>> Nicole LeBlanc: We have panel number two, our second panel is about the roll out of H.R.1, otherwise known as the not so big beautiful bill, and how this affects Medicaid. First speaker is Gelila Selassie. Gelila is the Director of Health Advocacy at justice in aging.
>> Okay. Sorry. Thank you, everyone. Hi. It's good to be here today. As we mentioned, I'm Gelila Selassie. I'm an attorney at justice in aging. And the Director of Health Advocacy, and I'm going to give an overview on Medicaid work requirements, which you've already had a great preliminary on earlier today.
So if we can advance to the next slide. I'm going to go through these pretty quickly just because I really want to prioritize our other speakers and Q&A. All of this is just little background and resources on the slides for you to use as a reference. This is just an introductory about justice in aging. I'm based out of the DC office, but we're also based out of California, and we're really prioritizing fighting senior poverty through a variety of issue areas, with my focus being on healthcare and Long-Term Services and Supports.
Next slide.
>> [Away from microphone] if it's possible to get a little closer to the mic,sorry .
>> I've never had that problem before so we can go to the next slide again. As I mentioned, we already had that primer, so I'll go a little bit more quickly. As we know, H.R.1 is also known as the One Big Beautiful Bill act or CMS has been relating to it as the working families tax cuts act. For some reason they don't want to be associated with One Big Beautiful Bill. So know that when you see that in communications, it's all the same law.
There's been quite a lot of changes to beneficiary, as we know. I listed a few as far as immigrant eligibility, cap on most home equity limits, reduced retroactive period, work requirements and increased renewal periods. It's important to note that there are changes on the state and provider side, like the state directed payment rule and provider tax cuts that are going to have a rippling effect on beneficiaries as well because it limits how the flow of money for Medicaid is happening.
So if we can move to the next slide. So I'll just first quickly touch on the more increased renewals beginning in 2027, it requires to have 6-month renewal period instead of annual. This is likely to lead to a lot of terminations, not because there is ineligibility, but because people are more likely to lose their coverage for procedural reasons, because mail gets lost, because forms are complicated and people forget to fill it out or the paperwork to verify what I really need is lost or takes a delay to get there. That's likely why we'll see terminations. No one really thinks that large swarms of people are going to suddenly become super rich within 6 months and no longer become eligible. It is really sort of a wrap-around tool to get people coverage of actually who should qualify.
CMS have a couple of options for how states can he role. Option one is a bad option. It's super complicated. Requires basically a change to an individual's redetermination date. Normally the one decent thing about Medicaid is that a lot of people know, or at least have an idea, like oh, in May every year I will get this paperwork, I will get that form, and that consistency is helpful.
>> [ Captioners Transitioning ]
>> Gelila Selassie: Versus, option two which is a better option which is allowing the existing redetermination periods to continue. Once the leg dated in May or whatever then they'll start their six-month renewal period there. Next slide. All right, work requirements is a big one, known as the Community Engagement Requirements. These are different from the worker requirements we see in SNAP or tan TANIF. This adds a bit of confusion. Although they meant to be similar and sort of working together, they are separate, distinct programs. That can be confusing for beneficiaries. Majority of Medicaid expansion unreleased of two-thirds of people working and another 25% or 30% are not working because they are disabled, care giving or in school.
So, in effect, if everything went according to plan, hardly anybody should be losing coverage. Again, we know that from past experience as we saw in Georgia and Arkansas when they had work requirements, it was not.
People should have been exempted or did qualify lost coverage because it was being done in a way putting the thumb on the scale to get terminated. That's why we are really, really concerned about this and many of you are rightfully so.
So state has to implement this by January 2027, a few states are implementing sooner. Nebraska implemented in May, and Montana in July and Arkansas is doing a soft launch in July, they are not terminating people from coverage just yet.
>> [Slide Change]
>> Gelila Selassie: The big takeaway here is only applies to the expansion of ages 19 to 64. I will go into a bit of details. There are two ways of meeting these work requirements. One is 80 hours of work, education, volunteering or job training and the IFR lays out process of how to calculate those, a mix of those different activities. That's really important for states like Massachusetts. About 30 something states have minimum wages well above the 725 national average. So, there are a lot of people who could qualify by working, you know, way less than 80 hours a month. Because for simplicity sake, everyone falls into the 80 hours. We want to make sure people are aware of that especially states with $15 or $16 minimum wages. That's easer for people to comply. HR1 shows that they are enrolled one month prior to application or their renewal period. Unfortunately, again, it gives states to redo that option of three-month of paperwork to show they meet requirements before getting Medicaid.
