ALEXANDRIA, Virginia & WASHINGTON—Ahead of the House Energy and Commerce Committee’s markup of proposed legislation impacting changes to the Medicaid program, aging and in-home care advocates urged Congress to protect Medicaid and preserve access to care.
"The ongoing conversations around potential reductions to Medicaid spending are increasingly concerning to the Alliance and our provider members that deliver home and community-based services (HCBS), hospice and palliative care to children with serious health conditions, older adults and people with disabilities," the National Alliance for Care at Home (the Alliance) said in a statement. "Although we recognize that leadership in the House and Senate have expressed support for preserving services to these populations, we do not believe that it is possible to reduce federal Medicaid expenditures by hundreds of billions of dollars over a 10-year period without negatively impacting eligibility and access to care."
The Alliance said that the reasons for this include:
- At the state level, Medicaid funding is fungible and reductions are often distributed across a wide swath of the program
- Reductions in federal funding would either require additional state money to backfill the loss—thus pulling resources from other parts of the program—or, more likely, would lead to similar reductions to the state matching dollars, resulting in compounded cuts at the service delivery level
- Services to older adults and people with disabilities represent more than 52% of total Medicaid expenditures, making it nearly impossible to effectuate large reductions in spending without impacting services to these individuals
- The optional nature of HCBS and the ability to cap enrollment and establish waiting lists creates additional vulnerabilities when Medicaid spending reductions and state budget shortfalls occur and
- Attempts to limit reductions to the “childless adult group” would negatively impact many paid and unpaid caregivers who provide HCBS
"We have stated previously, and reiterate now, that we believe there are opportunities to find common ground around reasonable provisions to strengthen program integrity in Medicaid," The Alliance said. "However, these provisions would not achieve the level of reductions contemplated by the reconciliation framework. We strongly encourage Congress to reevaluate the framework and pursue more reasonable and achievable policies that do not put services to older adults and persons with disabilities at risk."
Katie Smith Sloan, president and CEO of LeadingAge, said that Medicaid isn't just a safety net but a lifeline for older adults and their families.
"Medicaid is the only public payer for long term services and supports," she said. "As the number of Americans age 65 and older surges and the care workforce shrinks, slashing or restricting Medicaid funding isn’t just irresponsible; it’s dangerous. The number of people estimated to lose coverage under these proposals is at least 8.7 million, and it will likely be more. Medicaid is an interconnected ecosystem—if you target one piece, the whole system will be impacted."
"We have been told that the intent of all these policies is not to harm older adults, but they will," she continued.
ANCOR, which represents community-based providers for people with intellectual and developmental disabilities (I/DD), also said it ws closely monitoring the markup and concerned about the potential impact.
"Included in the legislation are significant cuts to health care that would total at least $715 billion. Any reduction in funding will diminish resources and force states to reduce their Medicaid spending as well,” said ANCOR CEO Barbara Merrill. “The thousands of community providers who support people with I/DD are already struggling immensely to retain workers, maintain services, and accommodate new referrals, all due to insufficient Medicaid funding. If Congress cuts Medicaid even more—whether or not those cuts are specifically targeted to disability services—the programs that enable people with I/DD to meaningfully participate in our society will be first on the chopping block when state budgets are unable to absorb the financial shock.”
“Family caregivers across the country would face devastating consequences under the proposed Medicaid cuts and work requirements unveiled today," said Jason Resendez, president and CEO of the National Alliance for Caregiving. "These harsh measures ignore the reality that more than 53 million Americans are already contributing $600 billion annually in essential, unpaid labor to care for aging parents, children with disabilities and loved ones with chronic illnesses, often sacrificing their own income, health and stability in the process."
"Stripping coverage from caregivers doesn’t create jobs," Resendez added. "It creates crisis, pushing families further into financial insecurity and deepening the pressure on an already strained long-term care system. Our new policy brief shows how work requirements would disproportionately impact caregivers who’ve already reduced hours or left the workforce to provide care, putting their health coverage at risk and destabilizing families further. Support for family caregivers has long been a bipartisan issue. From the National Strategy to Support Family Caregivers to the RAISE Family Caregiving Act, lawmakers from both parties have recognized caregiving as a shared national responsibility. These proposed cuts betray that legacy. We urge Congressional leaders to reject policies that would gut Medicaid’s caregiving supports and instead invest in the invisible infrastructure of care that keeps families together and health care costs dow."