Amber Christ: Hello everybody and welcome to at present’s webinar, Medicaid Cuts in H.R.1-Updates for Growing older Advocates. My title is Amber Christ, I take advantage of she/her pronouns, and I’m the managing director of Justice in Growing older Well being Advocacy. I’m joined at present by my colleagues Natalie Kean and Gelila Selassie, administrators on our well being staff who’ve been main our federal advocacy to defend Medicaid. Earlier than we dive into content material, only a few logistics. All contributors are going to be on mute, so when you’ve got a query in regards to the materials being offered or a technical concern, please use the query perform. We can even depart time on the finish for query and reply. When you expertise any difficulties accessing the webinar, please e-mail trainings@justiceinaging.org. The supplies we’re going to debate at present will likely be accessible on Justice in Growing older’s web site and our useful resource library and a recording of this webinar will likely be posted in our useful resource library and likewise made accessible on our Vimeo web page.
The hyperlinks to the sources can even be shared within the chat field. And if you want to allow closed captioning throughout this webinar, you’ll be able to hit the CC perform in your Zoom platform. So just a bit bit about Justice in Growing older. For these of you who is likely to be new to us, we’re a nationwide nonprofit group and we’re targeted on eradicating senior poverty by rising entry to reasonably priced healthcare and rising financial safety for older adults with restricted sources. We deal with older adults who’ve been marginalized and excluded from justice, together with older adults of shade, older girls, LGBTQ plus older adults, older adults with disabilities, older immigrants, and people whose main language just isn’t English. To hold out our mission at Justice in Growing older, we’re dedicated to making sure that everybody has entry to what they want as they age with out discrimination. Our advocacy is rooted in making certain that these experiencing the best obstacles to financial safety, healthcare and housing can train their rights and totally entry the providers and applications they want.
The passage of Finances Reconciliation Act of 2025 or H.R.1 is an assault on that imaginative and prescient and makes the most important cuts to Medicaid funding in historical past, whereas additionally stripping away eligibility and important protection from tens of millions of older adults with restricted sources. We at Justice in Growing older are dedicated to combating again towards this regulation. To that finish, we’re offering in depth training on what’s within the regulation and the way it will affect older adults. And we’re equipping advocates with the instruments to cut back the regulation’s hurt throughout implementation, making certain older adults, their households and caregivers keep entry to important well being and long-term care.
So turning to at present’s agenda, Natalie and Gelila are going to offer an in depth overview of the adjustments to Medicaid and Medicare and H.R.1, with a deal with the provisions that affect older adults. This overview will embody a timeline of when these adjustments will go into impact, and we’ll even be offering advocacy tips about the right way to begin mitigating the hurt as this regulation is carried out at each the federal and state ranges. We’ll additionally do a preview of some new sources we now have developed and we’ll depart it open for query and reply on the finish. So with that, I’m going to show it over to Natalie to kick us off.
Natalie Kean: Thanks, Amber. Good afternoon everybody. My title is Natalie Kean. I’m the director of Federal well being Advocacy at Justice in Growing older, and I take advantage of she/her pronouns. Earlier than we get into the main points of H.R.1, we wish to present a fast refresher on Medicaid’s function for older adults. Greater than 7 million individuals aged 65 and older and 10 million individuals with disabilities depend on Medicaid. Medicaid additionally helps greater than 12 million individuals with Medicare entry the care they want and tens of millions extra older adults and folks with disabilities and power circumstances are insured by means of Medicaid enlargement. And this contains over 5 million older adults, ages 50 to 64 who’re enrolled in Medicaid enlargement. Medicaid can be not like different typical medical health insurance. It’s a lot broader and it actually fills in lots of gaps for older adults who’ve Medicare. Medicaid covers issues like dwelling and community-based providers in addition to long-term nursing facility stays. It covers issues like non-emergency medical transportation that assist individuals get to their physician’s appointments and it even offers monetary help for Medicare beneficiaries who’re dually enrolled in Medicaid.
So turning to H.R.1 itself, it is a price range reconciliation invoice that handed Congress on July third with solely Republican votes and it was signed by the president into regulation on July 4th. The invoice was beforehand named the One Massive Lovely Invoice Act, however that title was stripped simply earlier than it was handed, and so we will likely be referring to it because the Finances Reconciliation Act of 2025 or H.R.1 for brief. As Amber talked about, H.R.1 makes the most important cuts to Medicaid in this system’s 60-year historical past, about $990 billion, so nearly a trillion {dollars} in cuts in accordance with the official rating from the Congressional Finances Workplace. That is practically 4 instances as massive as any earlier Medicaid cuts in this system’s historical past, and whenever you add cuts to Medicare and the ACA in H.R.1, the overall is properly over a trillion {dollars} in cuts to healthcare. The opposite measure of the regulation’s affect that we now have proper now’s how many individuals will turn out to be uninsured.