[Slide Changed]
>> Gelila Selassie: We are talking about exclusions and exemptions. Next slide again.
>> [Slide Changed]
>> Gelila Selassie: 41 states have a traditional Medicaid expansion and two states have that expansion programs through waivers of Georgia and Wisconsin. These applied to them too because congress is congress and their statute is complicated and how they describe these expansion-like states and waivers so it may seem like more states are subjected to requirements if they have an expansive waiver group. It is really just Georgia, Wisconsin and these 41 states. They list out the applicable individuals or who rather are not applicable individuals under the statute. So, again, under 19 over 65 if anyone is entitled to Medicare or duo eligibility. And then anyone receiving Medicaid for pregnancy or post partum coverage. Next slide.
>> [Slide Changed]
>> Gelila Selassie: We have a list of mandatory exceptions. Just know there are quite a bit over there.
>> [Slide Changed]
>> Gelila Selassie: One thing the statute does not do a great job is explaining who's - who's sort of not subject to the work requirements but meets the exemption. What the IFR is clarifying who's the specified excluded individuals. People in the duo or SSI or whatever or in the disabled program, these are people who should not be receiving ideally exemption paperwork or anything at all. They are not apart of that world. People who are caregivers, they are applicable individuals, they may have an individual circumstance like disability or health conditions or whatever that excludes them from our requirements. So, those are folks who should be getting the exemption forms and there are materials like that. Quick comparison is consider a 61 years old who's on SSI and receiving Medicaid because they are on SSI. They are not at all network requirement world versus the same 61 years old before they get on SSI and we know it is a multi-year process for many people. They are disabled and they are not receiving Medicaid because of disability. They have to provide paperwork or documentation of some sort to show that they meet that exemption. That's an important distinction. We know it is a mess to begin with that we don't want more people in the world of work requirements that's absolutely necessary.
>> [Slide Changed]
>> Gelila Selassie: Then, we have the medically frail exemption that's listed out here in statue. One quick note and these are all defined in much more detail in the IFR and our resources which I will share at the end. One quick notice the IFR came out last week did add an in ability to work criteria or the specific language is that their condition, their disability that's causing medical frailty prevents them from meeting the requirements. This is significantly more limiting. It is referring to the Social Security Administration of Disability which, you know, -- so, pretty clearly outside of what the statute says as what congress intended. If that was the intent, they should default to Social Security limits. That's one big concern.
>> [Slide Changed]
>> Gelila Selassie: The other super big exemption is the caregiver exemption. Quick note here is that caregiver, the exemption applies to caregivers and family caregivers, a dependent children age 13 or under or a disabled individual. Again, language of care giving means providing care within a broad range of assistance. They'll use the ADA definition of disability which is having a physical or medical impairment. So the language that states you and trying to figure out how people meet that frail exemption is crucial. That's something we are looking out for. Unfortunately, the IFR again made a restriction that was not in the statute where the family's caregiver exemption only applies to individuals who are living, if your caregiver is living with the individual or having a familiar relationship with them. That's really problematic, consider if I am providing care with my disabled parents who live across town, I get these exemptions. It is arbitrary and problematic. The hours I do provide care giving can be unpaid work or volunteer hours so I report that towards my work requirement limit but again, it was not apart of the statue and it is going to affect quite a bit. Next slide.
>> [Slide Changed]
>> Gelila Selassie: There are some reporting requirements that was provided in the IFR. It is important that states use data that's existing in their data system first before requiring individuals to submit documentation. The IFR did say states can accept self-attestation one time per enrollment. So, not for the renewal or benefit period. Next slide.
>> [Slide Changed]
>> Gelila Selassie: I am going to go over what folks are doing in terms of advocacy and what you all can do. Nebraska decided to implement early in May. Advocates suggesting that and sprung to action and mitigating the harm of that. They proposed a few state bills to mitigate the coverage loss. Some of these like the first one may be affected by the IFR because it was all done in April and May. But, some of these other things are something that states can use, for example, not requiring prohibiting the state to do frequent renewal periods in six months. Another good one, requiring the state to publicly report comprehensive aggregated data on worker requirements compliance. That's LB777, which is crucial and that data is necessary. And then next slide.
