The American Recovery & Reinvestment Act (Public Law 111-5)

1. The American Recovery & Reinvestment Act (Public Law 111-5) Hilary DalinAssociate Director, My Medicare Matters, National Council on Aging April 22, 2009

2. What Will We Cover? • Background on the legislation • Key provisions for your clients • Healthcare improvements included in legislation • Other important low-income provisions • Resources • Questions/comments

3. Background on the Legislation • To help reverse the downward trend in national and local economies, President Obama and Congress proposed a stimulus bill to make investments in programs and provide tax cuts to help stimulate economic growth. • Leadership in both the House and Senate and relevant committees worked on provisions to include in the legislation.

4. Economic Stimulus Bill Works Its Way through Congress • The House drafted H.R. 1, the American Recovery and Reinvestment Act, which passed by a vote of 244-188. • The Senate then made some changes to the House version, cutting some of the spending in the bill. The bill ultimately passed by a vote of 61-37.

5. Economic Stimulus Bill Works Its Way through Congress (cont.) • Leadership in the House and Senate then convened a conference committee to come up with a form of the bill that both chambers could agree to. • In the end, the final vote was: • House: 246-183 • Senate: 60-38 • President Obama signed the legislation on February 17, 2009.

6. Economic Stimulus Bill Overview • The final version of the economic stimulus bill includes health related provisions, tax cuts, appropriations and other provisions. • Today we are going to focus mainly on the provisions that most directly affect your clients, plus other health related and low-income provisions that may be of interest.

7. Key Provisions for Your Clients

8. Extension of Qualified Individual (QI) Program • The QI program is extended through Dec. 31, 2010. • About QI: • This Medicaid program pays Part B premiums ($96.40/month in 2009) for eligible Medicare beneficiaries (those with incomes between 120-135 percent of poverty). • People eligible for QI (and the other Medicare Savings Programs) are also automatically eligible for the Medicare Part D Low-Income Subsidy.

9. One-Time Payment • $250 one-time payment going to almost everyone who gets: • Social Security, • Supplemental Security Income (SSI), and/or • Railroad Retirement Benefits, and Veterans, Disability Compensation or Pension Benefits. • As long as they received a benefit in November, or December 2008 or January 2009 • Spouses each get a one-time payment

10. One-time Payment, cont. • Some people will not get one-time payments: • People who owe state or federal agencies money or are delinquent in child support – money will be offset • People not legally in US • People living overseas • People on SSI on Medicaid living in nursing homes or living in some types of governmentally run facilities • People denied benefits because they made false or misleading statements • People in prison or who violated parole or probation, plus fleeing felons • Kids getting Social Security • But SSI kids do get a payment

11. One-time Payment (cont.) • Will be received by first week in June 2009 • NO need to file a tax return or take any action • SSA, VA and RRB making the payment automatically • The one-time payment will be made separately from regular monthly benefit payments. • Payment method will be the same as for monthly benefit (direct deposit or mailed check). • Payment won’t count as income for purposes of determining eligibility for or amount of any federal, state, or local benefit. • As long as some federal funding supports the program • Payments are not taxable income • No tax return required in 2010 because of getting this one-time payment.

12. One Time Payment – Poll • Are you getting lots of questions from your clients about the one-time payments? • Yes a lot • Not so many • Nobody seems to know about the payment • Take a look at a consumer-focused flyer

13. Any Questions? • We’ll take your questions now about: • QI extension • One-time payments • Remember to put your questions into the question function

14. Healthcare Improvements Included in Legislation

15. Premium Subsidies for COBRA Coverage • Workers who were involuntarily terminated between Sept. 1, 2008 and Dec. 31, 2009 are eligible for a premium subsidy of 65 percent to pay for COBRA coverage for themselves and their family for up to 9 months. • The subsidy terminates if/when the worker is offered any employer-sponsored health care or becomes eligible for Medicare. • To qualify, income in 2009 cannot be more than $125,000 for a single person (or $250,000 for families). • The subsidy is not counted as income when determining eligibility for (or amount of) any federal, state or local public benefit.

16. Federal Medicaid Assistance Percentage (FMAP) Increase • The rate at which the Federal government reimburses states for Medicaid (FMAP) will be increased 6.2% for all states for the period of Oct. 1, 2008 through Dec. 31, 2010. • A total of $87 billion has been allocated for this effort. • Additional funding will also be available for states based on their unemployment rate. • States with higher unemployment rates will receive even higher payments.

17. FMAP Increase (cont.) • Important notes: • To qualify for funding, states are required to maintain eligibility standards, methodologies and procedures that are not more restrictive (under its State Plan or waiver) than those in place on July 1, 2008. • If states have restricted Medicaid eligibility recently, they can only become eligible for the increased FMAP funds by reinstating eligibility requirements that were in place on July 1, 2008.

