| House
and Senate Set to Consider Legislation Reforming and Cutting Medicaid;
Proposals to Curb Targeted Case Management Rejected
October
31, 2005
NAMI E-News
This
week and next, both the House and Senate will be taking up legislation
to reform the Medicaid program and achieve a net $10 billion in
savings over the next 5 years. Congressional leaders and the Bush
Administration hope to reach agreement on the legislation –
known as budget "reconciliation" – by Thanksgiving.
The reconciliation package touches not only Medicaid, but also a
broad range of domestic programs including farm subsidies, student
loans, food stamps, and child support enforcement to achieve an
overall savings target approaching $50 billion.
House & Senate Bills Differ Substantially on Medicaid
Reforms
The separate bills reported by the House Energy & Commerce and
Senate Finance Committees this past week differ substantially. The
House bill closely follows recommendations put forward by the National
Governors Association (NGA) granting states unprecedented flexibility
to impose higher cost sharing and premiums on beneficiaries and
design benefit packages below current Medicaid standards. By contrast,
the Senate bill achieves most of its savings through cuts in payments
to Medicare managed care plans and higher rebates paid to states
by generic and brand name drug makers.
Action Needed
Advocates are urged to contact their Senators and House member and
urge them to oppose provisions in this budget reconciliation package
that would adversely impact children and adults on Medicaid living
with severe mental illness. Of greatest concern to NAMI are the
following proposals:
• A House proposal that would allow states to require beneficiaries
(including adults with mental illness on SSI) to pay higher cost
sharing (co-pays) for services, including "non-preferred"
prescription medications and non-emergency services delivered in
emergency rooms;
• A House proposal that would allow states to require certain
beneficiaries (those above 100% of poverty) to pay higher enrollment
premiums; and
• A House proposal that would permit states to offer alternative
benefit packages to Medicaid eligible populations that might exclude
mental illness treatment and community supports.
In addition, there are a number of provisions in both the House
and Senate bills that NAMI is supporting and that would improve
upon the structure of Medicaid. NAMI urges support for the following
proposals:
• A Senate provision authorizing a demonstration program that
would waive the Institutes for Mental Disease (IMD) exclusion and
allow federal Medicaid matching funds for acute inpatient psychiatric
care (see details on the Snowe Amendment in the background paper
below); and
• A House provision that would direct states to invest in
evidence-based disease management programs for the prescribing of
anti-psychotics and anti-depressants as an alternative to prior
authorization requirements (see details on the Buyer Amendment in
the background paper below).
All members of Congress can be reached by calling the Capitol Switchboard
202-224-3121 or online through www.congress.org.
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