H.R.1 itself is predicted to terminate protection for at the very least 10 million individuals, principally Medicaid enrollees. After which as a result of Congress selected to not prolong the Inexpensive Care Act enhanced premium tax credit on this invoice, one other 4 to five million individuals may turn out to be uninsured if these tax credit expire on the finish of this yr. So we’re a complete of 15 million individuals who will turn out to be uninsured over a 10-year interval, as this invoice is carried out, this regulation is carried out. When it comes to the massive image of how these cuts will end in that protection termination, H.R.1 cuts federal Medicaid funding and shifts price to states. This can power states to chop their Medicaid providers, eligibility or supplier reimbursement and certain they are going to lower a mix of those. The regulation additionally will increase obstacles to accessing Medicaid, issues like work necessities that we’ll discuss extra about intimately. And it additionally instantly terminates eligibility for Medicaid, Medicare and ACA tax credit for a lot of lawfully current immigrants.
So we now have just a few slides going by means of an implementation timeline. I’m going to undergo this fairly rapidly as a result of we’ll be going over many of those adjustments intimately later in our presentation. Additionally, we now have a brand new explainer with a graphical timeline that helps illustrate how the adjustments impacting older adults are clustered round just a few key dates. So we encourage you to verify that out for extra element. A number of provisions of the regulation took impact immediately, when the invoice was signed. These embody the moratoriums on the nursing dwelling minimal staffing and Medicaid streamlining guidelines. Sure lawfully current immigrants are not eligible to newly enroll in Medicare and states are prohibited from implementing new supplier taxes to fund their share of Medicaid prices. States are additionally permitted below the regulation to start work necessities, whether or not or not they’d a waiver in place or pending.
After which subsequent yr, in 2026, originally of the yr, and truly even this fall, as individuals want to enroll within the ACA market, these premiums are going to be spiking for everybody, however particularly for older adults if Congress doesn’t prolong the improved premium tax credit. After which later in 2026, in October, many immigrants can have Medicaid terminated and they’ll not be eligible for ACA premium tax credit on the finish of 2026.
Loads of the adjustments we’re going to speak about at present that basically affect enrollees take impact in 2027. In January is when all states are required to start out imposing work necessities on most adults ages 19 to 64. Protection renewals for the enlargement inhabitants will turn out to be extra frequent, at the very least each six months, and the retroactive protection interval will likely be shortened. A pair days later in January, older immigrants who’re already enrolled in Medicare however not eligible below the brand new regulation can have their protection terminated. And in October, states which have expanded Medicaid and use greater supplier and insurer taxes now must lower these taxes again to fulfill a brand new decrease protected harbor restrict.
In 2028, the Medicaid long-term providers and helps dwelling fairness restrict will likely be decreased to $1 million in 12 states that at the moment have the next restrict. Supplier taxes and state directed funds, which states, once more, use to fund their share of Medicaid prices are going to be additional restricted. States that select to take up a brand new 1915 C waiver choice below the regulation can start to get approval for these waivers and enlargement enrollees are going to start out going through copays for a lot of healthcare providers. And by the top of 2028, states that obtained an excellent religion effort waiver for his or her work requirement implementation will likely be required to totally implement these work necessities, in order that the nice religion waivers expire on the finish of 2028.
In order that’s an outline. Some adjustments do take impact later in that interval, however the bulk of them will likely be in impact within the subsequent few years. And we’re going to dive extra into extra element on what a few of these adjustments imply for older adults. As I discussed, H.R.1 cuts federal Medicaid funding in a number of methods. It restricts state’s capacity to fund their share of Medicaid prices by freezing and decreasing supplier and insurer taxes. These taxes are one thing that each state, apart from Alaska, makes use of to assist fund their share of Medicaid prices they usually’re actually essential as a result of states have to spend their very own cash first earlier than they will obtain reimbursement from the federal authorities. So the federal match, often known as the FMAP, kicks in after a state spends cash. If a state has much less of their very own cash to spend, they can even be getting much less in federal reimbursement.
The regulation additionally ends an additional 5% federal match incentive for states that haven’t but expanded Medicaid. It reduces the federal match for emergency Medicaid providers offered to adults who’re ineligible for Medicaid on account of immigration standing. And along with these, it undermines Medicaid enlargement in a number of methods. It penalizes Medicaid enlargement states extra closely. It disincentivizes non-expansion states from increasing and it reduces enrollment in Medicaid enlargement. And that is actually vital as a result of states which have expanded Medicaid obtain a 90% match, at the very least a 90% match, from the federal authorities for his or her Medicaid enlargement inhabitants. And so if they’ve fewer enrollees or a tougher time maintaining that enlargement going, that’s much less federal funding.
Just a little bit extra element on restrictions on the funding mechanisms when it comes to the supplier and insurer taxes, there are provisions that affect these taxes in a few methods. First, the regulation is prohibiting all states from establishing new supplier taxes or rising present taxes. And second, for Medicaid enlargement states, the regulation lowers the protected harbor restrict for these taxes from 6% to three.5% in 2032. So this successfully acts as a cap on how a lot income states can elevate by means of these taxes. And you’ll see in an enlargement state, it’s successfully reducing that cap in half. So non enlargement states can proceed to tax as much as 6%. After which additionally the taxes on nursing amenities are topic to the freeze. So states can’t implement new taxes on nursing amenities, however they will nonetheless, people who have taxes as much as the 6% threshold can hold these taxes.
