Home- and community-based services would be “especially vulnerable to deep cuts” if the American Health Care Act passed by the House of Representatives were to become law, according to a new report from the nonpartisan Center on Budget and Policy Priorities.
That’s because the bill would cap federal Medicaid funding at a fixed amount per beneficiary and decrease funding to states by increasing amounts over time, the authors said.
“Faced with deep and growing cuts from a per capita cap, states would likely cut back HCBS to reduce Medicaid costs in the short run, even though doing so could ultimately lead more seniors and people with disabilities to be forced into nursing homes, worsening their quality of life and raising long-term state costs,” wrote Judith Solomon and Jessica Schubel, who are vice president for health policy and senior policy analyst, respectively, at the center.
|Medicaid funding changes concern LeadingAge, AMDA, PHI, others
The Senate should reject the American Health Care Act passed by the House of Representatives and should “engage in a transparent, bipartisan dialogue on needed reforms to enhance healthcare access and affordability for older adults, people with disabilities and their families,” LeadingAge, AMDA – The Society for Post-Acute and Long-Term Care Medicine, the Paraprofessional Healthcare Institute and 74 other organizations told Senate leaders in a letter Monday.
Potential changes to Medicaid funding are among the groups’ concerns, they told Senate Majority Leader Mitch McConnell (R-KY) and Minority Leader Chuck Schumer (D-NY). The letter-signers raised many of the points also made by the Center on Budget and Policy Priorities in a new report (see accompanying article).
“Federal cuts to Medicaid brought about by per-capita caps — which have nothing to do with the [Affordable Care Act] — would drive states to make hard choices, likely leading states to scale back benefits, impose waiting lists, implement unaffordable financial obligations, or otherwise restrict access to services,” they wrote. “We are concerned, for example, that home- and community-based services would be targeted for cuts because they are optional, while nursing home coverage is mandatory.”
Some states might even decide to end their HCBS programs altogether, they said.
Many assisted living communities have provided HCBS to their residents through Medicaid waivers. Most HCBS are optional Medicaid benefits, however, and states can cut them when they face financial shortfalls; nursing home care, by contrast, is a mandatory benefit for those on Medicaid, the authors point out.
Almost 3 million seniors and people with disabilities received HCBS in 2013, Solomon and Schubel said, and states now spend more for HCBS than they do for nursing home care. In 2014, 53% of state expenditures for long-term services and supports went to HCBS, compared with 18% in 1995, and the number of people served by HCBS has increased “dramatically,” too, according to the report.
Cuts to Medicaid also could exacerbate workforce issues already plaguing the senior living industry, Solomon and Schubel said, because they would make it more difficult for providers to increase the pay and benefits needed to attract and retain a sufficient direct care workforce.
“Medicaid pays for a large share of the care delivered by direct care workers, so there is a direct link between state capacity to increase provider reimbursement and the direct care workforce’s salaries and working conditions,” they wrote.
The fate of the AHCA bill that passed the House is uncertain. Senate leaders have indicated that they will craft their own bill, which may be markedly different than the one approved by congresspeople. The House has not forwarded its bill to the Senate in case assumptions made about its fiscal impact don’t jibe with the findings of the Congressional Budget Office, which are expected to be released Wednesday.