Proposed changes would put Medicaid recipients, providers at risk, advocates say

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Congress should reject proposed “radical structural changes” to Medicaid funding that would lead to reduced services for beneficiaries and payments for providers, 100 advocacy organizations, including LeadingAge, told legislative branch leaders Friday.

Financing Medicaid through block grants or per-capita caps would lead to fewer people covered, fewer services available and higher healthcare costs for lower-income individuals, the groups said in a letter to Senate Majority Leader Mitch McConnell (R-KY), House Speaker Paul Ryan (R-WI), Senate Majority Leader Chuck Schumer (D-NY) and House Minority Leader Nancy Pelosi (D-CA). Both ideas recently have been suggested by members of Congress.

“These proposals are designed to reduce federal support to state Medicaid programs, not to better serve Americans who rely on Medicaid to access health and long-term care,” the letter said. “Medicaid block grants or per capita caps would impose rigid limits on the amount of federal money available to states for Medicaid, endangering the health and wellbeing of older adults, people with disabilities and their families.”

Medicaid covered more than one in seven (6 million) older Americans in 2015 and provides income and jobs to hospitals, private physicians and other healthcare providers, the groups noted. “Today, Medicaid pays for approximately 61% of all [long-term services and supports] expenditures, including services in nursing facilities, in various community settings, including assisted living residences and adult foster homes, and in the home,” the letter said.

Currently, the groups said, the federal government pays a fixed share of states' Medicaid costs that averages more than 60%. Under a block grant, the federal government would pay its share of a state's Medicaid costs only up to an overall fixed amount, the letter stated, and under a per-capita cap, the federal government would pay its share of a state's Medicaid costs only up to a fixed amount per beneficiary.

“Unlike the current Medicaid structure, a state experiencing higher-than-usual enrollment and/or Medicaid spending per enrollee (reflecting changes in a state's demographics, economy, medical needs or the introduction of new, lifesaving breakthroughs, for example) would no longer receive matching federal funds above its block grant or cap,” the groups said.

Some of the other organizations signing the letter included Altarum Institute's Center for Elder Care and Advanced Illness, the American Geriatrics Society, Justice in Aging, the Gerontological Society of America, Lutheran Services in America, the National Association of Social Workers, the National Association of State Long-Term Care Ombudsman Programs, the National Consumer Voice for Quality Long-Term Care, the National Council on Aging and the Paraprofessional Healthcare Institute.

The letter also was sent to members of several Senate committees, including the Special Committee on Aging.

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