Repeal of the Affordable Care Act, reform of the Medicaid program to fund it through per capita caps or block grants, and cuts to affordable housing programs all are proposed as part of the fiscal year 2019 budget request released Monday by the White House Office of Management and Budget.
The document reflects President Trump’s priorities, although it remains to be seen whether Congress will agree and act on them.
The budget request’s Medicaid reform proposal is “modeled closely” after legislation introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) in September in an effort to repeal the ACA, according to the OMB. “It will give states the choice between a per capita cap and a block grant with the goal of empowering states to design individual, state-based solutions that prioritize Medicaid dollars for the most vulnerable and support innovations such as community engagement initiatives for able-bodied adults,” the document states.
Such changes to Medicaid funding also were proposed as part of several other unsuccessful attempts to repeal the ACA in 2017, and LeadingAge CEO Katie Smith Sloan said her organization continues to oppose them.
The American Health Care Association/National Center for Assisted Living also had opposed the Graham-Cassidy bill’s proposed per capita caps and block grants for Medicaid, saying last fall that they could undermine care for the “tens of thousands” of assisted living residents who rely on Medicaid to pay for long-term services and supports.
“States may be forced to scale back these Medicaid waiver programs that offer the older adults and people with disabilities long-term care in the setting best suited for their needs,” AHCA/NCAL President and CEO Mark Parkinson said at the time. Many assisted living communities provide home- and community-based services through Medicaid waivers.
Monday, LeadingAge also said it opposes the budget’s cuts to Department of Housing and Urban Development programs.
“LeadingAge is deeply concerned about the future of affordable senior housing, as the request seeks to cut HUD by more than 18% compared to FY 17-enacted funding,” Sloan said. “It would reduce funding for HUD’s senior-specific housing program and deeply cut the voucher program as well as phase out the nation’s public housing program.”
The public housing portfolio would be decreased, according to the budget document, because “the federal government recognizes the need for greater contributions from state and local governments and the private sector to help address affordable housing needs for low-income families.”
HUD rental assistance programs — Housing Choice Vouchers, Public Housing, Project-Based Rental Assistance and Housing for the Elderly and Persons with Disabilities — account for 80% of HUD’s total budget, and program costs increases average 3% every year, according to the OMB, which described the increases as “not sustainable.”
The budget calls for $563 million for the Section 202 Housing for the Elderly program, a $61 million increase from last year’s funding level but $10 million below the dollar amount included in House and Senate spending bills, according to the National Low Income Housing Coalition. The president also proposes giving the HUD secretary the authority to not provide rent adjustments for Section 202 properties, which could make it more financially difficult to operate such properties, the NLIHC said. The budget also would allow Section 202 Project Rental Assistance Contract properties to convert under the Rental Assistance Demonstration, the group said.
“The breadth and depth of cruelty reflected in this budget proposal is breathtaking,” Diane Yentel, NLIHC president and CEO, said in a statement.
Other highlights of the budget request:
- $1.4 trillion in Medicaid cuts over the next decade.
- $17.9 billion in cuts for the Department of Health and Human Services for fiscal year 2019.
- A 36% cut to the budget of the HHS Office of the National Coordinator for Health Information Technology, to $38 million.
- $19 million in additional funding to fight healthcare fraud compared with the FY18 request, for a total of $770 million in funding for FY19.
- Elimination of 22 agencies or programs, including moving some to different areas of the government. Among the agencies affected would be the Agency for Healthcare Research and Quality, for which activities would be consolidated under the National Institutes of Health.
Fiscal year 2019 begins Oct. 1. The budget document is available on the OMB website and elsewhere.