States will be forced to dramatically cut the services Medicaid covers and cut the number of people who qualify for them if Congress makes changes in state Medicaid funding. And the services that states will likely drop first are those on which seniors, people with disabilities, and others with serious health needs rely.
Current Republican proposals to repeal the Affordable Care Act would allot Medicaid funding to states through block grants (which give states a fixed sum of money for 10 years) or a per capita cap (funds per enrollee that don’t increase as fast as their costs).
The first services that states will likely look to cut are those that are “optional” in the Medicaid program. And under the House bill, even more services may become optional. But such cuts will cause grave harm to seniors, people with disabilities, and others with serious health needs.
The changes being proposed put important services at risk, including:
Home and community-based care: Imagine that your parent or loved one is recovering from a serious illness or needs long-term care. Help with bathing, dressing, eating, and taking daily medicine is crucial to helping that person stay out of an institution. But this is a service often cut by states facing financial pressure. In 2014, Medicaid spent about $81 billion on home and community based services and $71 billion on other long-term care.
Prescription drugs: Though all states currently cover prescription drugs in their Medicaid programs, this coverage is optional. When they have faced financial pressure in the past, states have limited drug coverage in harmful ways, such as by placing arbitrary limits on the number of prescriptions they will fill or refusing to cover expensive medications needed by people with serious health conditions. People needing mental health drugs were among those who suffered. In 2014, about $22 billion of Medicaid spending(after rebates) was for prescription drugs.
Physical, occupational, and speech therapy: What if your loved one has a disabling stroke that puts him or her out of work? It will be at least 24 months after the person qualifies for Social Security Disability benefits before he or she will qualify for Medicare, and meanwhile, he or she may need to rely on Medicaid for care. But therapy services, now covered in most states, that are crucial to helping a stroke victim recover the ability to walk, talk, and use their hands are all optional services that a state Medicaid program could cut under financial pressure.
Dental care and dentures: Dental care is not covered by Medicare. For the 11 million people on Medicare who also have Medicaid benefits as well as for other adults, it is up to states to decide what, if anything, Medicaid will cover in the way of preventive dental care, fillings and extractions, and dentures. Good oral health care is important to overall health. It eliminates excruciating and unnecessary mouth pain, increases the likelihood of catching disease before it worsens, improves people’s ability to eat and follow good nutrition, helps working-age adults get jobs, and is important to people’s sense of well-being.
Lawmakers must understand that voting to restructure Medicaid is a vote to cut services like these.