The Modern Medicaid Alliance sat down with Karl Cooper and Nuria Piracha from the American Association on Health and Disability to learn more about the organization and their efforts related to Medicaid.
Modern Medicaid Alliance (MMA): Tell us about the American Association on Health and Disability (AAHD) and how you help improve the overall health of adults and children with disabilities.
Karl: AAHD is dedicated to ensuring health equity for children and adults with disabilities through policy, research, education, and dissemination at the federal, state, and community levels. AAHD strives to advance health promotion and wellness initiatives for people with disabilities. Our goals are to reduce health disparities between people with disabilities and the general population, to support full community inclusion, to promote full accessibility in health care settings, to integrate disability into the broader public health agenda, and to advance knowledge translation and disability research. AAHD is governed by an esteemed group of board members representing people with disabilities, disability researchers, disability advocates, health care, and public health professionals.
MMA: How does AAHD help people with disabilities navigate the Medicaid coverage environment?
Nuria: In 2013, AAHD established the National Disability Navigator Resource Collaborative which aims to provide cross disability information and support to navigators and other enrollment specialists thereby ensuring people with disabilities receive accurate information when selecting and enrolling in their coverage options.
AAHD worked with Community Catalyst from 2017 to 2023 on a Medicaid/Marketplace plan outreach project to educate people with disabilities about enrolling in and utilizing health insurance, including health insurance literacy and the importance of open and special enrollment periods. AAHD created plain-language consumer-facing materials that emphasized key messages around financial assistance, in-person help, and how to maintain health care coverage.
We continue to work with the Center on Budget and Policy Priorities with support from the Robert Wood Johnson Foundation to support those who require enrollment assistance. This project aims to monitor and provide resources and trainings on Marketplace and Medicaid policies and application processes, how to maximize coverage during open enrollment periods for people with disabilities, and consistent policy coverage and application of related Medicaid/Marketplace changes, such as the Medicaid Unwinding, the period of time when all enrollees have to re-establish eligibility for the program.
Combined, these projects provide the disability population and Navigators with effective outreach and resources in maintaining coverage that is affordable, continuous, and accessible.
MMA: What are AAHD’s advocacy priorities when it comes to Medicaid?
Karl: AAHD’s public policy priorities state that all U.S. Department of Health and Human Services (HHS) health programs should use comprehensive and consistent demographic categories in the collection, analysis, and transparent reporting of data for disability status. Our priorities include the expansion of Medicaid Home and Community Based Services (HCBS) and addressing the Medicaid institutional bias by expanding & strengthening HCBS infrastructure to work toward the ideal of a mandatory HCBS Medicaid benefit. AAHD aims to work towards comprehensive health insurance coverage through the Affordable Care Act marketplaces, Medicare, and Medicaid and to promote more effective and person-centered services and supports for persons dually eligible for Medicare and Medicaid.
MMA: How is AAHD supporting people with disabilities during the Medicaid redeterminations process?
Nuria: AAHD has continued to monitor and report on the Medicaid unwinding through factsheets, weekly newsletters, promotion of the Health Reform: Beyond the Basics webinar series, and social media updates for the disability community.
AAHD is actively involved in the Consortium for Constituents with Disabilities (CCD) Health Task Force and co-chairs a working group that is part of the task force that is focused on the ending of the Public Health Emergency and the Medicaid unwinding.
MMA: What is the importance of home and community-based services (HCBS) for people with disabilities? How does Medicaid play a role in providing HCBS?
Karl: While Medicare covers time-limited episodes of home health services and therapies, Medicaid provides ongoing HCBS and supports for people requiring such support in order to reside in their community. Some state government ID/DD, mental health, and physical disability programs offer non-Medicaid HCBS supports on a continuing basis. PACE programs provide at home services and supports for persons over age 55 with significant health challenges and disabilities. Medicaid is the main source of publicly funded health coverage which includes a benefit for individuals to receive services and supports in their home. HCBS allows people with disabilities to still receive the services and support they need in their home without having to be placed into an institutional setting. This allows people with disabilities to maintain their dignity and community living with family and friends and still have a place that they can call their own and not having to choose between getting the services they need or living in their home. Unfortunately, HCBS is not a guaranteed benefit under Medicaid as it is funded through waiver programs which often have long waiting lists of individuals who want to be able to take advantage of this benefit. As care at an institutional setting is a guaranteed benefit under Medicaid, this is referred to as the “institutional bias.” AAHD advocates for the removal of the institutional bias that is built into the Medicaid system and expansion of the HCBS benefit.
MMA: How does Medicaid provide essential mental and behavioral health services to people with disabilities?
Nuria: Medicaid is the largest provider of health care coverage for people with disabilities. In fact, 37.2% of people with disabilities receive their coverage through Medicaid. Additionally, Medicaid is the largest payer for mental health services in the United States. Many people with disabilities have co-occurring mental and/or behavioral health issues and many of them rely on Medicaid to provide coverage for the treatment that they need for these services.
For more information on AAHD, visit their website.