Medicaid Cuts in House ACA Repeal Bill Would Limit Availability of Home and Community Based Services

From the Center on Budget and Policy Priorities:

 The House-passed bill to “repeal and replace” the Affordable Care Act (ACA), which the Senate is now considering, would make home-and community-based services (HCBS) that states fund through Medicaid especially vulnerable to deep cuts. The House bill would radically restructure Medicaid’s federal financing and effectively end the ACA’s Medicaid expansion

 Facing steep cuts in their overall federal Medicaid funding, states would likely curtail HCBS  programs, which in 2013 allowed almost 3 million seniors and adults and children with disabilities to receive care at home instead of in a nursing home.

 The share of Medicaid expenditures for long-term services and supports that states allocate to HCBS has climbed from 18 percent in 1995 to 53 percent in 2014, with the number of people served with HCBS rising dramatically as well. States now spend more for HCBS than for nursing home care.

 The House bill —officially the American Health Care Act (AHCA) —would place a fixed cap on per-beneficiary federal Medicaid funding, cutting federal funding to the states by growing amounts over time. Capping and cutting federal funding would force many states to make excruciating decisions on whom they cover because unlike most services in Medicaid, which states must cover, most HCBS are optional  Medicaid benefits that states can cut when they face funding shortfalls.

The services that states provide in their HCBS programs vary, but they generally provide home health services plus help with chores, meals, transportation, and other services such as adult day care and respite care for family caregivers. Most states already limit HCBS due to funding constraints, and HCBS are a likely target if states must make substantial cuts due to federal funding shortfalls, because they spend more on optional HCBS than on any other optional benefit. The AHCA would therefore likely generate large increases in HCBS waiting lists.

 Read more on how the proposed fixed cap on per-beneficiary funding will result in reduced federal Medicaid payments to the states: http://www.cbpp.org/sites/default/files/atoms/files/5-18-17health.pdf

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