Medicaid block grants and per-capita caps would return under President Trump’s proposed budget for fiscal year 2020, released Monday.

As with last year’s budget request, this year’s proposal would have states choose one or the other to fund Medicaid under a plan “modeled closely” after legislation introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) in 2017 in an effort to repeal the Affordable Care Act.

Transforming Medicaid into a block grant or system of per-capita capped grants to the states “has never been a good idea, since it would reduce federal Medicaid funding by several billion dollars,” LeadingAge President and CEO Katie Smith Sloan told McKnight’s Senior Living.

Indeed, under the proposed budget, federal Medicaid spending would be reduced by almost $1.5 trillion, with future growth tied to the rate of inflation, over the next 10 years. The block grant / per-capita cap change would begin in 2021.

“States already struggle to adequately finance long-term services and supports through their Medicaid programs,” Sloan said. “Medicaid is the largest public source of funding for long-term services and supports. We strongly oppose this budget proposal and urge Congress to reject it.”

The budget would provide $1.2 trillion in mandatory and discretionary outlays for the Centers for Medicare & Medicaid Services, which the White House said is a net increase of $60.5 billion above FY 2019. Thirty-six percent of that amount would fund Medicaid. The budget also calls for “targeted savings” of $954.1 billion in CMS mandatory programs over the next decade.

Beth Martino, senior vice president of public affairs for the American Health Care Association and National Center for Assisted Living, told McKnight’s Senior Living that AHCA / NCAL was still reviewing the proposed budget, “but we’re concerned about any changes to Medicaid that would threaten funding and access to long-term care.”

Affordable housing

The budget’s proposal for affordable housing also is “deeply disappointing,” Sloan said.

The Department of Housing and Urban Development’s Supportive Housing for the Elderly (Section 202) program would be funded at $644 million, an increase of $43 million over the president’s 2019 budget request but $34 million less than the 2019 annualized continuing resolution level, according to HUD. Rent increases for older adults would be phased in over six years.

“The request is deeply disappointing to LeadingAge, whose members provide quality affordable housing to older adults with average incomes of $13,500 a year,” Sloan said. “Not only must we fully preserve existing affordable homes; we must expand the supply of affordable housing as well. Phasing in a rent increase is still a rent increase. The older adults LeadingAge members serve cannot afford rent increases today, and won’t be able to afford them over the next six years.”

Nondefense discretionary caps must be raised, she said.

“HUD’s programs must better reflect the nation’s severe affordable housing shortage, which today forces elders to choose between rent, food and healthcare,” Sloan added.