Summary of Position on Medicaid-Related Bills 2016
Copays and Premiums for Medicaid Recipients – Opposed
Brand Name/Generic Drugs and Discontinuation of OTC Medications — Opposed
Dedication of Copays/Premiums to NOW Fund – Opposed
Fees for Non-Emergent Care in ER Settings – Supported with Conditions
MLTSS for OCDD populations – Opposed at this time
Increased Premium on FOA Medicaid from $50 to $65 –Opposed
The following are the positions of Special Needs & Parent Support Services of LA, LLC to various bills in the Louisiana Legislature in 2016. All positions are mine, Karen Scallan, as owner of SNAPSS of LA, LLC.
Copays and Premiums for Medicaid Recipients – Opposed
Copays on medications, doctor visits and premiums in Medicaid might sound good on the surface but research has repeatedly proven they will cost more, not save money as people begin to ration critical and chronic care needs. The National Health Law Program or NHELP’s paper on Medicaid Premiums and Cost Sharing, March 2014, indicated cost sharing and premiums was heavily studied and the “consistent and ever-expanding literature … repeatedly demonstrates that premiums and cost sharing pose barriers to care for low-income and vulnerable populations….”
Since Medicaid recipients are mostly children, the poor, elderly, sick people and people with disabilities, that is who will be affected by these fees. When individuals who are poor, sick, elderly and disabled have to pay $4-$8 per medication, a copay to the doctor and $50 a month premium, they are going to have to decide what they can do without…food or medication, heat in the winter or doctor visits. They will ration critical care and that will push people to more expensive care when symptoms and conditions reach unbearable levels– strokes without blood pressure medications, heart attacks without blood thinners, greater numbers of seizures and brain damage without seizure meds and all will end up in the ER, intensive care, and other hospital settings in our state—care venues which cost the most and account for the largest portion of that 1/3 of our budget we’re complaining about.
NHELP’s paper cites a Canadian study that found that a recipient’s reduced use of essential drugs by 14% correlated to an 88% increase in hospitalizations and death and a 78% increase in emergency room visits. Conversely, studies also show a reduction in cost sharing is linked to increase adherence and improved health outcomes. Increased health outcomes translate to lower costs. Healthier people cost less. And, NHelp cites studies focusing on nominal copays for Medicaid recipients in the range of $2 or $3 for individuals with schizophrenia that showed the individuals discontinued their medications at a significantly high rate when charged the copay. Individuals on antipsychotics reduced their use by 12% and those on antidepressants by 20%. In a Mississippi study, patients with schizophrenia were 5% less adherent to medications and 20% more likely to have a 90+ day gap without medications. Now how would that affect our mental health care system? Law enforcement? Are we really ready for that?
Individuals in group homes and institutional care are also at a huge disadvantage. They already pay almost all of their income for their care except for a meager allowance. Who will pay the copay for these individuals? Who will pay their premium? There’s nothing left. House Health and Welfare Committee members heard testimony on March 22nd about how Home and Community Based (HCBS) providers are on the verge of collapse now with the roughly 22% cut they’ve taken since 2008.
Medicaid recipients are in the emergency room more often, and their care generally costs more, because they are more likely to be chronically ill and need emergency and high cost care. And, as we begin to add administrative costs to collect these fees as more people ration critical care and move into emergency rooms, intensive care and other hospital settings we will see this sink our state even more in the hole. This will cost more, not save money.
Brand Name v. Generic Drugs and Discontinuation of OTC Medications – Opposed
Moving all name brand drugs to non-preferred status would be detrimental to many individuals with special health care needs. In very specific circumstances for individuals with complex medical needs, generic drugs simply do not work the same. Individuals, particularly children with seizure disorders know this difficulty all too well. A considered approach to any preferred drug list must be taken to protect medical necessity for our most vulnerable individuals.
Additionally, over the counter medications are costly for families of children with disabilities, the poor and elderly. One bottle of Miralax for children is over $20. Without providing for payment for this under Medicaid, children with special health care needs will not receive the care they need if the family cannot afford another $20 per month.
Dedication of Copays/Premiums to NOW Fund- Opposed
HB 173 includes a provision to dedicate the copays and premiums to the New Opportunities Waiver Fund. This provision proposes to pay for one of the needed developmental disability waivers on the backs of the poorest, sickest and most disabled individuals in our state while we protect corporate welfare. Yes, Medicaid is expensive and yes we need a funding stream for the developmental disabilities waivers in Louisiana, but this is not the answer!
Fees for Non-Emergent Care in ER Settings – Supported with Conditions
Non-emergency care in emergency room settings continues to be a problem for the state by unnecessarily increasing the high cost of care to Medicaid recipients. But, if Medicaid recipients are to be charged a fee for non-emergency care administered in the ER, great care must be taken to protect individuals with significant and complex medical conditions or disabilities whose conditions are not readily evident to their caregivers due to such things as inability to communicate symptoms for example. For individuals with developmental disabilities, a significant and dangerous medical condition may manifest itself in acting out behaviors and little else due to lack of communication. Others with significant developmental and physical delays may simply “look bad” to the care giver and given their fragile state might need to be seen in an emergency room. If it turns out ultimately that there was no emergency, these individuals must be exempt and protected from being charged for emergency room use.
MLTSS for OCDD populations – Opposed at this time
MLTSS for OCDD populations (individuals with intellectual and developmental disabilities or I/DD) MUST NOT be implemented at this time. Not one component of an MLTSS program for individuals with I/DD is ready for implementation at this time, not DHH, OCDD, The Advisory Committee, the providers or the Managed Care Organizations (MCOs). Additionally, the deadline which HB 790 imposes on implementation of MLTSS would mean that virtually none of the protections agreed upon by the state and the Advisory Committee would be implemented because there simply is not enough time. And, finally, MLTSS as proposed in HB 790 and 309 are proposed for implementation as a cost saving measure. There is absolutely zero actuarially sound data anywhere in the US that indicates that managed care for individuals with I/DD will save money. That was never the purpose in DHH proposing it in the first place. In fact such a program for OCDD recipients will cost more in the first year and be cost neutral thereafter.
Increased Premium on FOA Medicaid from $50 to $65 –Opposed
A $15 increase in the premium for Family Opportunity Act Medicaid families will most definitely not solve the budget crisis but will add yet another burden to families who already cannot afford their child’s care. Families of children with disabilities pay significantly more just to care for their child on a daily basis as compared to a “typical” family. Burdening them with a higher premium on top of the private insurance premium many have and the other costs they face is tantamount to punishing them for their child’s disability, especially since it will do nothing to alleviate our budget crisis.
Parent Perspectives on MLTSS 