Disability advocates are preparing to defend against potentially seismic cuts to Medicaid and community services now that President Donald Trump is back in the White House and Republicans are in control on Capitol Hill.
Republicans in the US House of Representatives are reportedly circulating a “menu” of possible options to cut more than $5 trillion in spending to fund tax cuts and other Trump priorities. Options described in a document Data obtained by Politico shows that up to $2.3 trillion could come from Medicaid.
If such cuts became reality, they would account for nearly a third of projected Medicaid spending over 10 years. according to KFFa nonprofit organization that conducts health policy research.
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This is raising major concerns for disability advocates who have been pushing for years to see greater investment in Medicaid home and community-based services, the nation’s primary support system for people with developmental disabilities.
«It would be difficult to overstate the seriousness of these threats,» said Zoe Gross, advocacy director for the Autistic Self Advocacy Network. «Medicaid is a lifeline program for our community; we must be clear that it must be expanded, not looted to pay for tax cuts for billionaires.»
Advocates have been warning for years that the Medicaid home and community-based services system is under extreme strain. A recent survey of hundreds of disability service providers nationwide found that 69% turned away new clients and 39% closed programs or services over the past year, and more than a third said they were considering additional program cuts.
Among the options Republicans are reportedly weighing is changing Medicaid to a “per capita cap system.” Currently, the federal government provides matching grants to states to help pay the cost of care for anyone eligible for Medicaid, no matter how expensive. But under a per capita cap system, the government would provide a set amount of money to each enrollee who leaves the states to make up for any difference in cost.
The draft document also lists reducing matching funds the federal government provides to states for Medicaid, implementing work requirements for the program and other options to squeeze out savings.
“We are concerned that when federal Medicaid funding is reduced, states will have to find new funds to balance the shortfall in state budgets. If new funding cannot be found, elective services such as community-based services for people with IDD are often reduced, leading to longer waiting lists for (home and community-based services) and higher rates of unnecessary and costly institutionalization,” said Elise Aguilar, senior director of federal relations for the American Network for Community Options and Resources, or ANCOR, which represents disability service providers nationwide.
All of this has given advocates a sense of déjà vu since Trump’s first term as president, when Republicans in Congress attempted to change Medicaid to a per capita cap system.
«Some of the proposals we’re hearing about are eerily similar to those proposed in 2017, such as fundamentally changing the structure of Medicaid,» said Nicole Jorwic, head of advocacy and campaigns at Caring Across Generations, an organization that advocates for caregivers and people. that depend on them. “This would put access to home (and) community services at extreme risk, increase waiting lists and further exacerbate the direct care workforce crisis.”
A broad coalition of more than 200 groups representing people with disabilities, family caregivers, older people and care workers met this month at a letter House and Senate leaders to reject any cuts to Medicaid.
“We are deeply concerned by recent statements by some congressional leaders supporting proposals that would deeply cut Medicaid funding. Medicaid is already agile and efficient,” reads the correspondence organized by The Disability and Aging Collaborative and the Consortium for Electors with Disabilities. “We strongly oppose per capita caps, block grants, work requirements, eligibility restrictions, barriers to enrollment, and any other cuts or harmful changes to the Medicaid program. The result is the same: taking away coverage from people with disabilities, older adults, and others who otherwise could not afford health care and long-term services and supports.”
Advocates now say they are meeting with lawmakers and activating their members to talk about the importance of Medicaid for this population.
“Whether the cuts come in the form of a work requirement (or) a per capita cap, it all means reducing federal dollars going to Medicaid and there is no state budget that can account for that loss,” Jorwic said. «People with disabilities and their caregivers should be aware of any changes and cuts to Medicaid, as well as threats to special education services, and be prepared to share how any cuts would be harmful.»
