Tuesday, March 7, 2017

DD Cuts 101: Medicaid, community supports on the line

What you need to know, and what you need to help your elected leaders understand

  • "Devastating impact" on people with I/DD and their families. Take action

1. YES, repeal of the Affordable Care Act affects you

The plan to repeal and re-do the Affordable Care Act - also known as Obamacare - would ALSO drastically transform Medicaid and cut cost-effective supports that help people with developmental disabilities live in the community.

  • Medicaid pays for federal and state services for people with developmental disabilities, including home- and community-based services. This means employment support, respite, positive behavior support, residential services and other services and therapies covered through the state’s Developmental Disability Administration are paid for by Medicaid.
  • Washington’s DSHS/DDA programs for people with developmental disabilities are actually federal-state partnerships. States design and submit programs for approval; then state dollars are matched by federal Medicaid dollars. These programs include the new Individual and Family Services Waiver; the Basic Plus Waiver; the Core Waiver; the Children’s Intensive In-Home Behavioral Support program; and the Community Protection Waiver.
  • Early Support and Interventions for Toddlers (ESIT) is paid for with Medicaid.
  • Washington State’s Apple Health is just our state’s name for Medicaid health care coverage. If you are enrolled in Apple Health, you are getting Medicaid.
  • Medicaid covers BOTH health care and the community-based services that help people with developmental disabilities live in the community. 
Cuts, caps and limits on Medicaid mean cuts, caps and limits on supports for people with developmental disabilities.

2. The new health-care bill is paid for by shrinking Medicaid

The bill up for vote removes the taxes and fees that offset the costs of helping low-income people pay for coverage. Instead, the replacement bill cuts back on support; and what assistance it does offer, it pays for by cutting Medicaid.
  • The replacement bill eliminates Medicaid expansion as of 2020. Millions of family caregivers, who cannot work because they care for a person with a significant disability, gained coverage through the Medicaid expansion.
  • The replacement bill swaps guaranteed coverage for per capita caps; that is, states receive a set amount per person enrolled. The amounts are based on the state’s 2016 spending.
  • Right now, Medicaid has a funding guarantee. This means the state can get funding for as many people as qualify and enroll. The amount of federal funding depends on the state contribution, and can vary from 50 to 75 percent of the state match. Since inception, federal funding changed to reflect new needs in the states. If more people needed services, or if new medical treatments became available, funding reflected new needs.
  • With the proposed per capita cap, states would get a set amount, per enrollee. Once the cap is met, there are no additional federal funds for that enrollee’s medical expenses. The problem is that the set amount doesn’t adjust to reflect actual cost or respond to factors that drive health care spending. 
  • Medicaid is already a lean program. It is less expensive per beneficiary and growing slower than private employer coverage; administration costs ran under 5 percent of total outlays in 2015, less than the rate typically seen in the private sector. Without fat to trim, reduction in funding means cuts to services.

According to analysis by the Kaiser Family Foundation, recent proposals to transform Medicaid would result in cuts by 25 to 40 percent over 10 years. Medicaid provides coverage for 1 in 5 Americans – or about 74 million people. Ten million are people with disabilities.

3. The timeline for replacing the Affordable Care Act leaves no time for a formal cost analysis

  • The bill was dropped March 6. Review by policy committees in the House is expected March 8. Fiscal and rule committees are expected to review and act by March 18. A vote in the U.S. House is expected by March 23, the anniversary of passage of the Affordable Care Act. Senate is expected to vote on the bill before the mid-April recess.
  • This aggressive timetable means a dramatic overhaul of Medicaid could happen without analysis and scoring by the nonpartisan Congressional Budget Office. People will not have an opportunity to learn about and weigh in on cost implications.

The upshot for Medicaid:

Much like the proposed block grants, the intent of per capita caps is to restructure the program and save the federal government money.

Inevitably there will be cuts in funding in the states. The negative impacts to Medicaid recipients could include:

  • Losing home and community-based services and supports. Waiting lists would quickly grow.
  • Losing other critical services such as personal care, mental health, prescription drugs, and rehabilitative services. If funds become scarcer, states may decide to stop providing these services altogether.
  • Being forced into unnecessary institutionalization. States could return to the days of “warehousing” people with disabilities in institutions.
  • Shifting the costs to individuals or family members to make up for the federal cuts. The costs of providing health care and long term services and supports will not go away, but will be shifted to individuals, parents, states, and providers.

The upshot for affordable coverage:

The Affordable Care Act is the most significant law for people with disabilities since the Americans with Disabilities Act. It ended practices like lifetime caps on benefits,and refusing coverage because of pre-existing conditions.

Because of the ACA, more people with disabilities and chronic health conditions are able to access health care due to the Medicaid expansion, including access to habilitative services often denied by private insurers.

In the absence of a formal analysis, experts in the field are weighing in:
  • For all but the youngest individuals, the new bill increases both overall costs and the risk of a financially devastating event.
  • Deductibles, co-pays, and other forms of cost-sharing are expected to increase under the new plan. The impact would be particularly severe for older individuals, ages 55 to 64. According to analysis published by Vox, their costs would increase by $5,269 if the bill went into effect today and by $6,971 in 2020.