Vital health care services for more than 17 million of the nation’s most vulnerable citizens could be on the chopping block if the Republican health care bill becomes law.
If Medicaid home and community-based services are cut for children with special needs and adults and seniors with disabilities, many would end up in costly nursing homes, require more assistance from struggling family members or simply do without the care that allows them to live independently.
Many of these low-income patients are functionally and cognitively impaired. They require home health aides, personal care attendants and day care programs to help with basic activities like eating, dressing, bathing and mobility.
Medicaid, the state-national health care plan for poor people and those with disabilities, is the largest public provider of these nonmedical services, covering 30 percent of working-age adults with disabilities like cerebral palsy, mental illness, and traumatic brain and spinal cord injuries.
Unlike coverage for nursing home care, which is mandatory under Medicaid, home care services for the elderly and people with disabilities are optional.
Patient advocates fear that states will trim those optional Medicaid services if the program faces the 10-year, $880 billion cut in federal funding that the GOP health care bill proposes.
If the legislation becomes law, and states roll back their home and community-based services, many Medicaid patients with special needs and disabilities will end up in nursing homes, said David Certner, legislative policy director at AARP.
“This really threatens the ability of people to live independently in their homes,” Certner said. “We can take care of three people at home for the cost of one person in a nursing home, so it’s bad policy and it’s bad in terms of what people prefer.”
People with disabilities make up 15 percent of Medicaid enrollees but account for 42 percent of program spending because of their costly care, according to the Kaiser Family Foundation.
Faced with a loss of services, other home care patients would require more support from family members, who “are already carrying a huge load for their loved ones,” said Alice Dembner, senior policy analyst at Community Catalyst, a national advocacy group for vulnerable patients.
Nearly 18 million Americans help support elderly, impaired family members, providing largely uncompensated care worth $234 billion in 2011, the Congressional Budget Office reported.
“That results in real effects in the economy, because you have lost wages and lost productivity from the folks who are now trying to balance more care of their family members than perhaps they can handle,” Dembner said.
The GOP bill moves Medicaid from an open-ended entitlement program to one with capped funding based on the number of enrollees.
That “per capita” funding formula wouldn’t keep pace with Medicaid’s current spending growth, leaving states to either make up the funding shortfall or cut costs by limiting enrollment, cutting services or lowering payments to Medicaid providers.
” Many home care providers already don’t participate in Medicaid because the payments are so low, said Howard Bedlin, vice president for public policy and advocacy at the National Council on Aging.
Bedlin, of the National Council on Aging, said he expects GOP congressional leaders to amend the bill in order to counter the mounting criticism of the legislation following the CBO report last week. The full House of Representatives is expected to vote on the measure this week.
“Whether it can get through the Senate is a whole other story,” Bedlin said.
IMAGE TAKEN from MCT Campus
