HFS – 2011 Annual Report Page 10
8. Family Cost Share and Income Caps
In response to budget concerns and the sustainability of this program, the group was asked to consider the impact of parental share or income caps for participation in the program and how parental share and cost caps could be reasonably applied to families with higher incomes. The participants were informed that the federal government imposes cost share limits for state and federal partnership programs. With certain exceptions, the federal government generally allows states to apply cost share based on the lesser of five percent of family income or 20 percent of the cost of services on families with income over 150 percent of the federal poverty limit (FPL). For state only programs there are no federal restrictions on cost share. Department analysis estimates that approximately 160 of the 650 children served in the Medically Fragile, Technology Dependent (MFTD) home and community based services (HCBS) waiver have incomes over 150 percent FPL. The cost share approach for
Medicaid eligible families is unlikely to produce significant revenue, but is a philosophical approach showing an effort for participants to contribute toward care and share in the cost when their incomes are above the Medicaid eligibility limits. Data analysis has shown that home based services are not always less expensive than residential services. Further discussion included the following comments.
Participants’ Feedback
• There was general consensus that some type of cost share would be reasonable if the following were considered:
– Other costs of care for special needs such as over the counter medications, certain durable medical equipment, specialized clothing, home modifications, assistive technology, co-payments for insurance
– Reasonable consideration of income caps, so that those with modest incomes are not forced to quit jobs, cannot seek services or drop private insurance.
– The adjusted gross income and other deductions are considered in establishing a cost share amount.
– Need to look at parental share across community and institutional settings, not just in home services.
– Before implementation, analyze dollars saved versus what may think will saved.
• Child care costs for most families average $12,000 to $15,000/year which is not an expense to families in the waiver.
• Consequences of eliminating the waiver are unknown and children could end up costing more if hospitalized, families could drop insurance and quit jobs.
• Health insurance companies need to be responsible for more of the care as almost universally; private duty nursing is not paid through insurance but should be if medically indicated.
9. Mental Health Interface with Care Coordination Innovations
Several voiced the importance of behavioral interventions and questioned how care coordination would interface with the current Screening, Assessment and Support Services (SASS) program. Though the definitive policy on this is still being considered, CCE/MCCNs are expected to identify the target population and service package that they will be responsible for supporting through their network of providers. Once an individual is part of a CCE/MCCN, that program would be responsible for delivering the medically necessary care required, including behavioral
