When the Medicaid Commission met in Washington, DC last week to begin their deliberations on making recommendations to the Administration and to Congress on the future of the Medicaid program that ensures the long-term sustainability of the program, their focus was on eligibility populations. This was consistent with a schedule that had been adopted in October for the next five meetings of the Commission. It included:

• January meeting – Considering fiscal constraints, who should be served and why?
• March meeting – How do we get the best quality acute and preventive care for our public dollars?
• May meeting – How do we get the best quality long-term care for our public dollars?
• July meeting – What are the tools to making our dollars go farther? How do we improve the infrastructure for quality care?
• September meeting – What are the tools to making our dollars go farther: information technology, fraud and abuse and financing?

However, on Tuesday evening, January 24, Secretary Michael O. Leavitt who appointed the Commission encouraged them to look closely at long-term care as a priority. At the present time, about one-third of Medicaid's budget goes to long-term care. So it is certainly understandable that the Commission should especially consider recommendations involving long-term care. At the recent White House Conference on Aging that meets every ten years, long-term care was the target of many of the recommendations from that conference. Also, on December 15, 2005, the National Council on Disability (NCD) released its report on "The State of 21st Century Long-Term Services and Supports."

At this past week's meeting, the Commission heard from many experts and representatives about Medicaid eligibility, private insurance's role, and state practices. Dr. Diane Rowland, Executive Director of the Kaiser Commission on Medicaid and the Uninsured, and Nina Owcharenko of the Heritage Foundation both addressed who should and should not be covered by Medicaid and why. Joy Johnson Wilson, a member of the Commission, who is the Federal Affairs Counsel and Health Policy Director at the National Conference of State Legislatures (NCSL) and Jim Frogue, chief liaison to state policy projects for the Center for Health Transformation (a group headed by Newt Gingrich), spoke about state responses to increased pressure on Medicaid enrollment and public financing. In addition to their presentations, we heard from the states of Idaho, Massachusetts, and West Virginia about their own state reform efforts, usually involving 1115 waivers [waivers are state programs approved by the Center for Medicaid/Medicare Services that depart from ordinary eligibility or benefit rules for temporary periods to test new, innovative policies but often also to expand eligibility, coverage or services or save on budget expenses.

These states were represented by their governors, secretaries of health and human services, and Medicaid directors. At one point, we had two sitting governors testifying, two sitting governors on the Commission listening and two former governors chairing the meeting – not to mention that Secretary Leavitt is also a former governor. Throughout the Medicaid debate, the states have pushed for increased flexibility to administer and implement the Medicaid programs within their own states. The 1115 waiver programs are presently a means with which states have some flexibility to "experiment" with Medicaid.

A report by Congressional Quarterly after the Commission's October meeting noted that many people believed it "was a 'sham' commission controlled by people hostile to Medicaid." But the article went on to say that after the two-day meeting, "members of the panel displayed the kind of concentration, curiosity, and passion that suggested their concern about the stakes involved." The questioning of witnesses was "sharp and detailed and interspersed with commentary that reflected a range of opinion on long-term changes." As evidenced by the National Governors Association, recommendations on Medicaid reform can cross state and political boundaries.

The next meeting of the Commission will be March 14 and 15 (tentatively) and will be held in Atlanta, GA (place not specified yet). Once the date and location are official, it will be on AAPD's website (www.aapd.com). The focus of that meeting has been changed from the original schedule and will be on long-term care. It is always possible for anyone to make public comments during the Commission's meeting, as well as to submit in writing any proposals or testimony for the Commission's consideration. For example, ADAPT submitted a proposal to the Medicaid Commission very early in its deliberations entitled "Program-matic/Cost Efficient Medicaid Changes to End the Institutional Bias." This proposal focuses on "how Medicaid's long-term services and support system can more effectively serve more people with disabilities and older Americans in the community by reforming the institutional funding bias that has existed since 1965 – and without block granting or arbitrarily capping Medicaid funding." A member of ADAPT will be testifying at the March meeting.

Recommendations made by the NCD in its December report should also be submitted to the Commission. NCD states in their report summary, "the development of long-term services and supports (LTSS) comprehensive policy will define the future economic independence of Americans with disabilities…The United States is a world leader in extending life and eradicating disease, but it has failed to develop an LTSS public policy that truly integrates disability as a natural part of the human experience." Written submissions to the Commission should be sent to Stacie Maass, Executive Director of the Medicaid Commission, 200 Independence Avenue, SW, Washington, DC 20201, phone (202)401-5879, Stacie.Maass@hhs.gov.