There’s one other part of the regulation that additionally restricts state directed funds and managed care with extra extreme restrictions for enlargement states. These funds are instruments that states use to extend Medicaid suppliers in sure specialties, particularly to deal with shortages of suppliers. So all of those cuts together with cuts to the SNAP diet program and new administrative prices for administering work necessities and issues actually depart states holding an enormous invoice, and states should stability their budgets and Medicaid is among the greatest line gadgets in most states budgets. So meaning they’re compelled to chop advantages, enrollment or supplier cost and certain will lower a mix of these to stability their budgets. When it comes to which advantages the states will lower, the advantages which are elective below federal regulation will likely be focused as a result of they are often lower. They’re elective. Loads of applications that older adults and folks with disabilities depend on each single day are literally elective below federal regulation. They’re not obligatory for states to offer.
These elective providers embody dwelling and community-based providers, issues like dental, imaginative and prescient and listening to that Medicare doesn’t cowl. It additionally contains elective eligibility pathways that profit older adults, such because the particular earnings rule and spend down or share of price eligibility. States that select to cowl immigrants with their very own state funding might need to roll again that protection as a result of they will not afford it. After which when it comes to different cuts to enrollment, states which have expanded their aged and disabled eligibility or eligibility for his or her Medicare Financial savings Applications may select to roll again that eligibility to the federal minimal.
And in addition states are probably to offer cost charges or at the very least not improve them. This can actually worsen what’s already an present direct care workforce scarcity and make it tougher for older adults to entry long-term care. And residential and community-based providers are significantly in danger as a result of they account for over half of all elective spending and nearly a 3rd of all Medicaid spending. And we all know from historical past that HCBS are lower when Medicaid funding is lower or when state budgets are tight. And we noticed this after the Nice Recession, however I wish to encourage us to not let historical past repeat itself right here. We actually have to be making noise and interesting policymakers at each stage to do every thing they will to cease HCBS from being scaled again. The regulation doesn’t prescribe these cuts, however it’ll be a really exhausting combat to maintain HCBS from being lower. And afterward, Gelila goes to speak about a few of our mitigation technique concepts, however for now I’ll hand it to Gelila to speak about work necessities and different provisions of H.R.1.
Gelila Selassie: Thanks a lot Natalie. Simply to [inaudible 00:19:54] Natalie’s earlier level, that we’re nonetheless in early days, and significantly on work necessities and a few of these different items, we predict extra steerage and knowledge by means of rules or casual steerage from the federal authorities, from Well being and Human Companies or facilities for Medicare and Medicaid providers over the following months and years. So with that, simply hold that disclaimer behind your thoughts, that we should have lots of unanswered questions as to a few of these particulars within the regulation. However to start out, work necessities are one of many greatest items in H.R.1 and is chargeable for a reasonably vital quantity of the anticipated protection loss. It might apply to adults aged 19 to 64 who would now be chargeable for finishing 80 hours of qualifying actions per 30 days. And by qualifying actions, that may be employment, volunteer work, so paid employment, volunteer work, job coaching or education.
And as a observe within the regulation, that is work necessities are phrased as group engagement actions. So you may even see it as both over the following few months. And work necessities don’t apply to sure Medicaid inhabitants. So individuals enrolled within the Aged, Blind, Disabled Medicaid program or getting Medicaid for his or her pregnancies, these are usually not topic to those work necessities. And there are extra exemptions, nevertheless it’s actually essential to know that these exemptions are nonetheless very restricted and there are not any computerized exemptions and there’s no flexibility for states to offer extra exemptions past what the regulation offers. So it does restrict states in some methods and the exemptions they will present.
Individuals should present that they’re working for at the very least one month previous to enrolling in Medicaid and previous to their eligibility redetermination. To allow them to’t get Medicaid first after which enroll in a qualifying work exercise. They should first get that job or volunteer work or no matter else after which apply for Medicaid or get Medicaid. And there’s one thing that was added pretty late is that there’s a lockout provision within the regulation. And in order that implies that people who are usually not in compliance with these work necessities can even not obtain market subsidies. And so this is able to be any person who’s topic to the work necessities, between the ages of 19 to 64 and never enrolled in one in all these different sorts of Medicaid applications just like the Aged, Blind and Disabled program, however additionally they don’t qualify for an exemption, which, as we’ll get to, is fairly limiting. Properly now that particular person, even when they might usually qualify for market subsidies, if their earnings was above 100% of the federal poverty stage, they might not be capable to do this below this regulation.
