Virginia Regulatory Town Hall View Comments

Department of Medical Assistance Services

Board of Medical Assistance Services

Administration of Medical Assistance Services [12 VAC 30 ‑ 20]

Action	Health Insurance Premium Payment (HIPP) Cost Effectiveness Methodology
Stage	Emergency/NOIRA
Comment Period	Ended on 11/25/2009

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11/17/09 8:31 pm

Commenter: John Carvil

Consider the Purpose of 12VAC30-20

Neither Town Hall Form TH-13 Substance nor the recent 12VAC30-20-211 are consistent with the purpose of 12VA30-20 which states, “The purpose of this regulatory change is to amend current Medicaid regulations to remove the requirement for enrollment in an employer-based group health plan, if such plan is available to the individual and is cost effective, as a condition of Medicaid eligibility…” Under the Substance section of 12VAC30-20 it is clear the primary objective is to: 1) Eliminate the requirement that Medicaid families "must" apply for HIPP and make it "voluntary" and 2) the regulation change attempts to capture/cover the 20% of disabled adults that live independently, but can still fall under the health insurance of the parent/family.

Neither TH-13 substance wording nor elements of 12VAC30-20-211 support the above purpose or the two objectives of the parent regulation. Further, 12VAC30-20-211 paragraph C.1 conflicts with 12VAC30-20-211 paragraph B Program Purpose, which states, “To enroll recipients WHO HAVE [capitalized for emphasis] an available employer group health plan that is likely to be cost effective…” Para C.1 then says that “existence of family healthcare coverage, shall be denied premium assistance…” This contradicts the spirit, intent, and stated purpose and objectives of 12VAC30-20 and the 1990 effort to achieve Medicaid cost savings.

Further, TH-13 presents new concepts that are documented neither in the 12VAC30-20-210 nor in the 12VAC30-20-211 regulation. I believe the Assistant Attorney General's letter references the erroneous TH-13 information, but probably without the benefit of comparing TH-13 to the amended regulations. Specifically, I’m referring to paragraph 2 that starts, “When the HIPP program was…” under the TH-13 Substance section. The wording in this substance section is inconsistent with 12VAC30-20-211. To further complicate matters, DMAS's recent letter to HIPP families cites rationale that may be consistent with the erroneous TH-13 substance statements, but is inconsistent with 12VAC30-20-210 and with 12VAC30-20-211 and is certainly not based on any reasonable evaluation of cost. This is causing lots of churn with families that have been eligible for HIPP in the past, but are now being told that cost was used as the determining factor for denial. The cost evaluation that DMAS purportedly used is inconsistent with the regulation. DMAS evaluation seems to be driven by the TH-13 substance explanation. I believe TH-13 obfuscates the intent of the regulation amendment. The amendment has the two objectives stated earlier, i.e.: 1) Eliminate the requirement that Medicaid families "must" apply for HIPP and make it "voluntary" and 2) the regulation change attempts to capture/cover the 20% of disabled adults that live independently, but can still fall under the health insurance of the parent/family. Current DMAS actions and the TH-13 explanation is inconsistent with the regulation purpose which says, "States are required to pay premiums, deductibles, and coinsurance on behalf of Medicaid beneficiaries eligible for enrollment in employer-based group health plans when it is determined cost effective to do so." For several years, it has been the determination by DMAS that families were eligible. Now, a TH-13 substance statement seems to be driving a determination to drop families based on the configuration of the family unit and not based on any true cost evaluation. Quite frankly, someone has decided (and not based on the regs) that families that have non-Medicaid children, in addition to one Medicaid child, are to be dropped from consideration for HIPP (refer to recent DMAS released letters to HIPP families). This is not based on "..determining cost effectiveness..", but is based on the rationale that families with plans, if dropped from HIPP, won't drop their family health insurance. This seems inconsistent with the purpose and objectives of the parent regulation.

I hope the proposed changes will be reconsidered. I don’t believe they are consistent with the purpose and objectives of 12VAC30-20. Last, a comment on TH-13 Family Impact paragraph. While impressive with its bureaucratic rhetoric I think the implications of these changes will certainly have an impact on some families. The state can say the “changes…encourage economic self-sufficiency”, but in-fact, these changes will put an economic strain on many families that will have to attempt to adjust from receiving HIPP payments to receiving zero payments with no reasonable warning or phasing in of this change. Also, I submit that the statement, “It does not strengthen or erode the marital commitment” is a naïve comment. Certainly, unplanned economic burdens can and do, unfortunately, strain even the strongest marriages.

CommentID: 10109