>> [Slide Changed]
>> Gelila Selassie: Justice in aging toolkit. It highlights how people can mitigate their coverage losses and we are going to tweak the letter so hopefully it can be used for templates or comments or IFR or if the states are providing any comment feedback period that may be good to use as a reference as well. Next slide?
>> [Slide Changed]
>> Gelila Selassie: I am sure everyone is doing this by the fact that we have this Summit today. It is important to partner with the government, nonprofits and aging disability, healthcare partners and making sure communication is available and early. One big thing for self-advocates is data and law is not everything. It is great. It is literally my job so it better be great. Those individual stories and narratives paint a picture of who should be covered and likely fall through the cracks. We have these sorts of questions to consider, who's going to be having barriers or who may be retiring early? Who's care giving or may not identify themselves as a caregiver even if they meet the language of care giving. So, these are all really important things to consider. Then, my last thing is be sure on the next slide is --
>> [Slide Changed]
>> Gelila Selassie: Be sure to submit the link there from the IFR. The IFR does go into effect immediately. It is helpful to build an administrative record where states can, or rather CMS is aware of these other problem setters potentially could happen or any litigations. That's what litigators use to help develop or sort of fight these rules and then also it helps with future guidance as well from states. So, CMS can issue technical guidance, state letters or whatever that are subjected to the same IFR, rulemaking things and so that would be really helpful as well. And so with that, I will turn it over to my copanels. Thank you.
>> [Applause]
>> Alixe Bonardi: Thank you, I want to thank the hosts to bring the whole conversation together. The conversation is going well?
>> Alixe Bonardi: Okay, I am going to spend a little bit of time talking about a project that goes back to what colleagues were talking about in the earlier session, specifically this is a project that's focused on early efforts to monitor changes to home and community-based services. And to your point, thank you for the work that you are doing and creating the administrative record of how things are changing as Medicaid changes roll out and in this case, home and community-based services roll out. I would like to go to the next slide, please.
>> [Slide Changeed]
>> Alixe Bonardi: This is a project of several collaboration. This is apart of HHS and we are collaborating with my colleagues along with LTSS Center at U Mass Boston. This is a project just got started this year and it is a planning brand with a small amount of funding from the SCAN foundation just to get this up and running. I will talk about where we are going.
[Slide Changed]
>> Alixe Bonardi: We know there are pressure coming on Medicaid budgets. Many states are going to be in a position where they are well likely responding and by reducing funding to those services that are optional, home community-based services being one and where as nursing home and institutional level supports are not optional. So, the types of changes of HCBS impacts are tricky to detect. It is something we have noticed over the years. Without spending some time to do a deep dive with states, it became clear it was going to be hard to see how this will all play out. Next slide, please. [Slide Changed]
>> Alixe Bonardi: So, when we start thinking of, okay, with the passage of, what may be some of the things that could result to HCBS. This is a slide of where our big concern are as it relates to reductions, noting that these are some of the thing that is we can anticipate, looking at elimination of HCBS programs and reducing waiver soloists or service caps to provider's rates. We have got some examples of that. Higher eligibility for programs and, for example, the levels of care could be changed by states. That's something states have control over. Policies that can force more people into more congregate settings. These are the kinds of things that were being raised as major concerns among advocates and people who were receiving services.
>> [Slide Changed]
>> Alixe Bonardi: When we looked at this, we were - we thought we had a little bit more time, honestly. We were starting to think about those in planning in 2025 and thinking - okay, if we anticipate these changes, we should think about setting up attracting systems to try to understand what is actually happening on the ground, in the moment and start documenting. So, the rational for this was really to ensure that we could be tracking realtime for the purposes of advocacy, number one. And when there is information ensured in a solid way, we can look at supporting advocacy efforts. Making sure that communities that may be impacted are aware and can react and respond appropriately. Documenting those changes in HCBS policies as I mentioned are hard to track and so we did need to think about how we are going to structure this in a way that's reliable and consistent. And then thinking about for future opportunities, we want to be sure that when we document changes -- this can help us be ready for future opportunities to potentially unnew or address harms. Also, changes to impacts of the population. So, next slide.