In order that’s actually regarding and that may result in lots of people being uninsured as a result of now they actually haven’t any choice. The work necessities are focused to the Medicaid enlargement inhabitants, that ACA enlargement inhabitants, nevertheless it’s not particularly said within the regulation that it solely applies to the enlargement inhabitants. So it might additionally apply to states like Georgia or Wisconsin that use particular Medicaid waivers, 1115 waivers to use very comparable expansion-like providers to the same inhabitants. And in order we progress, we’ll proceed to watch if there are some other particular Medicaid teams that aren’t topic to the exemptions, however may very well be topic to work necessities. And searching into among the harms of labor necessities, as I stated, that is the largest foundation for the Medicaid protection losses. 5 million individuals are estimated to turn out to be uninsured. That quantity is admittedly prone to affect older adults, aged 50 into 64, and folks with disabilities who can’t get Medicaid or Medicare for his or her disabilities as a result of there are very strict Medicaid guidelines for the right way to get incapacity and what’s outlined as a incapacity.
So we all know that the enlargement inhabitants does cowl lots of people with disabilities, however they’re, for bureaucratic causes or anything, they’re restricted from getting different sorts of Medicaid for his or her incapacity. And in order that’s actually, actually regarding. As we talked about, the exemptions are fairly slim. We’ll discuss in regards to the incapacity exemptions in a bit extra element, however incapacity just isn’t well-defined. Neither is power circumstances or any of the opposite said exemptions within the regulation. And fogeys, guardians and caretakers and household caregivers are additionally exempt. However once more, that definition is fairly restricted. So dad and mom of minor kids below 13 or caretakers who present for a member of the family with a incapacity is because it’s outlined in one other statute, the RAISE Household Caregiver Act. We’ve seen, as states have finished work necessities, that it’s at all times didn’t, one, get individuals working and two, finally ends up harming not simply the inhabitants that’s topic to work necessities, but in addition different Medicaid populations as properly.
That’s significantly true in Georgia, the place there have been large administrative burdens that harm each the enlargement inhabitants and different Medicaid populations as properly, together with older adults. So when Georgia instituted their 1115 waiver that included work necessities, the state spent 90% of their $26 million on this system simply on administrative prices to implement the waiver. So that cash may have gone to providers and every thing else, however as a substitute was going to the executive prices. After which relatedly, there have been delays in purposes for everyone and lots of restricted buyer assist as a result of so lots of the state’s sources was going into implementing work necessities. So we’re utilizing that as a how to not act when it comes to how this will likely be carried out throughout all states, shifting ahead. Subsequent slide. And we do have some sources about among the challenges of proving incapacity. We’ve got a weblog that highlights how tough this may be and creates a little bit of a paradox.
In order I discussed, the regulation does record out, medically frail is a terminology they use, medically frail people as exempt, as properly an inventory of power circumstances and disabilities that may also be exempt in addition to an inventory of examples. However one factor that’s actually essential to know is that this class of people who find themselves exempt, that aren’t enrolled in incapacity particular applications like SSI, which is the place lots of people with disabilities get Medicaid, or Medicaid for blind and disabled applications. And we’ve seen when individuals attempt to present their incapacity for a few of these Medicaid applications, that it’s an unattainable catch-22. Fairly often, you want medical documentation and medical information to point out that you’re disabled or the character of your incapacity, however you can’t entry these physician’s appointments or these healthcare visits with out Medicaid. So it’s actually difficult for individuals to get the providers they want simply to get Medicaid below these disability-based applications. And now that’s prone to be prolonged with the necessities that the regulation now imposes for these exemptions.
In order that’s very regarding and once more, we’ll see extra info because the federal authorities offers some steerage and a few rules on this. There are different eligibility restrictions as properly. Beginning in January of 2028, there will likely be a freeze on the utmost allowable restrict for individuals’s dwelling fairness that counts in direction of their countable property. That will likely be stated at 1 million. Presently, it’s tied to inflation, so it’s at 730, however when you think about inflation prices, that rises as much as 1 million 97, 1.097 million, and a few dozen states are at or above the 1 million restrict. So for these states, the restrict will truly be decreased after which that $1 million isn’t adjusted for inflation. And so no matter how excessive property values get, that 1 million will stay. And the one exemption is for agricultural lands.
That is actually, actually dangerous for older adults, a lot of whom are, in the event you’ve heard the expression, cash-poor, house-rich, might have bought their home many years in the past when property was a lot, less expensive and at the moment are going to be unable to get Medicaid long-term care except they should resolve to promote their properties successfully, which is admittedly the one asset. They’ve very restricted financial savings. And so once more, as property values proceed to rise, particularly in excessive price states, that is going to be actually problematic for older adults needing Medicaid long-term care. There’s additionally a provision that cuts retroactive Medicaid protection at the moment that’s three months. So somebody can get, in the event that they met all the opposite eligibility necessities, they will get Medicaid to cowl three months previous to the month of software for any healthcare providers they obtained. The regulation now limits that to at least one month for the Medicaid enlargement populations and two months for all different Medicaid populations. And that begins at early January 2027.
