Monday, September 18, 2017

WA set to lose billions in latest effort to cut Medicaid

  • Please also see Hearing and national call-in day Sept.25 for Medicaid

  • Disability rights advocates are putting out a red alert on the latest federal bill to repeal the Affordable Care Act. This bill is called the "Graham-Cassidy" bill, after its two Senate sponsors Sen. Lindsey Graham, R-S.C., and Sen. Bill Cassidy, R-La.

    Note: Funding amounts updated Sept. 25 with new analysis from the Kaiser Family Foundation 


    For Washington, it is a matter of numbers and lives.

    As of 2016, Washington had 1,825,000 people enrolled in Medicaid; 586,500 people enrolled as part of the state's expansion, according to the Kaiser Family Foundation.

    The costs associated with changes to marketplace spending, block granting Medicaid expansion funds and then ending them, and capping funding for traditional Medicaid could hit $17.1 billion for Washington. According to the Kaiser Family Foundation's state-by-state estimates on spending changes:

    2020-2026 - Changes to Federal Spending for Affordable Care Act Coverage under Graham-Cassidy
    • WA: -$5.5 billion; or down 16%
    2020-2026 - Changes in Federal Spending under Graham-Cassidy due to ACA Block Grant and Medicaid Per Capita Cap
    • WA: Total -$6.5 billion
    • Broken down: -$5.3 billion (block grant/expansion funding); -$1.2 billion (caps on traditional Medicaid)
    2027 - Changes in Federal Spending under Graham-Cassidy due to ACA Block Grant and Medicaid Per Capita Cap
    • WA: Total -$6.3 billion
    • Broken down:-$5.9 billion (end of block grant for expansion funding); -$347 million (reduction to traditional Medicaid funding)

    The so-called traditional (or non-expansion) Medicaid funds pay for therapies and other supports for people with developmental disabilities, as well as health care for the traditional Medicaid population, which includes people with disabilities as well as impoverished seniors, children and mothers.

    The Graham-Cassidy bill eliminates Medicaid as we know it and ends the entitlement by placing a per-capita cap on the traditional Medicaid population. It also block-grants for the expansion population until 2026. After 2026 there will be no funding at all for the expansion population.
    The block grants will also redistribute existing allocations. Starting in 2021, money will be pulled from states that expanded Medicaid and pledged matching funds (such as Washington) and reallocated using a new formula to states that didn't.

    Washington is one of 20 states that would experience severe cuts of 35 to 60 percent below projected funding.

    Remember: Medicaid funds pay for Apple Health, and pay for services provided through the state Developmental Disability Administration. This includes everything from respite, to assisted technology and other services and therapies that help a person learn, keep, or improve skills and functional abilities that are not developing normally. It even pays for supported employment and supported living.

    So to recap: The state would lose all of the funding from Medicaid expansion by 2026 (which benefited many family caregivers). It would lose that funding at an accelerated rate, starting in 2021 when the government would reallocate some of it to other states. It would also lose billions in funds for the traditional/non-expansion Medicaid population made up of people with disabilities, and impoverished children, mothers and seniors.

    Other takeaways that advocates are flagging:

    The Graham-Cassidy bill places the Essential Health Benefits at risk and allows states to remove covered services like habilitative care, opioid treatment, and mental health treatment. Habilitative care is the term for services that help a person learn, keep, or improve skills and functional abilities that are not developing normally. Prior to the Affordable Care Act, many insurers would cover rehabilitative services -- say to restore loss of function after an accident -- but not habilitative services for children born with a developmental disability.

    The Graham-Cassidy bill also allows insurance companies to discriminate against people with pre-existing conditions. This means these individuals could pay higher premiums, and potentially be priced out of the market.


    A preliminary assessment of the Graham-Cassidy bill from the Congressional Budget Office (CBO) is expected early next week. However, this preliminary assessment will not include consumer information, such as how the changes would affect health care coverage or insurance premiums. Those could take several more weeks - well past the deadline of September 30 for a simple majority passage of an Affordable Care Act repeal.


    Contact your Congressional representatives and share your story. (Hotline: 202.224.3121) Then post it on Facebook or Twitter. Let people know how loss of services would affect you.


    - Ramona Hattendorf, Director of Advocacy