18. Investment in Evidence-Based Programs • $1 billion for a new Prevention and Wellness fund, to invest in proven clinical preventive services and community-based prevention programs. • $300 million is allocated to the Centers for Disease Control (CDC) immunization program, and • $50 million is to be provided to states for “healthcare-associated infections reduction strategies.” • Remaining $650 million is directed to “evidence-based clinical and community-based prevention strategies… that deliver specific, measurable health outcomes that address chronic disease rates.”

19. Funding for Health Information Technology • The Federal government will establish standards to allow for the nationwide electronic exchange and use of health information to improve quality and coordination of care. • No later than 2010 • $19 billion is invested in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors, hospitals and other providers to use health IT to electronically exchange patients’ health information.

20. Other Healthcare Provisions • $500 million to support programs which place health care providers in underserved communities. • $1.1 billion in comparative effectiveness research to provide patients and providers with information about the merits of different treatments • Not to be used to establish cost or coverage criteria for Medicare or Medicaid • $2 billion for community health centers to provide for repairs and renovations, allow them to invest in Health IT and provide critical services. • Transitional Medical Assistance (TMA) extended through Dec. 31, 2010. • TMA provides Medicaid coverage to those people transitioning from welfare to work. The bill provides a state option of a 12 month initial eligibility period.

21. Any Questions? • We’ll take tour questions now about: • COBRA extension • FMAP increases • Evidence-based programs • Health IT • Other healthcare-related provisions • Remember to put your questions into the question function

22. Other Important Low-Income Provisions

23. Supplemental Nutrition Assistance Program (SNAP, formerly the Federal Food Stamp Program) • $19.9 billion in additional funding for SNAP • Will increase the benefit by 13.6 percent for recipients. • The additional funding begins no later than mid-April 2009. • The Secretary of Agriculture is required to establish a simple process for states to notify households.

24. Senior Nutrition Programs • The following programs will receive a total of $100 million in additional funding: • $65 million for congregate meals, • $32 million for home-delivered meals, and • $3 million for Native American nutrition services. • Funding is available immediately. • No time period is required for expending the funds.

25. Community Service Block Grants • $10 million under Community Services Block Grant to states and • “shall be used for benefits enrollment activities related to identification and enrollment of eligible individuals and families in Federal, State & local benefit programs”. • Source: American Recovery and Reinvestment Act of 2009, H.R. 1(ARRA) Title VIII, DHSS, Administration for Families and Children, Children and Families Services Programs, – page 65

26. Senior Employment • SCSEP (Title V) will receive $120 million • Could help create as many as 24,000 additional slots for low-income older workers. • The funding is required to be distributed to current state and national grantees by mid-March and will be available through June 30, 2010.

27. Extension of Unemployment Benefits • Through 2009, up to 33 weeks of extended unemployment benefits will be available to workers exhausting their regular benefit. • Through this time period, unemployment benefits will be increased by $25 each week.

28. Social Security Disability Claims • $500 million for processing disability and retirement workloads, including information technology acquisitions and research in support of such activities. • Goal is to reduce the backlog of disability claims at Social Security • Funds are included to facilitate use of electronic medical records for disability claims.

29. Digital TV Conversion • $650 million is provided for the Digital-to-Analog Converter Box Program. • Most of the funding will be for additional coupons, • $90 million is allocated for education, outreach and direct assistance for “vulnerable populations, including senior citizens, minority communities, people with disabilities, low-income individuals, and people living in rural areas.”

30. Any Questions? • We’ll take your questions now about: • SNAP • Senior Nutrition Programs • Community Service Block Grants • Senior Employment (Title V) • Unemployment Benefits Extension • SSDI Determinations • Digital TV Transitions

31. Resources • http://www.recovery.gov (Review how and when money is being spent under the stimulus legislation) • http://www.mymedicarecommunity.org/attachment.php?attachmentid=277&stc=1&d=1239037166(The text of the legislation) • http://www.ncoa.org/userfiles/file/Stimulus_bill_summmary_FINAL.pdf (NCOA’s summary of selected provisions of the legislation) • http://www.cbpp.org/1-22-09bud.htm (State-by-state estimates of provisions affecting low and moderate income Americans) • http://waysandmeans.house.gov/MoreInfo.asp?section=50. Summary of legislation from House Ways & Means Committee. • http://www.ssa.gov/payment (Read more about the one-time $250 payment to Social Security and SSI recipients. • http://www.councilofnonprofits.org/stimulus (National Council of Nonprofits Special Reports on Economic Stimulus and Recovery)

32. Questions/Comments? Please contact: Hilary Dalin Associate Director, My Medicare Matters, National Council on Aging hilary.dalin@ncoa.org