>> [Slide Changed]
>> Alixe Bonardi: And when we think about what some of the potential impacts we were concerned about, right? These are some of the deepest impacts that people have addressed in the conversations so far. Concerns related to people just no longer having access to HCBS, increases on the waiting list, concerns as this relates to the direct workforce crisis as we have already talked about. The potential of family caregivers and unpaid caregivers will take on what would be support to people for their families, loved ones and noting that may also be having significant impact on both families and as we discussed perhaps potentially the economy.
Thinking how this can lead to increase institutional care, the impacts on the healthcare system and the health of people themselves and just looking at sort of a -- an idealogical shift and turning back the rebalancing slide that Joe was sharing earlier.
>> [Slide Changed]
>> Alixe Bonardi: We got rolling with this with our collaborating team. We did a landscape scan and identified what we could be cracking at this very moment. What we are tracking right now are proposed and enacted HCBS policy changes across all authorities, across all populations that could be using HCBS in any states. We are looking not - we are looking at what legal authorities could be used to create those changes? Next slide, please.
>> [Slide Changed]
>> Alixe Bonardi: This is a wonky slide but I am going read a link of the HCBS tracker landing page. That's a short link that'll take you to a page that is on the George Washington website page. What's important as we were starting to track this, we felt it was really important to be getting the information back out to communities that are sharing information about tracking, about changes that are happening in their states. This page will take you to an impact tracker. It is a basic Google sheet that is where people can see where all the impacts we are currently tracking. On that page, there is an information collection form where if you are in a state or interested in sharing information back. This is very much of a by directional sharing resource tool right now publicly available. As we get this up and running, we are just doing what we can to share this information out. Next slide, please.
>> [Slide Changed]
>> Alixe Bonardi: I will not spend a lot of time on the next slide. It is really just demonstrating there is a little guide for how to use the tracker and if you are comfortable in navigating Google sheet, it is pretty - I think it is pretty easy to navigate. Next slide, please.
>> [Slide Changed]
>> Alixe Bonardi: As I mentioned, there is an Information Collection Form. This is intended to be sharing information so that we can include this in our tracking process. We have developed quite a robust tracking process to see how we collect information and how we do the quality assurance and report it out. Next slide.
>> [Slide Changed]
>> Alixe Bonardi: Coming soon, just recognizing a Google sheet may not be everything people need in terms of understanding changes to Medicaid. We are working on developing a next phase project with funding from the WITH Foundation which will give us another examples of how people are using the information and sharing their stories. Next slide, please.
>> [Slide Changed]
>> Alixe Bonardi: So, I want to take just a couple of slides worth of your time to share out early trends we are seeing. What we are seeing is we got 28 states already that are taking action specific to changes to HCBS. We are tracking since July 4th, 2025. What's important to notice that of all of the actions that we have tracked currently, actual things that are happening, 70% of those actions are cuts to HCBS. We had seen some actions that can be interpreted to effort to increase access to HCBS and then some that are changes that we can categorize either way. Next slide.
>> [Slide Changed]
>> Alixe Bonardi: That's very small. I apologize. What's important to notice in early trends we are categorizing the wave of the information -- we are categorizing the way, the kinds of changes that are happening and the first two categories of 22% are limits on hours or service visits. The next one is reduced provider rates and we have heard examples of that. The next one, the green bar is what we are tracking in terms of increases in HCBS, just generally increases. So, what's important to note is we are seeing a vast majority of net changes in HCBS. We are at this point tracking to see how they are played out. We are putting updates every two weeks and we are doing these early trend analysis and we are just getting rolling with them as we are collecting this. Our intend is continue to do this to see how it plays out overtime. Next slide.
>> [Slide Changed]
>> Alixe Bonardi: This is our final slide showing what we are starting to see. You will see at this point that majority is taking a budgetary action. Actions that we are able to track in terms of how states are making adjustments to their budgets as it plays out in terms of HCBS and agency actions that we have been able to track and we are starting to see some legislative actions coming through. Then, finally, to note that when you look at the actions, the status of actions that we see are 55% of those actions are inactive so things that have come up and have been put in place. We have seen some tracking in terms of being proposed and some are on pause and some because of advocacy and some reversed because of advocacy. This is part of the work we are keeping an eye on how it is being played overtime. I think it is my last slide. Thank you.
>> [Applause]
>> Hi, y'all, my name is Elizabeth.
