The Future of Georgia’s Medicaid Program
With sweeping changes occurring in Washington, DC under the new administration, one of the biggest proposals to come out of the White House was the American Health Care Act (AHCA) – a replacement for the Affordable Care Act (ACA) that became law on March 23, 2010.
Many of those changes would directly affect Medicaid services and supports on which people with disabilities rely. Georgia Council on Developmental Disabilities (GCDD), with Alison Barkoff, director of advocacy for the Center for Public Representation, hosted a webinar to discuss the changes and how it could affect the disability community.
Healthcare Acts
The Affordable Care Act (ACA) has several pluses for people with disabilities. The biggest advantage to the ACA was insurance companies could no longer deny coverage to people with preexisting conditions or charge them higher rates. As we experience high unemployment among people with disabilities, the ACA further helped with lower insurance premiums and lower out-of-pocket expenses such as deductibles and copays.
In the past, people with disabilities were often denied Medicaid benefits or disability benefits because they were not seeing a doctor for treatment or didn’t have test results to corroborate their disability. With the ACA, healthcare became more accessible and more people who applied for disability assistance have been seeing doctors regularly, receiving proper diagnoses and records to support findings of disabilities.
Currently, Medicaid serves as the primary health insurance for 10 million non-elderly people with disabilities across the United States. People with disabilities make up 21% of the national Medicaid population but account for 48% of Medicaid costs, often due to long-term services and support needs.
The Medicaid program is jointly funded by the federal and state governments. The share the federal government pays is based on the income and poverty level of the state. Currently in Georgia, 68.5% of every Medicaid dollar is funded by the federal government, while Georgia’s state funds cover the remaining 31.5% of Medicaid costs. In 2016, Georgia ranked 48th in Medicaid spending.
AHCA and Medicaid
The biggest threat is to Medicaid, which could result in significant changes for Georgians who currently rely on the program if the ACA is repealed. The AHCA is required to go through federal budget reconciliation, meaning the plan must reduce the federal deficit. Therefore, not only must the AHCA be a cost-neutral bill, it also must save money over a 10-year period. Congress plans to use the money saved from Medicaid cuts to cover the new AHCA.
The Medicaid cuts will come from per capita caps, or federal funding per enrollee. Enrollee spending during the year would be tracked and that amount would increase over time based on a pre-set amount (i.e., inflation or inflation plus a percentage). This means that the federal government will now pay a set amount per Medicaid enrollee rather than paying for Georgia’s actual Medicaid service costs.
The per capita caps differ from block grants, where states receive a pre-set funding amount for Medicaid (not based on number of enrollees) that could be increased each year, again based on inflation or inflation plus some percentage. The per capita caps do account for changes in Medicaid enrollment, but do not account for new health technologies, aging population, changing health needs, etc. The goal of both per capita caps and block grants are to massively reduce federal spending.
The federal government, under the AHCA, will now use a formula for giving money to the states on a set amount per person enrolled in Medicaid based on their 2016 spending. For example, this funding will not consider an aging population who may begin to need more services. States like Georgia that spend less per capita on Medicaid (seventh lowest spending in the United States) will be negatively impacted.
Under the AHCA, funding will begin with setting a base year spending level, possibly as soon as 2018. A growth index, such as the Consumer Price Index, will be used to set the yearly growth rate for the base spending level. The issue is that growth indexes increase much more slowly than Medicaid spending. This will make the federal funding gap grow every year and Georgia’s state budget Medicaid program shortfalls will increase each year.
As Georgia considers raising provider rates to make sure people who have more complex behavioral or medical needs receive services, the State won’t be able to cover those rates under this formula. Georgia, which has almost 9,000 people on the Medicaid waiting lists for various needs and supports, won’t have funding available to help them.
While the per capita cap does provide more money if more people enter the Medicaid program, it will not provide more money for growing healthcare needs and changing technology assistance, among other things.
The entire AHCA bill’s savings is $327 billion, however the Congressional Budget Office is estimating an $880 billion cut in federal Medicaid spending over the next 10 years. That is over a 25% cut to Medicaid. As state Medicaid budget shortfalls grow, chances are people will see reduced services or total elimination of optional services such as waivers. Waiting lists, which are already lengthy, would increase. And provider rates, already low in Georgia, would more than likely decrease.
Funding caps will likely cripple state flexibility in program design. Creation of innovative and new programs often requires up-front investments to help in changing systems.
“It’s up to all of us to educate our [government] representatives and to tell our stories about what Medicaid means to people with disabilities,” urged Barkoff on the webinar.
Shortly after the webinar, the House Republicans withdrew the AHCA from voting – meaning the ACA is still the law of the land. However, healthcare remains a hot topic and people with disabilities should continue to educate themselves while informing their legislators to continue working towards a strong Medicaid program.
Ways to Get Involved
Educate your representatives in Congress. For so many people with disabilities and their families, Medicaid can make the difference in living independently, providing in-home supports so parents can work outside the home, etc. Help Congress understand how important Medicaid is, how cost-effective it is, and what the cuts will mean for people with disabilities.
- Educate your governor and state representatives. Georgia’s governor and representatives will have to deal with Medicaid budget shortfalls. Help explain how per capita caps will hurt the budget because it shifts costs to our state.
- Tell your story. There is nothing better than explaining how you and your family will be personally impacted by the AHCA and the per capita caps. Be honest and up front about what this will mean for you. Share how great this negative impact would be.
- Build state-level advocacy coalitions. Because these Medicaid cuts will impact so many, connect with others in your community and circle of influence. Remember, in addition to people with all types of disabilities, these changes will affect seniors and those who are low-income. Partner and work together to advocate together.
- Connect with national efforts already in place. The Consortium for Citizens with Disabilities (www.c-c-d.org) and The ARC of the United States (www.thearc.org/) already have efforts underway to fight against these Medicaid cuts. These organizations and groups have information and updates going out to those who connect with them so everyone can have the latest news and developments.
- Engage the media. Write a letter-to-the-editor, post on social media, make your voice public and share your knowledge. The hashtag for the movement is #savemedicaid.
Contact Your Legislators:
Find your Georgia federal legislators at https://www.govtrack.us/congress/members
Georgia’s state legislators are listed at https://openstates.org
Governor Nathan Deal (R) can be reached at 404.656.1776.
Keep Informed: https://medicaid.publicrep.org/
Georgia Council on Developmental Disabilities' (GCDD) spring edition of Making a Difference quarterly news magazine covers a review of the 2017 Legislative Session; Talking Disability Advocacy at the Georgia State Capitol during Advocacy Days; the Future of Georgia's Medicaid Program; Georgia Options Leads the Way; tips on advocating for employment and more.