And so lots of older adults who want long-term care typically have a hospitalizing occasion like a fall or a stroke that places them within the hospital after which they find yourself assembly, qualifying for Medicaid. However as a result of they weren’t eligible for Medicaid earlier than, they’d whichever situation that precipitated them to be within the hospital and needing long-term care, they’d no purpose to use for it. And so having an extended retroactive interval actually protects individuals in order that they will get the healthcare they want. Suppliers like long-term care suppliers can settle for sufferers figuring out that, even when their Medicaid software isn’t submitted, in the event that they’re gathering all of the documentation they want, they’ll be reimbursed for no matter providers they supply for individuals throughout that retroactive interval. So by limiting that retroactive interval, it’s making it a lot tougher for individuals to obtain care after which use no matter time they should collect the documentation to point out their property, present their earnings, to point out their useful eligibility necessities as wanted. After which once more, it makes it tougher for suppliers, particularly long-term care suppliers, to get that reimbursement for a shorter interval. Subsequent slide.
After which within the final administration, there have been a sequence of guidelines that have been finalized and printed that might’ve actually helped with Medicaid entry and long-term care high quality, long-term care entry. The regulation stops implementation and blocks implementation of these guidelines. The primary is the streamlining Medicaid eligibility and enrollment guidelines, which assist take away lots of obstacles that folks face when getting Medicaid or when making an attempt to resume their Medicaid. And this was, the eligibility enrollment rule was throughout all Medicaid populations. There was one other a part of the rule that was particular to the Medicare-Medicaid dually enrolled particular person as a result of they’ve receiving healthcare from Medicare on one finish and Medicaid from the state, the best way they obtain their care and their providers might be very, very tough.
And so this rule had methods to be sure that individuals weren’t misplaced within the shuffle between these two applications. And so we do count on lots of dually eligible people to lose their Medicare Financial savings Program, MSP, that’s administered by Medicaid, that might assist restrict their Medicare prices and assist subsidize their Medicare prices. With out implementation of that rule, many individuals may fall into the cracks and may improperly lose their MSP, which might make their Medicare unaffordable. The regulation additionally blocks the implementation of the nursing dwelling minimal staffing rule, which did simply that. Ensured {that a} minimal variety of nurse aides and registered nurses have been on workers at nursing amenities throughout the nation. The rule was estimated to avoid wasting 13,000 lives per yr. And as we all know that well being outcomes and high quality of long-term care is predicated closely, closely on the variety of nurse aides and nurse staffing that amenities have. In order that’s actually regarding as properly for a inhabitants that’s actually weak to very harmful outcomes with out correct staffing.
After which there are additionally cuts to Medicare. We’ve talked extensively about these cuts to Medicaid, and Medicare will likely be impacted in a few other ways. One is that there are tens of millions of people who find themselves dually enrolled in Medicaid and Medicare. Nearly one third of all Medicaid funding is spent on people who find themselves additionally enrolled in Medicare. So any of those cuts to Medicaid can have a huge effect on these Medicare enrollees, significantly these dually eligible individuals who may lose their Medicare subsidies paid for by Medicaid. After which additionally for a lot of, lots of the Medicare enrollees who depend on Medicaid for his or her long-term care, as a result of Medicare is so restricted in the way it pays for nursing facility care and even home-based care. Along with these cuts, there are direct cuts to many people who find themselves on Medicare.
Lawfully current immigrants will not be eligible for Medicare except they belong to 3 very particular immigration classes. And that’s lawful, authorized everlasting residents or inexperienced card holders, Cubans and Haitians who below a household reunification program and people who find themselves residing below the compacts of free affiliation. And that’s only a very restricted variety of nations within the Pacific. So exterior of these classes, all different lawfully current immigrants will lose their Medicare eligibility. Present enrollees will likely be terminated in January 2027. And this actually is admittedly dangerous for lots of causes that we’ll talk about. However once more, these are individuals who have paid of their Medicare taxes and paid into the system who will now lose protection. After which by statute there may be additionally a sequestration subject that might take impact subsequent yr, except Congress acts. By regulation, any laws that considerably will increase the deficit has to end in an computerized lower to budgetary sources elsewhere. And that’s generally you may hear it as a PAYGO or may hear it because the Medicare as a sequestration.
And so that might apply in 2026, except Congress takes motion. In the event that they don’t, then it is going to mechanically set off a $500 billion lower in Medicare. Now we do count on Congress to take motion. They’ve up to now when this has give you different laws, nevertheless it’s not a really perfect state of affairs for Congress to be in in any case, to should be sure that these cuts don’t come into impact. Subsequent slide. And in order we talked about, the cuts to Medicare eligibility for immigrants is admittedly dangerous and actually harmful. For one, it decouples social safety eligibility and Medicare eligibility. Due to the foundations of price range reconciliation, social safety can’t be touched with the price range reconciliation course of that was used to go this regulation. And so for that purpose, eligibility for social safety for lawfully current immigrants hasn’t modified, nevertheless it has modified drastically for Medicare, when usually these two applications have fairly comparable eligibility necessities.