>> Elizabeth: I am here to talk about the working Tax Family Access Act. I want to talk about the MassHealth program by the number. It is an important place to ground the work that we do. So, if you will flip to the next slide.
>> [Slide Changed]
>> Elizabeth: You will see that we are serving about 2 million members now. It is about half of kids across income and more than 60% of residents in nursing facilities and more of a third of individuals and with disabilities in Massachusetts. So, it is really important to think that Medicaid as a program serves a lot of different individuals with a lot of different needs and it plays a critical role and across the Commonwealth as well. If we'll flip to the next slide.
>> [Slide Changed]
>> Elizabeth: I won't go through all the requirements. We don't expect all 2 million members to be impacted. Many of those will have individual level exemptions when we are thinking of pregnancy having a complex conditions, that makes you medically frail or having a child under the age of 14 and the other exemptions we walked through. If you will flip to the next slide.
>> [Slide Changed]
>> Elizabeth: As we prepare for Massachusetts, we have three guidance in mind. The first and foremost is helping eligible members keep their health coverage. We know secondly, at this point, we see folks who lose coverage sometimes because they are no longer eligible. Oftentimes because they are not receiving their mail or take action when they need to at the right time. So, when we are thinking of how to design these policies and implement work requirements, we are trying to make decisions to support members through this and making sure folks who are eligible have the fewest hurdles to stay covered in MassHealth. The second pillar is around building on lessons learned from the post-COVID redetermination process. We were fortunate to do that here in Massachusetts. We have an incredible coalition of stakeholders and community groups across the states. We received funding for working in education requirements and changes related to the legislature to provide an expansion for healthcare for all. We find that the community-based organizations across the state and increase the number of assistance to help folks with applications and renewals and understanding their mails from MassHealth and build a network of folks who are hearing information directly from us about that these changes mean.
Who are receiving toolkits and example materials they could share and really building a broader group how the states are approaching this and who are trusting members in the community by our members. Who work with them day-to-day and who know them in a way that we as a state are not always able to.
We knew it is a critical piece to not do again but expand on and think of how it differs from redetermination. This is about making those who need it but not causing alarm of those who may be impacted. Third, we need to be compliant with these federal laws and rules. We are still digesting the 400 or so page IFR that came out on the 1st. There is a lot in there that really at times present as a challenge with our first two goals. We have a complicated policy, how do we make it as easy as possible to stay on and how do we explain a complicated policy in a way that resonates and easy to understand. I promise our team are hard at work balancing the IFR and on the legal side and already having conversations. If you will flip to the next slide.
>> [Slide Changed]
>> Elizabeth: It really builds the most important lesson learn from redetermination which is the more work we can do to prevent members from having to take action, the more people who will apply successfully and stay covered. So, for us it means as much as possible in using data to automatically exempt and verifying individuals. For us is a three-step process. Identify members who don't quit the require of something subjected to work in education requirements. In some cases it is straightforward, we know if you are 66 or 13 and other cases we have information and the application that identifies people who are pregnant, they can --
>> Elizabeth: We know the first step is critical. One is easy for possible members and two, helping the minimize administrative coverage losses as much as possible. The second step is we can't exempt you. Do you have income that's more than $580 a month? Are you enrolled in a school or we can pull data and do the check for you and make it so that you don't have to worry about submitting a transcript or letter of enrollment. Third, we know there will be people we are not able to exempt or automatically verify. Here is where the community partnership is more important. How do we help folks who need to act? How do we make sure that not only our staff at enrollment center are ready to help and having steady access to translation lines and other services. How is the broader coalition of folks who support them inform and able to help them directly or point them in the right place? So, we are working with health plans and providers and community groups making sure our sisters are well trained and a whole host of folks across the state so they know exactly to point them at Mass Health to help them complete the application and complete their renewal form or understand what documentation they may have to upload. If you will flip to the next slide or the next slide.
