January 15, 1996
     DRAFT POSITION PAPER
     MEDICAID
WHAT IS MEDICAID?
     Medicaid is the basic safety net health care program for 37.5 million
Americans including 4 million individuals with disabilities.
     Medicaid includes not only the traditional acute health care services
such as Physicians, Hospitals and pharmaceutical, but it also pays for
diverse services such as wheelchairs, personal assistance services,
transportation, therapies, home modifications, disposable medical supplies,
and even long term care such as nursing home care, home health care such as
alternatives to institutionalization and even housing and care in group
homes.
     It is an entitlement program for low income children and women,
children and adults with disabilities and the poor frail elderly. Medicaid
has a means test and an maximum assets test.
     In New Jersey, approximately 3,900 developmentally disabled
individuals are funded for institutional care in intermediate Care
Facilities - Mental Retardation (ICF-MR), 3,000 receive group housing,
3,700 receive day training services, and over 1,000 individuals receive
respite care.
     Approximately 21% of Mental Health expenditures and 50% of Community
Based Mental Health Services are funded by Medicaid.
HOW IS THE PROGRAM PRESENTLY FUNDED?
     The present program is funded 50 % by the Federal Government and 50 %
by the State of New Jersey.
WHAT IS PROPOSED FOR CHANGE IN MEDICAID?
     The congressional proposal is to rename the program - Medigrant and
make block grant to the states. Originally, the congressional proposal
reduced the projected size of the program by $ 182 billion over the next
seven years, although the more recent Congressional budget decisions have
reduced these program cutbacks to approximately $ 117 billion.
     Each state would be able to change its own priorities and the items on
which it pays for services. The program would no longer be an entitlement
program, and the program would vary from state to state. Unless a state
decided to retain the safety net aspects of the program, the entitlement
element would cease with the funding change.
     Most states would change from fee-for-service payments to managed care
providers. In New Jersey, managed care is already being implemented for low
income women and children (approximately 25 % of budget), and plans are
being discussed for managed care for individuals with disabilities in 1997.
     The long term aspects of the former Medicaid program such as housing,
nursing home care, community waivers and respite care are still to be
discussed.
     Among the types of services that seem to be at risk are payments for
adaptive equipment, personal assistance services, behavioral supports,
respite, and services for integrated and inclusive community based
activities.
WHAT IS THE PRESIDENT'S POSITION?
     The President proposes to retain the national safety net concept with
modifications to give the states some flexibility. His reductions amount to
$ 54 billion over seven years.
     The President would however cap the federal governmental exposure.
This cap would utilize the 1995 expenditures for acute and long term care
divided by the total number of disabled persons for each state; there would
also be a maintenance of effort provision for each state.
     Because of the manner in which the State of New Jersey previously
budgeted and expended Medicaid dollars, the cap and the maintenance of
effort provisions could negatively affect New Jersey.
     The program would continue to serve approximately 4 million persons
with disabilities and continue to utilize a fee-for-service delivery
system.
WHAT I CAN DO?
     You can call the White House at (202) 456-1111 and express your
opinion.
     You can call both Senator Bill Bradley (202) 224-3224 and Senator
Frank Lautenberg (202) 224-4744 and express your opinion.
     You can call your Congressional representative and express your
opinion,
Robert Andrews        (202) 225-6501
Frank LoBiondo        (202) 225-6572
James Saxton          (202) 225-4765
Chris Smith           (202) 225-3765
Marge Roukema         (202) 225-4465
Frank Pallone         (202) 225-4671
Robert Franks         (202) 225-5361
William Martini       (202) 225-5751
Robert Torriceiii     (202) 225-5061
Donald Payne          (202) 225-3436
Rodney Frelinghuysen  (202) 225-5034
Richard Zimmer        (202) 225-5801
Robert Menendez       (202) 225-7919
 * OLX 2.2 TD * DEN BBS, Hackensack, NJ, 1:2604/305, 201/342/3273
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