Chopping Medicare for immigrants additionally breaks Medicare’s promise. These immigrants have paid into Medicare for many years by means of Medicare taxes, anticipating to turn out to be eligible after which they’re dropping a profit that they paid into, which is simply patently unfair. The regulation additionally excludes many lawfully current immigrants from Medicaid and {the marketplace} subsidies on high of Medicare. And in order that’s going to considerably improve the variety of uninsured older adults that we now have as a result of they’re blocked from these main applications from receiving healthcare. Then there’s additionally vital harms to all People, even apart from the immigrants which are dropping healthcare. Immigrants play a significant function in healthcare and long-term care. One in 4 direct care employees are immigrants, and now by dropping entry to healthcare, by dropping, probably, a path to citizenship, they make it that a lot tougher for them to stay in these very important jobs the place they supply take care of probably the most weak of our populations. And so there’s lots of harms that may happen for immigrants, after which only for us throughout the board. Subsequent slide.
And so hopefully, on a barely extra optimistic-ish observe, when it comes to what we will do in some mitigation methods, we’re going to offer extra particular suggestions and greatest practices, once more, as we transfer additional alongside into implementation. And so these are just a few excessive stage issues that, as advocates, you’ll be able to take into consideration and message to assist lay the groundwork as we get some extra info. To start out, we’re going to have a ballot query for everyone, and I imagine there’s going to be an choice that pulls up, however we’d wish to know, are you or your purchasers and older adults in your group acquainted with H.R.1 and the adjustments to Medicaid and Medicare?
We’ll give of us possibly one other 20 seconds or so. And simply to learn out the choices are sure, very acquainted, considerably acquainted, or no, not acquainted. Okay, responses are slowing down a bit, nevertheless it does appear to be for most individuals, it’s considerably acquainted or not acquainted are the important thing. In order that’s actually useful to notice and that’s going to information us when it comes to the sources we offer for everyone and on your group. So thanks for that. Subsequent slide. Going to a few of our mitigation methods, one massive factor is, like we stated, it looks like about half of oldsters stated that older adults of their communities have been unfamiliar with H.R.1 and little below half stated have been by no means acquainted. I believe solely about 4 or 5% stated they have been very acquainted. In order that’s actually essential, is to be sure that we’re educating purchasers and older adults and companions on what’s and isn’t within the closing regulation.
There are some issues that didn’t occur which are good. So there have been no structural adjustments to Medicaid, like block grants or per capita caps, that might’ve ended Medicaid’s entitlement. It might’ve been a, as soon as the cash runs out, it runs out. And in order that didn’t occur within the closing regulation, which is admittedly essential. And there have been additionally no adjustments to earnings eligibility for most individuals. So throughout the board, the eligibility necessities are nonetheless there. There could also be extra restrictions or there could also be some restrictions on the way it’s funded on the state facet, however for probably the most half, Medicaid remains to be there, and so it’s actually essential that folk enroll in the event that they’re eligible. Relatedly, even the cuts which are going to affect individuals gained’t take impact for months or years. Going again to that timeline that Natalie highlighted originally and the useful resource that we’ll present on the timeline, people who find themselves enrolled ought to stay enrolled in the event that they’re eligible and get enrolled, in the event that they turn out to be newly eligible.
What we don’t need is for there to create a chilling impact, the place individuals don’t hassle making an attempt to get Medicaid as a result of they assume it’s not price it. It’s and it’s nonetheless there and so individuals ought to use the healthcare providers they want and are entitled to. Lastly, and actually, actually crucially, all people have due course of protections, together with all Medicaid enrollees. So what this implies is that the state can’t terminate Medicaid with out superior written discover and a possibility to attraction antagonistic choices. And many individuals have group organizations or authorized aides or different teams that may assist with that. So it’s actually essential that folks keep in mind that if Medicaid is terminated, they do have a proper to attraction the choice to find out if it was finished rightfully or not. After which there are some extra methods for working together with your states, to attempt to reduce the hurt. Once more, we would see extra on this as we get extra steerage from CMS or HHS, however the states typically can have a good quantity of discretion in how they implement these cuts.
For instance, in setting the house fairness exclusion restrict, many states which have that restrict at 730,000 now may develop that to 1 million. Similar with not requiring extra frequent eligibility checks, which is a part of the eligibility and enrollment rule that was not allowed to be carried out below the regulation. Properly now, states can resolve that they’re going to verify to not improve eligibility restrictions past what the regulation requires, so that might be actually useful. After which there’s some restrict in setting the greenback quantity for the Medicaid co-pays, to allow them to restrict how a lot cash individuals should pay for his or her co-pays. These are just a few examples that we see proper now. It’s actually essential that states don’t rush implementation quicker than they should and that advocates interact on potential points. One factor that we realized from the Medicaid public well being emergency unwinding a pair years in the past, there was a interval the place lots of people have been getting disenrolled from Medicaid following the well being of the COVID-19 public well being emergency.
