Advocates for children, the elderly, and those with disabilities are gearing up to urge state governors and Congress not to advance proposals they believe will slash Medicaid dollars.
Leaders of five advocacy groups professed deep concern over potentially shrinking Medicaid funding during a press call on Wednesday, ahead of the National Governors Association's Winter Meeting that begins Friday.
Bruce Lesley, president of First Focus, a "nonpartisan advocacy organization dedicated to making children and families the priority in federal policy and budget decisions," noted that "child advocates have urged Congress to do no harm. Unfortunately, Medicaid block grants and per capita caps would do harm."
Lesley said such changes would force states to cut people off coverage or withhold benefits, create waiting lists, freeze enrollment, cut provider payments, or raise taxes "or some combination of all of the above."
One problem with block grants is that the lump sum states receive would not adapt to a state's changing needs -- funding wouldn't increase if the population surges, a natural disaster hits or a recession strikes. The dollars also wouldn't adjust for medical inflation, Lesley noted.
Proposals have been floated that would replace the current system with block grants -- under which the federal government would give each state a lump sum each year, with the states free to determine how to spend it within broad parameters -- and/or per capita caps. The latter would depend upon an assessment of spending for a particular category of enrollee. States would then get a set amount of dollars for every enrollee in that category at that amount.
The cuts to eligibility likely to result from an overhaul of Medicaid financing -- through either mechanism -- would force governors into choosing whether to cut services to children, the elderly, or people with disabilities, asserted Donna Meltzer, CEO of the National Association of Councils on Developmental Disabilities.
"There just won't be enough funding to go around," she said.
Meltzer described a handful of children with autism and Down syndrome, who are now "happy, active, tax-paying adults" thanks to mental and behavioral health services provided by Medicaid and its waivers.
Howard Bedlin, JD, vice president of Public Policy and Advocacy for the National Council on Aging, said that the cuts to Medicaid would not create "winners and losers," but "losers and big losers."
He noted that the variation in spending on senior and disabled citizens, and the growth rates for these groups, vastly differed across states. For example, Nevada spends $4,500 per person on its older and disabled population while New York spends $23,000.
"By locking in current inequities per capita, caps would penalize efficient states that have low spending per person and create major problems for states with higher than average growth rates," he added.
Switching to a per capita cap or block grant financing also raises questions over whether these structures could respond to variations within a certain population, such as seniors in their 80s and 90s who need nursing home care, which can cost upwards of $90,000 a year.
None of the proposals to overhaul Medicaid adjust for increasing age-related needs, Bedlin added.
Bedlin warned that threats to cut Medicaid are real, pointing to a proposed $913 billion cuts over the next decade in a House Budget proposal. Proposed healthcare reforms, including alternative plans to the Affordable Care Act, delineate plans to shift to a system of block grants or a per capita cap.
The "Patient Choice, Affordability, Responsibility and Empowerment Act (CARE) sponsored by Rep. Fred Upton (R-Mich.), Sen. Richard Burr (R-N.C.), and Sen. Orrin Hatch (R-Utah) also includes plans for a modified block grant.
During confirmation hearings, Tom Price, the new Secretary of Health and Human Services, would not explicitly say whether he would continue to support block granting Medicaid.
On the other hand, Sen. Bill Cassidy (R-La.) noted in a recent interview with MedPage Today that President Trump has said he does not want to cut Medicaid, and that Price is charged with fulfilling that agenda.