New rules could hurt Medicaid access


MONTPELIER -- Vermont legal advocates are at odds with state officials over language in new health care rules that they believe could exclude certain populations from long-term care benefits.

The proposed rules are part of the state's wider efforts to implement health care reform, one of Gov. Peter Shumlin's main priorities. Because of the concerns raised, the Legislative Committee on Administrative Rules voted Thursday to postpone approval of the lengthy set of health care rules until next month.

Vermont Legal Aid told lawmakers that a subset of people would, under the new rules, become ineligible for a Medicaid-funded program called Choices for Care. It offers benefits for long-term care and is designed to assist people who require intensive assistance.

The profile of the person who could be affected is very specific: Under age 65, non-disabled, above the poverty income threshold, without dependent minors, not pregnant and not blind.

But defining disability would be the tricky part under new rules. If a person fitting that profile sustained injuries in a massive car accident and requested Choices for Care under the new rules to cover rehabilitation under a year long, they'd be rejected because they wouldn't be considered disabled, said Vermont Legal Aid's Chief Health Care Advocate Trinka Kerr.

Under existing Choices for Care, expenses are taken into account for financial eligibility, according to Vermont Legal Aid staff attorney Christine Speidel. In the new rules only income not expenses would be taken into account for determining assistance for the program if you don't fit an existing category of eligibility, according to Vermont Legal Aid.

Increased wait times could also result from the new rule, according to Community of Vermont Elders' Director Gini Milkey who also gave testimony to the committee.

"Any rule changes that will increase administrative burden and increase delays will exacerbate an already broken process," Milkey said.

With the emergency health care rules set to expire at the end of July, the deadline for filing more permanent rules is fast approaching. And it's not clear that what advocates are asking for can be accommodated because of federal regulations. "We're happy to work with them and talk about it but we can't change that regulation at this point," Agency of Administration Health Policy Analyst Devon Green said.

How eligibility has been determined is anything but clear.

State officials and legal advocates essentially disagreed with how the rules have previously functioned. State officials say they don't see the rules as a change at all.

"We're not seeing this in a change in law," Leslie Wisdom, a general counsel for the Department for Children and Families.

"Part of what we've done in this rule is consolidate," Policy analyst for Department for Children and Families Robin Chapman said. Clarifying the system showed stakeholders all the elements of the process, some of which might have been unfamiliar to them before, according to Chapman.

Commissioner of the Department of Vermont Health Access said despite differences in understanding about this issue, Vermont Legal Aid has been an important partner for designing these rules.

"We will continue to work together (with Vermont Legal Aid) because it is our goal that we will continue to share a similar understanding," Mark Larson said.


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