Policy Update

Policy Update – Employment, Health Care and Disability – November/December 2015

The LEAD Center Policy Update – Employment, Health Care and Disability is a project of the LEAD Center in collaboration with the Autistic Self Advocacy Network.

Open Enrollment For The Affordable Care Act Began November 1st

Open Enrollment for 2016 coverage through the Health Insurance Marketplace began November 1, 2015 and will end on January 31, 2016. Consumers must sign up by December 15th if they wish to begin January 2016 with Health Insurance Marketplace coverage. The process has been significantly streamlined for efficiency and it takes significantly less time to sign up for coverage than previously. Eight out of 10 people this year may additionally qualify for financial assistance to lower the cost of their monthly payments. In states that have expanded Medicaid coverage to all individuals with incomes less than 138 percent of the Federal Poverty Level (FPL), individuals under this income threshold can also enroll in Medicaid through the exchanges even outside of the Open Enrollment period. Open enrollment through the marketplaces may benefit the many workers with disabilities who do not qualify for employer-based insurance, Medicare, Medicaid or Medicaid buy-in programs, but who need health coverage in order to remain at work and in the community.

For further information on Open Enrollment, please visit the Affordable Care Act enrollment website, HealthCare.gov, or contact the Affordable Care Act call center at 1-800-318-2596.

Capitol Hill Budget Deal Avoids Premium Hikes and Budget Cuts in Medicaid and Social Security Disability Insurance

The White House has proposed an FY2016 budget deal that would prevent the double-digit premium increases feared by many Medicaid and Social Security Disability Insurance (SSDI) beneficiaries. Specifically, the deal will stave off a 52 percent premium increase for Medicare Part B enrollees and would prevent a 20 percent broad cut of all Social Security disability benefits.

The budget deal is in anticipation of the impact of an expected early 2016 Medicare budget shortfall for Social Security. The Social Security fund may be depleted, meaning that the government may only be able to pay off 80 percent of what is actually owed to Social Security beneficiaries. House and Senate leaders in both parties, concerned about the effect of this shortfall on Americans, have put forward many different measures that would reform Social Security without compromising disability benefits programs like Medicaid and SSDI.

Unfortunately, a two percent cut in all Medicare payments is a key provision in the bill, along with several other cost-saving revisions to the budget law, all of which would impact people with disabilities. The White House and the GOP struck a compromise deal on a provision that requires large employers to automatically enroll new employees in their health plans and rollover current employees, which is projected to save $8 billion through 2025. Other reforms to Social Security would impose stronger oversight, reporting requirements and stricter penalties for fraud and abuse of the system. These stricter oversight requirements and changes to the way in which employees are enrolled may change how some workers with disabilities, currently enrolled in Medicare, receive benefits.

For further information, read The Hill article, the Congressional Budget Office report on the automatic employee enrollment provision and the Board of Trustees report on the expected 2016 Social Security budget shortfall.




HCBS Transition Plans: Additional Updates And Concerns

As the states continue to release home and community-based services (HCBS) transition plans, it has become clear that each state interprets the HCBS regulations in a different manner. Some of these interpretations classify a certain type of setting as meeting the requirements, while other interpretations classify the same setting as not meeting the requirements.

For example, in Wisconsin’s transition plan, all group supported employment services are presumed eligible for HCBS funding. By contrast, the state of Maine presumes that all non-individualized, group supported employment settings are presumptively ineligible for HCBS funding. Tennessee’s transition plan, which became available this month, states that settings will be assessed based upon the qualities of the setting and whether it supports individuals receiving HCBS in the broader community. Tennessee explains that they will use a thorough, multi-step analysis that will examine, among other things, the number of individuals participating in facility-only services versus those participating in services in the community, the number of people in each setting who are participating in competitive integrated employment, and a review of both person-centered plans in use by each agency and assessments by individuals of the facility’s services. All new supported employment and integrated day services in Tennessee must at least include the exploration of both volunteer and community activities, and supported employment. They must also provide the individual with access to activities that reflect their interests and life goals. Integrated day services must provide the individual with access to the broader community and must maximize the individual’s autonomy and independence.

CMS may need to update its guidance in light of the very different ways that the states are interpreting the regulations. For further information:

EEOC Issues Proposed Rule To Amend Title II Of GINA

On Friday, October 30, 2015, the U.S. Equal Employment Opportunity Commission (EEOC) issued a Notice of Proposed Rulemaking (NPRM) that will amend Title II of the Genetic Information Nondiscrimination Act (GINA) to enable employers to provide limited financial incentives to employees in exchange for the employee’s spouse, who is also a participant in the employer’s health plan, providing information about his or her current or past health status.

The proposed rule states that an employer can offer a financial incentive, no greater than 30 percent of the total cost of the plan in which employees are enrolled for, providing genetic information as part of an employer-sponsored wellness program. The incentive may be financial or non-financial (e.g., time off, awards, prizes) in nature. The incentives are consistent with those provided in proposed changes to the Health Insurance Portability and Accountability Act (HIPAA) and the sections of GINA that involve health insurance.

The EEOC is accepting comments on the proposed rule through December 29, 2015. Those wishing to make public comments on the rule can submit them to the Federal Register website, which also contains the NPRM. You can also read a summary of the changes in a National Law Review article.



Kansas: Vocational Rehabilitation Agency Returns $15 Million to Federal Government

The Kansas Department of Children and Families (DCF), a state agency charged with helping people with disabilities find employment, has returned over $15 million dollars in unspent funds to the Department of Education’s Rehabilitation Services Administration (RSA). According to the agency’s director of rehabilitation services, Michael Donnelly, DCF made this decision because the number of people asking for vocational rehabilitation services from the agency has dropped dramatically since 2011. The $15 million constituted nearly 60 percent of the state’s $25.5 million vocational rehabilitation allotment for that year. No other state has relinquished a higher percentage of the Federal money set aside for its vocational rehabilitation program.

Kansas advocates were surprised and worried by the news. They report that other factors, such as the length of time it takes the Department of Children and Families to determine whether someone is eligible for services, may have contributed to the recent drop-off in the number of applicants. DCF also reported having a difficult time training and retaining the vocational rehabilitation counselors it needs to service applicants for services. Donnelly continues to defend the decision and notes that the state, nonetheless, has enough money in a reserve fund to cover Kansas’ projected costs for this year. He stated that an outreach initiative is “in the works” that will encourage people with disabilities to seek employment. For further information on the actions taken by DCF, read the Salina Post news article.