Medicaid Infrastructure Grant Advisory Committee

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					                 Medicaid Infrastructure Grant Advisory Committee
                      Technical Design Subcommittee Meeting
                  Meeting Summary: Wednesday, August 14, 2002

Design Subcommittee members attending: Joe Ashley, Leslie Hutcheson, Sharon
Koehler, Kathryn Kotula, H.K. Lee, Jr., Pat Lovell, Linda G. Broady-Myers, Teja Stokes,
Jim Taylor, Quincy Umphelette

Others attending: Jack Quigley, DMAS staff; Paul Hedrick, DMAS staff; Danielle
Hughes, DMAS staff

Welcome and Introductions
The meeting began at approximately 10:10.

Review of Olmstead Coordination Grant Objectives
Joe Ashley explained the Department of Rehabilitative Services' Olmstead Coordination
Grant objectives and requested letters of support from the committee members. The
purpose of the grant is to customize WorkWorld according to Virginia specific policies
and fund a staff person to coordinate these efforts. The WorkWorld software will also be
used as a policy development tool and to help system integration. The application for the
grant will be sent out on Wednesday, August 21, 2002.

Examples of Medicaid Buy-In programs in other states
Committee members reviewed examples of Medicaid Buy-In programs from other states.
Jack Quigley went over the income limits, resource limits, allowable resources,
disregards, and the premium structures from other states. These categories were broken
into high level states, medium level states, and low level states.

Income limits
Income limits from other states were compared to Virginia’s current limits in the
categories of SSI recipients and the Aged, Blind, and Disabled. Virginia’s current federal
poverty level is 74% for SSI recipients and 80% for the Aged, Blind, and Disabled. The
examples from the states ranged from Colorado’s high of 850%FPL to Wyoming’s low
of 100% FPL. Joe Ashley asked if Medicaid could only pay an employer’s health
insurance premium despite a potential participant’s high income. Jack Quigley stated
that DMAS already pays Medicare premiums for certain Medicaid recipients and also
pays employer health insurance premiums for some recipients through its HIPP program.
The state may be able to pay the employer’s premium if it is more economically
beneficial than enrolling the person in Medicaid.

Resource limits
The resource limits from four other states were compared to Virginia’s current limits of
$2,000 for an individual and $3,000 for a couple. The highest state was New Hampshire,
which had a $20,000 limit for an individual and $30,000 for a couple. The lowest state
was California with a limit of $2,000 for an individual and $3,000 for a couple.
Allowable resources
The amount of allowable resources ranged from states having a wide array of accounts
that had specific limits to states that had only a few accounts, but they were open ended.
The highest allowable resources were in Indiana, which allowed accounts for retirement,
savings, medical savings, and savings for independence and employability with a limit of
$20,000 for goods and services not covered under any other publicly funded program.
The lowest state was California, which only allowed a retirement account.

The disregards were items that would not be included in determining income eligibility.
An example of a high disregard is in Illinois, which disregards all of the spousal income
and assets. An example of a low disregard would be Maine, which disregards unearned
income up to 100%FPL. Joe Ashley noted that if a person probably is not working or
may not be able to work if they have a high unearned income. Therefore, the committee
might want to consider a cap on unearned income to ensure that people are working.

Three examples of premium structures were provided. The most expensive option for
participants was Alaska who required 10% of a recipient’s income that was above 100%
of FPL. The least expensive option for a recipient was Maine’s premium structure which
required recipients to pay $10 if their income fell between 150% and 200% of the FPL
and $20 if their income fell between 200% and 250% of the FPL. During this discussion
members felt that it would be more helpful to look at states that had a premium and co-
pay structure. The suggestion was made to look at the state of Iowa. DMAS staff agreed
to provide this information for a later meeting. Linda G. Broady-Myers felt that the
premium structures should not be too high because then the program would not be a work
incentive. She felt that if the premiums were too high a person would not be willing to
go to work and start paying for something that they were already receiving for free. The
majority of the other members disagreed and felt that the premiums should be a
substantial amount of money that was similar to the state employees benefits package and
in essence the “real world.” The suggestion was also made that a person’s premium
should not increase as soon as their wages increase. The premiums should only be
evaluated during their one-year redetermination meeting.

Virginia Medicaid’s Medicare costs and Other SSDI Data
Jack Quigley briefly went over a document about Virginia Medicaid’s Medicare costs
and reported that 2001 Utilization Data for Medicaid Recipients in Blind or Disabled
eligibility categories shows expenditures of $1,261,261,327 (47.3% of total) for an
average annual expenditure per eligible recipient of $10,738. He also distributed data
from the Social Security Administration but noted that he was not able to obtain the
document in other than PDF format at this time. Among other things, this document
showed the number of SSDI recipients within income groupings of $100.

DRS Data Update
Joe Ashley also gave an update on the data that they would be prnvidhng for thd
Medicahd Infrartrubttrd Fr`nt. Dr. Ashley stated that the Department of Rehabilitative
Services closed about 4,000 cases last year for people that had been working for at least
90 days above the SGA limit. He also stated that the average salary per week per person
was $285. They hope to provide this information in early September.

Key Issues - Design Options Worksheet
Joe Ashley and Jack Quigley used the Design Options Worksheet as a template for
discussion on the key issues of the Medicaid Buy-In program. The discussion began with
a correction to the worksheet that stated employment could be defined by the number of
hours a person worked. According to the Balanced Budget Act of 1997 and the Ticket to
Work and Work Incentives Improvement Act of 1999 states can not define employment
by the amount of hours worked or the amount of money earned. Only if a state covers
the Medical Improvement group are they allowed to state specific hours. Joe Ashley
mentioned an earlier fact sheet that was handed out at the full committee meeting, which
gave examples of other state’s definitions of employment. Joe would like for DMAS to
circulate this fact sheet again to refresh people’s memories. Kathryn Kotula suggested
adding to the fact sheet the CMS definition of competitive employment. Joe Ashley also
mentioned adding the RSA definition of employment, which seemed to be similar to the
definition from CMS.

While discussing cost containment strategies the group decided to make it mandatory for
an individual to apply for an employer-based health care program if it was offered.
Medicaid would pay for the premiums if it were cost effective. The question came up
what if a person has Medicare, employer-based coverage, and Medicaid, in what order
are these programs responsible for the payments. DMAS offered to conduct further
research on the topic and get back with the group. Joe Ashley requested that individuals
be required to use Medicare if they are eligible for Medicare.

The group also discussed allowable accounts that would not count towards the resource
limit. There was consensus that Virginia should allow for a retirement plan that was
open-ended. The group also discussed having an independence and employability
account, but they could not come to an agreement on whether it should be open-ended or
have a limit. Some other accounts mentioned were a medical savings account and an
assistive technology account. The group came to an agreement that all of the accounts
should be IRS approved.

The meeting was adjourned at 3:00.

The next meeting will be August 28, 2002 from 10:00 a.m. to 3:00 p.m. Discussion
topics will be posted to the listserv prior to the next meeting in order to expedite the
finalization of recommendations that is expected to occur at the next meeting.