AAHD Public Policy Agenda

AAHD 2023 Public Policy Priorities:

1. Continue to assertively advocate: Collect, Analyze, and Regularly Publicly Report –demographic factors including disability status, race, ethnicity, sex, age, primary language, sexual orientation, gender identity, and socio-economic status, in all settings and by setting.Ideally, the data system analysis should be able to cross-walk between these various precise demographic factors; for example, disability status and race. All Medicare, Medicaid, and HHS health programs should use these comprehensive and consistent demographic categories in the collection, analysis, and publicly transparent reporting of such data. Quality and performance data should be stratified by such categories.

2. Reduce health disparities and promote health equity and wellness in people with disabilities, including women’s health, access to healthcare providers and health care facilities, and training of health care providers, including maintenance of existing protections through the Americans with Disabilities Act. Support federal government efforts to identify and reduce Social Determinants of Health (SDOH) and Social Drivers of Health and better align federal and state health programs to reduce disparities and increase equity.

3. Support inclusive healthy communities and full accessibility, including maintenance of existing protections through the Americans with Disabilities Act, the Rehabilitation Act of 1973 as amended, and Affordable Care Act Section 1557 prohibitions against discrimination.

4. Expand the patient/consumer centered health (medical) home and promote the bi-directional integration of behavioral health, general health, and primary care.

5. Promote Self-Management and Self-Direction in Health Promotion and Wellness. Support expanding and strengthening Community Health Workers, Direct Support Professionals, and Behavioral Health Peer Specialists and Supports. 

6. Expand Medicaid Home and Community Based Services (HCBS) and Address the Medicaid Institutional Bias including expanding & strengthening HCBS Infrastructure. Work toward the ideal of a mandatory HCBS Medicaid benefit.

7. Provide for more comprehensive health insurance coverage through the Affordable Care Act marketplaces, Medicare, and Medicaid. Promote more effective and person-centered services and supports for persons dually eligible for Medicare and Medicaid.

8. Promote Quality and Performance Measurement, including appropriate self-directed, home and community-based services targeted to persons with disabilities.

9. Support efforts to reduce program silo barriers and increase the integrated program responses for persons with co-occurring disability and chronic illness, co-occurring disability and behavioral health challenges, and co-occurring mental illness and substance use disorder.

Medicaid and Disability – AAHD Presentation To the CMS Administrator

On April 7, AAHD joined a by invitation CMS Administrator listening session. Available here is AAHD’s issue brief on five issues discussed by AAHD at the CMS Administrator Listening Session: (1) Medicaid Home-and-Community-Based Services (HCBS); (2)  Medicaid Home-and-Community-Based Services (HCBS) – Core Quality Measure Set (3) More Effective Coordination (Ultimately Integration) For Persons Dually Eligible for Medicare and Medicaid; (4) System Silos and Barriers To Serving Persons with Co-Occurring Conditions; and (5) Integrating Behavioral Health-General Health-Primary Care. The issue brief also identifies our work with the Lakeshore Foundation.

AAHD to/on the HHS Draft Strategic Plan:

AAHD and Lakeshore Foundation November 2021 submitted comments on the HHS draft strategic plan are here: (PDF)

The American Association on Health and Disability and the Lakeshore Foundation provide comments on the HHS draft strategic plan. Our comments are consistent with those submitted by the Consortium for Citizens with Disabilities (CCD), and we support the CCD statement. We go beyond the CCD statement detailing quality measurement approaches; focusing on the need for effective integration for persons dually eligible for Medicare and Medicaid; endorsing “bi-directional” behavioral health-general health-primary care integration; focusing on the particular and complex challenges faced by a variety of persons with co-occurring disabilities and chronic conditions; and grappling with the search for consistency in disability and related demographic data collection, analysis, and public reporting/transparency.

Barriers to Effective Treatments for Mental Illness and Substance Use Disorder:

AAHD and Lakeshore Foundation November 2021 submitted comments to the Senate Committee on Finance RFI on Mental Illness and SUD treatment are here: PDF.

AAHD, as a member, has endorsed the submitted comments of the Mental Health Liaison Group (MHLG). The Committee’s RFI has generated discussion in disability coalitions.

Our letter here addresses several issues not addressed by the MHLG – focusing on the need for effective integration for persons dually eligible for Medicare and Medicaid; endorsing “bi-directional” behavioral health-general health-primary care integration; focusing on the particular and complex challenges faced by a variety of persons with co-occurring disabilities and chronic conditions; quality measurement approaches; and, “peer support” and “community health workers” as reinforcing community supports. Our colleague organization – No Health without Mental Health (NHMH) – recently submitted comments to the Committee documenting best practices and need for revised payment policies to promote “bi-directional” behavioral health-general health-primary care integration. We signed the NHMH letter.