>> [Slide Changed]
>> Elizabeth: I want to talk about outreach. We know that past work requirement programs have resulted in a lot of coverage loss. A key component of this going as well in Massachusetts is helping folks to understand what these changes are and if they are impacted. We also know this is not a one-solution problem. We can't just mail a notice to everyone and think - check the box, we are done and everyone knows and understands the requirements. So, we are building on a past effort that we have done around the redetermination of day-to-day, we'll be doing texts and e-mails and calls and we have hosted a series of public webinars earlier this year which were more information and broad. This is what's coming ands the what we already know and this is what we don't know yet. We'll plan another series of these later this summer that are able to provide more information about medical frailty and documentation you may need and exactly what the process will look like. We'll continue those webinars as well. Once the policy goes into effect so people really need help, there are videos they can watch or live webinars they can join for Q and A. Whenever possible avoiding legally policies, we want these messages to make sense and resonates with our members. We have been fortunate to work with Healthcare For All to start off with communication work and really helping understand what does and does not make sense to the folks we serve. I spoke about our coalition of our community-based organizations and sister agencies and providers and more, we know that partnership is critical not just to helping folks but to amplify our message. Making sure as many people know what's happening in 2027 and where they can get help so when the blue envelope does land in their mailbox it is not the first time they are hearing about it.
Last and not least, once it is finalized in early July, we'll be blasting out to make sure folks know what's happening and what website they can go to to learn more creating a one-stop shop for folks for folks who may be impacted by these changes. If you will flip to the next slide and the next one.
>> [Slide Changed]
>> Elizabeth: A lot of folks with worried about this and even though nothing is changing now, we know it is not the case in the future. We try to focus on the top four things that members should note about these coming changes. First and foremost, nothing is changed yet. Keep going to doctor's appointments and keep getting care. If anything about your own circumstances change, let us know. If you are pregnant -- if you have a disability that you are working through or apply through the process, that's a great path to go down. Third, always read or reply a letter from MassHealth. The blue envelope is a renewal but other materials that contain important information as well. Last, we are here to help, you can call us or find us in the community. The last slide I will end us on before we shift to Q and A. We have done a lot of work building a base of how we are approaching this and starting to provide some of that high level awareness of what changes are coming. This summer will kick-off our member education outreach efforts. So, now that we have this guidance, once we have digested it and figured out what it means, we'll be sharing kit, webinars and showing up at a lot of our trusted stake holder meetings to help share information as well. Then, of course, and we have coverage changes that'll impact 2500 immigrants in Massachusetts. In winter of 2027, January 1st, we'll see the implementation of working education requirements and more renewal and coverage. The code online shows you our key website for folks that'll we'll keep updating and as we learn more and have more available. With that, I am turning it back to Nicole for Q and A. Thank you, y'all.
>> Nicole LeBlanc: Great presentation. One thing is good to touch up, how is this going to impact the economy? That's one thing we have not heard?
>> Elizabeth: In terms of folks who are gay workers?
>> Nicole LeBlanc: The economy has definitely risen.
>> Elizabeth: It is a great question. One thing up here in Massachusetts, this is not necessarily like a one-time system bill, right? Just because we can't get something before January 1st, does not mean there will not be enhancement. One of the things we are learning from CMS is what they are calling the Eligibility Made Easy where a worker instead of having to download pay stubs and reupload them, enter their credentials to create a pipe. That's one path where it is not quite data integration because that data is not really available for states in the department Of Revenue Data is. We are thinking of how do we make it easy for folks to do this once we digest the IFR, we'll have more to share.
>> Nicole LeBlanc: Awesome, great answer. Next question, I have to do determination every six month or so, I can't do it online. It is very annoying. And support from agency --
>> [Inaudible to hear the question]
>> Nicole LeBlanc: More people are seeing their coverage lapsed. Maryland passed a law -- trying to stop people from losing Medicaid coverage because of administrative errors. Will this law work and helping people in the state not to lose coverage?
>> Elizabeth: It is a great coverage and it speaks to a lot processes. We know in Massachusetts first and foremost, the most important thing we can do is use data that we already have or access to other data sets. For instance, being able to confirm that somebody has a federal or state determine disability and exempting them automatically from worker requirements. Outside of the context, automatic renewals are always a huge priority for states. I think that's a great place where if we can find data that confirms your income or does not raise any questions, you should not have to do anything whether 12 or 6 months. We are always looking for ways to maximize our general autorenewal rates because we know that's what moves the lever in preventing administratively.
>> Nicole LeBlanc: Great answer. How can we track changes to Medicaid and HCBS together? Why is it important to collect this data?
