Amber Christ: Hello everybody and welcome to at present’s webinar, Defending Medicaid from Cuts in Congress: Updates for Ageing Advocates. My title is Amber Christ. I take advantage of she/her pronouns, and I’m the managing director of Justice in Ageing’s well being advocacy. I’m joined at present by my colleagues, Natalie Kean, director of federal well being advocacy, and Gelila Selassie, a senior lawyer with our staff. Quite a bit has occurred since our final webinar in March on defending Medicaid. Most notably, the Home handed its model of the reconciliation invoice on Might twenty second. And if enacted into the regulation, this laws would reduce over a trillion {dollars} in federal healthcare spending by drastic cuts to Medicaid, Medicare, and market protection. These are unprecedented cuts. If you pull out $1 trillion in federal spending from healthcare, each state, each supplier, and each single individual on this nation will likely be impacted.
The Congressional Price range Workplace initiatives that 10.9 million folks would lose medical health insurance. That 1.3 million older adults and disabled folks will lose monetary help to pay for Medicare’s out-of-pocket prices. And since the invoice considerably will increase the deficit, it might set off $500 billion in cuts to Medicare. And there’s way more that may cowl intimately all through this webinar. With the passage of the invoice within the Home, it’s now with the Senate. And simply yesterday, the Senate Finance Committee launched its model making even deeper cuts to Medicaid and Medicare than the Home model. Lawmakers repeatedly declare that these proposed well being care cuts are designed to guard older adults and folks with disabilities. However as we’ll talk about all through this webinar, this isn’t true. These cuts, the truth is, would considerably hurt older adults and disabled folks opposite to the rhetoric getting used to justify them. And regardless of the large affect the reconciliation invoice would have on healthcare, it’s essential to know that at its core the laws is a tax invoice.
None of its provisions goal to enhance or strengthen healthcare. As a substitute, they goal to do one factor, to take the cash the federal authorities at present spends on healthcare and use it as an alternative to pay for tax cuts that overwhelmingly profit the wealthiest Individuals. But proper now, many individuals throughout the nation have no idea that that’s what’s taking place. Our purpose as advocates is to alter that, to ensure folks know that this tax invoice is a healthcare invoice that may considerably hurt older adults and tens of millions of different individuals who depend on Medicaid for his or her well being and well-being. As we speak, we’re going to give you an summary of the healthcare proposals and their affect on older adults so that you’ve got the data it’s worthwhile to defend in opposition to these cuts. However earlier than we dive into content material, only a few logistics. All members will likely be on mute. You probably have a query concerning the materials being offered or a technical concern, please use the query perform and we’ll depart time on the finish for query and reply.
For those who expertise any difficulties accessing the webinar, please electronic mail trainings@justiceinaging.org. The supplies we’ll talk about at present can be found on Justice in Ageing’s web site and our useful resource library, and a recording of the webinar may even be posted within the useful resource library and made obtainable on our Vimeo web page. The hyperlinks to the assets may even be shared within the chat field. If you want to allow closed captioning, please hit the CC perform in your Zoom platform. And just a bit bit about Justice in Ageing. For these of you who may be new to us, we’re a nationwide group centered on eradicating senior poverty by growing entry to reasonably priced healthcare and financial safety for older adults with restricted assets, with a deal with older adults who’ve been marginalized and excluded from justice, together with older adults of colour, older ladies, LGBTQ+ older adults, older adults with disabilities, older immigrants, and people whose main language shouldn’t be English.
To hold out our mission at Justice in Ageing, we’re dedicated to addressing the enduring harms of racism and different types of discrimination throughout all areas of our advocacy. So turning to our agenda at present, Gelila and Natalie are going to give you a refresher on the essential function Medicaid performs for older adults. They’re going to supply you an replace of the present state of play in Congress. And the meat of at present’s presentation, they’re going to supply an summary of the cuts to Medicare and Medicaid which can be included within the laws. After which we’re going to pivot to advocacy methods, together with a evaluate of the important thing messages to push again on chopping Medicaid and assets you need to use in your advocacy to guard entry to take care of older adults and folks with disabilities. We’ll then open it up for questions. I’m now going to show it over to Natalie to kick us off to supply an summary of the important function Medicaid performs for older adults.
Natalie Kean: Thanks a lot, Amber, and it’s good to be with you all. That is hopefully a little bit of a evaluate, however an necessary one for all of us to understand that Medicaid is simply as necessary for older adults as Medicare, to make sure that they’ve entry to all of the help that they should dwell wholesome and effectively and keep unbiased as they age. Greater than 7 million seniors and 10 million folks with disabilities depend on Medicaid. Thousands and thousands extra, older adults and folks with disabilities and continual circumstances, are insured by Medicaid who don’t qualify on the premise of their age or incapacity. This consists of at the least 9 million older adults, ages 50 to 64, and at the least 6 million folks with disabilities. Medicaid may be very broad. It’s way more than medical health insurance and covers way more than conventional medical companies. Most critically for older adults and folks with disabilities, it’s actually the one supply of residence and community-based companies and the one protection for long-term nursing facility care.
