Block Grants for Medicaid – Not a Solution for People with Developmental Disabilities
A paramount shift in Medicaid policy is occurring without the option of public discussion and debate so central to our governmental structure. On January 29, 2020 CMS Administrator Seema Verma sent a letter to State Medicaid Directors detailing the “Healthy Adult Opportunity” (HAO) policy. The administration is doing this under Section 1115, which allows for Medicaid pilots. The HAO would essentially allow States the flexibility to cap eligibility, costs, and services for individuals who became eligible under Medicaid Expansion. It is an exceptionally dangerous precedent to allow capping, or block granting, any section of Medicaid. We are especially concerned about this as there was no opportunity for anyone other the administration to vet the initiative.
For many years State block grants for Medicaid have been “on the table”. Through a rulemaking process which included public comments, the initiatives were stopped. Block grant proposals are consistently met with resistance because data has already shown that Medicaid is cost efficient. That said, Medicaid is also very expensive. The pool of people who are eligible has grown for many reasons, including rampant inflation in healthcare itself, low wage jobs that don’t provide health coverage increasing the demand for coverage for nondisabled nonelderly, an aging population with more elderly in need of long term care, and Medicaid’s role as the last stop for reimbursing hospitals of low-income people ensuring that everyone has access to at least a minimal amount of healthcare in the U.S.A.. Every one of these “causes” for the high price tag of Medicaid needs to be addressed, but not by cutting out a hole out of the safety net.
In every state and territory Medicaid funds services that are simply unavailable to anyone who is not very wealthy, no matter what kind of insurance they have. For these families Medicaid is a lifeline because it is not just a health program, but a system of services that allow people to live in and contribute in their communities in ways that would be impossible if they lived in nursing homes and other institutions. Unlike more traditional healthcare, an individual’s need for home and community based services does not necessarily decrease…a person with cerebral palsy who needs help eating is going to continue to need help no matter how high quality or efficient that help is.
As soon as the HAO experiment was launched the Maine Developmental Disabilities Council’s phones began to ring with concerns from families at the precedent of capping any kind of Medicaid option. Posts sprung up on social media about how the HAO is worrisome. While MDDC assures the frightened callers that this present initiative would not affect children, elderly, pregnant women, or people eligible under disability categories. It will allow caps and limited coverage, if the State determines appropriate, for these individuals. They invariably express concern that once policies like this are legally enacted it becomes significantly easier to broaden the umbrella of capping services and costs.
Without public vetting (i.e., rulemaking) there is nowhere to express these concerns. Without public comments and a balanced discussion that allows Congress weighing the pros and cons of capping any section of Medicaid, our healthcare safety net faces serious threats. Essentially, we are very concerned that this might strip the many laws that govern Medicaid from oversight authority.