>> Alixe Bonardi: Yes, great question. We acknowledge changes are happening, right? As these are happening in multiple different states using many of the different authorities that they could use, we don't really know how this is going to play out for people. So, there is a couple of things. One: We have to be collecting these changes because as I mentioned that for advocacy is important and see the changes, predict what it is going to be. We are actually trying to build this as a way so when we do see changes, we are working with partners and collaborators that have access to Medicaid data so they're going to actually - we'll be able to see in terms of claims and Medicaid claims. Did people go to the hospital more often, right? What kinds of experiences are people having? We got other ways and we are thinking of getting information that we collect so we can see how to reduce access to Medicaid and what it means in people's lives.
>> Nicole LeBlanc: Great answer.
>> Gelila Selassie: One thing that's being said a lot when the HR1 was being up for debate on the house floor was this idea of preserving Medicaid for those really need it. This idea is that Medicaid in particular and Medicaid expansion is a complete separate population from everybody else. We know that's not the case. Plenty of people with disabilities and caregivers and workers, whoever else are on expansion and who are essential integrated with the disability community. On top of that, this sort of budgetary pool that states are going to be experiencing which is going to lead to HCBS cuts. It is important to highlight and draw as close of a connection to these actions and these cuts to the disability community that many lawmakers suggested they're trying to protect. Because we are trying to do everything we can from the state level and that's amazing. The state legislatures is our advocate and amazing. Congress created this and we would love for them to take it away. The more we can make those connections, the better.
>> Nicole LeBlanc: Can you share more information about MassHealth right now?
>> Elizabeth: Yes, we are working to get more income data. Also the $580 threshold which in a state like Massachusetts is looking like 39-40 hours of work versus 80 hours if you think of our state minimum wage. We are working with the federal government to get access to higher education enrollment data and as well as data sources we already have like Department Of Revenue and our claims data. We need to understand what the IFR means with the new condition around medical frailty about how we can best use claims to accept people. We know this is a critical component of keeping folks covered and also a lever we as the state are uniquely able to all. I can certainly say it is our top priority and it is not something that's finished on December 31st, right? This is a short runway to start a program like working in education requirements so we know we are doing everything we can before January 1st. It will be to process beyond that as well.
>> Nicole, I think we have time if you want to open up to audience question?
>> Nicole LeBlanc: Anyone in the audience have questions? Ask away.
>> I have a comment than a question. It is a worry that I have. I am from MassAbility. We are seeing the clip of it for people who are not able to go beyond their ability to work because they are suffering from insurance and healthcare or so fear of the SSI and on and on. We saw our data and the average individual is now working 27 hours. I fear in five years from now, after this falls down, falls out that more and more people are going to be even more fearful of going back to work. So, I would really ask that we think about that information. As of now we look at the impact because it is going to be essential for people to really think about working in different ways and they're not going to take the risks. Again, it impacts the comments you are making of economic of people who want to work who can go to work or tax paying dollars who'll not go to work or increase their hours because of all the fear that's happening.
>> Nicole LeBlanc: Why don't we get on the outside and ends of this nightmare, pushing universal healthcare and basic income and getting rid of assets and earning caps. We got it. Nothing lasts forever. All regimes fall.
>> Nicole, I think we have another question in the audience and we have someone on virtual chat that I can share as well.
>> Hi, the research and the impact between rural locations and urban rural location, we live -- the number of services provided are far less --
>> Thank you so much for that question. We'll do a quick pause to make sure everyone has access to hearing your question and answer.
>> The interpreters are not able to hear.
>> We'll pause to make sure everyone has access and we'll get back. We should be able to get up in a minute.
>> [Pause]
>> Katelyn, do you want me to call Luke?
>> Yes, that would be wonderful.
>> Can you hear us now? This is a question for the interpreters.
>> Interpreter: It is not that we can't hear you but several people are keeping fast. When we are using the CART captions, it throws us off because our lag time for us processing the information is significantly different. When we do have the captions that were on recently. Here they are. Excellent, we are back in the game. Thank you.
>> Is the captioner able to type?
>> Captioner: Yes, this is the captioner, I am fine.
>> Thank you everyone for helping us troubleshooting that. We can return to the questions.