And the states that rushed to disenrolled had large procedural errors, the place individuals have been improperly terminated from Medicaid when they need to have gotten protection they usually additionally had lots of technical points. So right here, one factor to notice is that if there’s a longer timeline to implement, states ought to make the most of that longer timeline. Advocates can even encourage their state Medicaid administrators and coverage makers to ask questions and lift issues with CMS, even earlier than steerage is written. They do have common methods of participating with federal officers on a few of these points, and so letting them know what’s occurring can even assist information steerage as properly, that that CMS places out and the rules that they put out. It’s additionally actually price noting that even in a state the place coverage makers have been supporting H.R.1 and assist the regulation, it’s very totally different whenever you’re speaking in regards to the affect of it because it’s occurring. As soon as their neighbors and their constituents are actively dropping protection, there’s an enormous, large distinction there.
It’s additionally actually essential to encourage your state assist HCBS. As Natalie talked about, HCBS could be very typically on the chopping block when states have funding issues and funding restrictions. So that may imply that states can take up Cash Follows the Particular person, which is one sort of very talked-about HCBS program that helps hold individuals out of nursing properties and diverts them away, transitions them out of establishments like nursing properties. There’s additionally group first selection and different ways in which states can entry extra HCBS funding. After which ensuring that states, though the streamlining or eligibility and enrollment rule isn’t carried out, a lot of these issues states can select to implement. One, it lowers administrative prices for the states after which they will additionally be sure that individuals retain their protection and that there’s fewer uninsured people. So working with states to see what areas they do have flexibilities, encouraging them to take these flexibilities to profit older adults is admittedly essential.
After which together with your group companions, it’s actually essential to attach with native advocates to watch implementation and the way it’s working throughout totally different teams and develop focused methods. So that features direct service advocates, supplier teams, getting old and incapacity advocates and the like. As we get rulemaking and steerage, there could also be alternative for commenting from CMS so stakeholders can submit feedback about what regulation CMS is placing ahead with respect to H.R.1 and supply some perception there. Relatedly, please join with us. Justice in Growing older could be very desirous to know what’s occurring and we wish to present info to you as properly.
So look out for extra webinars and sources and also you’re welcome to e-mail us at data@justiceinaging.org for any questions or issues which are occurring with how your group is impacted by the H.R.1 implementation. After which lastly, we’ve stated this all through, as we have been gearing up for the invoice getting handed, however public training and storytelling is admittedly essential. We’re at all times joyful to offer the authorized evaluation and coverage evaluation and the information, however proceed to share how individuals are being impacted by the implementation. In the event that they’re getting scary notices, in the event that they’re nervous about these payments or these cuts, these tales actually resonate with each policymakers, with the media, on social media, at public talking engagements, et cetera. And so please contemplate persevering with to make use of that as a robust device of advocacy as we gear into implementation. And with that, I’ll go it over to Natalie.
Natalie Kean: Thanks a lot, Gelila. As Gelila stated, that is just the start and we will likely be producing extra sources and doing extra trainings and we actually want your assist. We wish to hear from you. We’d like your assist to doc the hurt and to assist course right, to mitigate the hurt. We do have just a few sources already on hr. One model new at present is an explainer on what’s within the Finances Reconciliation Act and what it means for low-income older adults’ entry to well being and long-term care. And on that hyperlink, in the event you click on on the PDF model of this useful resource, you will note a graphical timeline of implementation. We even have a extra detailed part by part of H.R.1’s Medicaid and Medicare provisions. We’ve got some background info on how Medicaid helps older adults. We’ve got a broader useful resource on the impacts of H.R.1, not solely on well being and long-term care, but in addition on diet and financial safety and older immigrants.
After which most of those sources will proceed to be housed on our Medicaid protection sources web page, which is the final useful resource right here. And we’re offering some sources from companions that specify provisions of the invoice intimately, and particularly provisions that we aren’t targeted on as a lot, associated to the Inexpensive Care Act and Medicaid that isn’t as instantly impacting older adults. Earlier than we reply a few of your questions, we now have yet one more ballot query for you. We’d love to listen to what sources can be most useful to you in your work to attenuate the hurt of H.R.1. And the choices are evaluation and explainers on what’s in H.R.1, mitigation methods and toolkits, one thing else. And when you’ve got an concept for us, please be at liberty to place that suggestion within the questions field. After which everybody’s favourite, the entire above.
So we’ll give of us just a few moments to reply the ballot query. And I believe Amber is up some Q&A for Gelila and I. All proper, we’ve gotten good participation. Share the outcomes right here. So we now have about half of individuals need evaluation and explainers, half need mitigation methods and toolkits. We do have just a few of us that counsel one thing else and one other good group of oldsters that desires to see the entire above. So actually respect that suggestions. We’ll be utilizing it as we go ahead. And with that, I believe we’ll flip to Q&A.
Amber Christ: Thanks each, and lots of good info there. And thanks all on your energetic participation. We additionally had lots of questions within the Q&A, so we’re solely going to get to a couple of these. The primary query I’ve for you each is we acquired lots of questions on definitions and particulars, particularly on work necessities. Really let me again up. We acquired lots of questions on what’s the enlargement inhabitants or what’s Medicaid enlargement. So earlier than we get into work necessities, possibly let’s outline what Medicaid enlargement or the enlargement inhabitants is.
