, Medicaid Buy-In programs, and other long-term services and supports if they were determined eligible for a “new adult” group created as part of Medicaid expansion.
Although CMS addressed these comments in their final regulation, the Government Accountability Office (GAO) is interested in learning more about how states are implementing this guidance. The GAO is interested in learning from NCIL members who have experience assisting individuals to apply for Medicaid before and after implementation of PPACA, or general knowledge of this process, specifically as it relates to individuals who could benefit from home and community based services waivers and Medicaid Buy-In programs. Some questions the GAO has are:
In your experience, to what extent does the Medicaid application process adequately screen for instances when individuals should be determined eligible based on a need for assistance with activities of daily living?
Do you instruct individuals you are assisting to apply for Medicaid to request a “non-MAGI” eligibility determination (e.g., a determination based on disability rather than income)? If so, why?
How does the Medicaid program handle instances where individuals applying are eligible under more than one pathway? For example, if an individual is eligible both based on their income and based on a disability are they given a choice of which application process to follow?
In your state, is there a difference in benefits for individuals determined eligible based on income vs. a disability that make one process advantageous? (e.g., potential out of pocket costs, access to certain benefits, inclusion or exclusion from managed care, or other implications.)