>> Alixe Bonardi: We are still troubleshooting our microphones a little bit. We are doing our best. Thank you for the little pause and in response the recent question about have we have done research to understand the experiences and how they really relate to rural versus non-rural impacts, and I will say the project we are talking about -- I am not sure we have break down by rural because a lot of it is statewide impact, the policies we are looking at. With that said, for outcome research, for different project associated with the project that Dorothy was talking about. Particularly, this is with HCBS and population with disabilities accessing state services. When we go out and states and talking to people who are receiving services about their experiences, we collect demographic information about their experience and demographic whether they are included in rural or non-rural settings and the different categories of non-rural settings. We have some information and all that to say, you raise an excellent point. We anticipate impacts are going to be different by where people live, by virtue of access to Medicaid providers for sure.
>> Elizabeth: I can just say we are certainly thinking about outreach in communications, recognizing that we need to think about how do we connect with folks across the state and not just in some city hubs. We think of the enrollment sisters and the sub grants we are giving and making sure we have options available that are virtual. For our enrollment center, we would love to have one in every city or every town across the state. You do have the availability to set up for telethon appointment as well.
>> Do we have any questions from the room? Destiny?
>> Yes, just one question.
>> Sorry, we are running the mic. Thank you.
>> Yes. Just one quick question. There was an issue with this mic as well. [Laughter]
>> I am wondering how telehealth is going to be discontinued on MassHealth. I have been hearing things back and forth with rolling out beginning in January and obviously concerned about that. If that's true or it is just another fear-mongering --
>> Elizabeth: I am not aware of any plan changes of telehealth.
>> [Pause]
>> We had some -- we have some questions in the chat. We'll respond to in the chat right now. Are there any questions from the audience? Well, one question in the chat we have is how they can keep hope? Anyone in the panel has advices on that? If you can speak slowly so the captioner can keep up.
>> Alixe Bonardi: Why did I reach for this microphone? There are things that we are actively to keep hope and one of the things that I do -- one of the things I think is most important is to continue to find opportunities when we are convening with people who are continuing to make changes. So, this is an opportunity we are all hearing when we are listening for those. I personally also looking for places where people who are being creative and using their voices so to -- to Betsy's point -- hello? To Betsy's point, the opportunity that people are coming forward and new people are moving into the space and using their art and voice and stepping up.
>> Nicole LeBlanc: Continue to resist, you know, and all things will come to an end, you know? Resist and fight for justice. Pray that our allies will help us and end this nightmare so we can reach this thing and our natural nightmare is over.
>> Gelila Selassie: I will add that when things are really bad, that's oftentimes when we get in the spotlight. So there has been and the last week my mother-in-law was on a Caribbean cruise when I came out and asked me about it. It was in the media so much and on her vacation which she didn't appreciate. It just goes to show that we have a lot in the spotlight because this is all going to be so bad and that will help us really highlight these immediate issues and also eventually when the tide turns, it will help us advance even further where we are not just stopping cuts or advancing good policies. There are so much spotlights of the people of disabilities have to have.
>> Let's make this the last question. I know we cut you off last time.
>> It is not a question. I am speaking wearing my nurse hat right now. I just want to say to the person looking for help, one of the things we can all do is vote for candidates that support the kind of issues that we believe that are good policies. It is my evidence-based voting.
>> Thank you. That was a quick one. We may have more questions?
>> It is a follow-up. As a legislature, I understand power of the people and how people are elected and what they can do. So, let's say that we have a complete - and all of a sudden we have a congress that's more content, the house and the senate are democrats, how quickly can they make budgetary changes -- I don't know how budget system works? Is it annual thing? Can they repeal some of these budgetary whatever that are passed by the Trump Administration? The Trump Administration won't sign them. What can actually happen? What can people hope for if we have a democrat-controlled house in the senate?
>> [Laughter]
>> Accountability.
>> Gelila Selassie: That's a billion dollar question. There are members of congress and state legislatures that are more Medicaid-friendly that wants to advance these great policies. I will add that no person and guarantee is 100% right for everything. Regardless of who's controlling what, there always has to be pressure. We saw earlier there were states, you know, governors and officials who were wonderful in the past of Medicaid but making hard decisions for the disability community. I think that's the biggest thing is advocacy. One thing we are doing while appreciating things like that, we are living out ways and using data from now to advance policy further. There is a few issues we have our eyes on long-term and on both sides of Social Security and we are seeing it coming up in a few years. To really make sure that. We are developing policies and a few states have on disability care plans on a statewide level. These policies are great to have in place so we can be prospective as much as possible as we are responding to the need.
>> Nicole LeBlanc: Thank you, all you have been an awesome panel. This concludes our session.
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