Natalie Kean: Yeah, go forward, Gelila.
Gelila Selassie: [inaudible 00:52:07]. This refers to individuals who obtain Medicaid below the Inexpensive Care Act. The Inexpensive Care Act expanded Medicaid eligibility for all adults, for probably the most half, all adults incomes lower than 138% of the federal poverty stage. And so exterior of this enlargement inhabitants, you’ll be able to solely get Medicaid in the event you’re very restricted earnings or meet very particular classes, such as you’re on SSI or being pregnant or baby below 19 or one thing like that. So this actually expands Medicaid the place you don’t have to suit a selected class past people who earnings restriction.
Amber Christ: And I’ll simply observe that I believe it’s, at this level, 41 states, together with Washington, DC have expanded Medicaid to this inhabitants. So after we have been speaking in regards to the impacts right here, we’re speaking about among the provisions affect people who find themselves enrolled by means of that pathway, by means of Medicaid enlargement. And among the provisions affect instantly states which have expanded Medicaid and deal with states which have expanded Medicaid in another way than states that haven’t expanded Medicaid. So that you heard us speaking about each of these impacts.
So then now turning to work necessities, we acquired lots of questions there, significantly there, however somewhere else about definitions and particulars about how the work necessities are going to be operationalized. How is caregiver outlined? How do individuals show that they’ve a incapacity? So are you able to communicate just a little bit about what’s broadly within the regulation after which what’s the method of shifting ahead on how these kind of particulars will likely be found out and what advocates can do to assist inform what these particulars truly find yourself being?
Gelila Selassie: Yeah. So the regulation does record out exemptions for caregivers, for fogeys of minor kids, for individuals with disabilities, or those that have medical frailty is the way it’s outlined. And the way it’s listed, I ought to say, within the regulation. The way it’s outlined extra particularly and what the method will likely be like will actually be as much as Facilities for Medicare and Medicaid providers and the rules and steerage that they put out. After which relatedly, they and/or the states can have some extra steerage for a way that course of will likely be. So if somebody can fill out a quite simple questionnaire or quite simple attestation saying, “I’m disabled or I must be exempt for a medical situation,” then certain CMS might permit that. They could have extra restrictions into how states operationalize this and what that course of will likely be like. In order that’s what we’re searching for within the subsequent months and the following yr or so.
Amber Christ: Thanks Gelila. I’ve a query round HCBS. There’s a very pointed query. Are there direct cuts in H.R.1 to dwelling and community-based providers or is the anticipated affect due prone to state choices to chop providers, profit and eligibility?
Natalie Kean: Yeah, there are usually not direct cuts to dwelling and community-based providers in H.R.1 it’s the affect of the entire different cuts and undermining of Medicaid that places strain on states to chop their dwelling and community-based providers program. And the explanation why we’re actually involved about these cuts and have to be making noise to make sure that they don’t occur is as a result of a lot of a state’s spending is on Medicaid dwelling and community-based providers and they’re allowed, below federal regulation, to restrict, remove, put ready lists on entry to these providers. So it’s as much as us as, advocates, to be sure that these cuts are minimized and prevented wherever potential.
Amber Christ: Thanks, Natalie. We additionally acquired numerous questions on whether or not there’s a possibility to cease H.R.1 altogether or the provisions in H.R.1, particularly contemplating that many of those adjustments aren’t going into impact instantly, however are down the highway. So possibly we will communicate just a little bit to what that probably may appear to be and what we’re coping with in real-time and what we may very well be working in direction of, shifting ahead.
Natalie Kean: Yeah, I believe there are alternatives, actually to delay many of those cuts. For instance, Gelila was speaking in regards to the issues of implementing work necessities and all of the issues states are going to wish to do and defining all of this, organising all these processes. If we will get states to be telling CMS, “We are able to’t do that by 2027, we want extra time,” that’s a possibility to delay implementation of this regulation. There’s a invoice launched in Congress now to repeal the well being provisions of H.R.1 fully, it’s a Democrat-only invoice, unlikely that it’ll go, however in future years, as states, once more, are attempting to cope with all of this and the make-up of Congress adjustments, we may see efforts to repeal all or elements of the invoice, of the regulation.
Amber Christ: Nice. Thanks each. I believe that we’re proper at time, so I believe it is smart for us to conclude. Any concluding statements from the each of you.
Natalie Kean: Simply respect everybody’s engagement and … know that, as Gelila talked about what’s not within the invoice, that Medicaid remains to be an entitlement in all of this stuff. And so that’s one thing we want to remember. We actually have a good time the advocacy to maintain a few of these even worse cuts out, but in addition hold it in thoughts as we’re shifting ahead that folks proceed to get entry to Medicaid.
Amber Christ: Thanks everybody for collaborating and please keep tuned for extra sources as we transfer ahead and you’ll get an e-mail following this webinar with the slides and the extra sources that have been shared. Actually respect the entire work you’re doing and your partnership.Paste Transcript Right here