It additionally covers issues like non-emergency medical transportation that assist low-income older adults get to the physician, in addition to monetary help for Medicare beneficiaries who’re duly enrolled in Medicaid. So, a bit bit extra about Medicaid’s function for folks with Medicare. There are 12.5 million folks dually enrolled in Medicare and Medicaid. Which means that they’ve some protection from each packages. Most people who’re duly enrolled are age 65 and older and have Medicare for his or her main well being protection, but it surely additionally consists of youthful people who find themselves eligible for Medicare based mostly on incapacity. However the factor that all of them have in frequent is that they’ve restricted earnings and most have greater healthcare and long-term care wants. Medicaid is what makes Medicare accessible and reasonably priced for these people. Medicaid pays Medicare premiums and, in some instances, out-of-pocket prices for over 10 million folks. That is assist obtainable by the Medicare financial savings packages.
Medicaid additionally covers companies that Medicare doesn’t. Medicare protection of residence and nursing facility care may be very restricted and way more centered on medical companies and rehabilitation. For instance, there’s a most of 100 days in a talented nursing facility that Medicare covers, so Medicaid is what’s usually choosing up for older adults once they want long-term care. It additionally offers different companies like dental, imaginative and prescient, listening to, in addition to transportation that Medicare doesn’t cowl in any respect. So, the place are we at present? As Amber famous on the prime, Congress is contemplating some huge cuts to Medicaid in addition to cuts to Medicare and the Reasonably priced Care Act, proper now. In whole, we’re anticipating 10 million folks to have their Medicaid protection taken away and 16 million folks will likely be uninsured. And people are minimal estimates. The precise hurt if this invoice is enacted could possibly be a lot worse.
Congress is doing this by a course of referred to as funds reconciliation. It’s a course of that’s obtainable to Congress to fast-track laws when one celebration holds the bulk in each the Home and the Senate and the White Home. They will make the most of this course of to maneuver laws with solely 51 votes within the Senate. It means this laws is filibuster proof and could possibly be handed with none democratic help. Price range reconciliation has particular necessities. Most significantly, that the payments included should relate to the funds and never add to the deficit over a 10-year interval. The Senate parliamentarian is an individual who decides what might be within the invoice and what might be out, and that course of is occurring proper now within the Senate. And notably, these guidelines are particular to the Senate. So what handed the Home could not be capable of get by the Senate’s guidelines. That course of, once more, is ongoing proper now.
So, the place are we when it comes to this funds reconciliation invoice in 2025? The Home and Senate, a few months in the past, adopted the identical funds decision, which is the primary a part of the method outlining their priorities for this laws. After which within the Home, we noticed some technique of the vitality & commerce committee marking up laws that features these huge cuts to Medicaid. There was a listening to that went on for a extremely very long time with plenty of proposed amendments to attempt to restrict the harm to Medicaid. Sadly, none of these amendments have been adopted and the Home ended up passing HR 1, additionally referred to as the One Massive, Stunning Invoice Act, we’re calling it the tax invoice or the funds invoice, on Might twenty second of this 12 months. It consists of cuts to Medicaid spending of greater than $700 billion. That’s the model that handed by the Home. Now, the Senate is contemplating this invoice. We don’t count on any course of within the committees.
Within the Senate, it’s the Senate finance committee that has jurisdiction over Medicaid and Medicare as effectively. They received’t be marking up a invoice in any form of public course of. All of that is taking place behind closed doorways. As I discussed, the Byrd bathtub is ongoing proper now. That is the method the place the Senate parliamentarian works with each senators on each side of the aisle to resolve what can stay on this invoice and what can’t. We don’t count on huge adjustments from this course of. We acquired a brand new textual content from the Senate finance committee simply final night, lower than 24 hours in the past, that sadly adjustments the invoice fairly a bit and in a nasty course. It truly deepens the cuts to Medicaid throughout and can result in extra folks insured. As Gelila and I’m going by a number of the specifics at present, we’ll level out some areas the place we’ve already famous some deeper cuts to Medicaid. However know that our evaluation of the Senate textual content is ongoing, and likewise that it’s solely a draft.
We have to keep in mind all through all of this, we nonetheless have alternatives each single day to attempt to cease these cuts from being enacted. The method for funds reconciliation ends on the finish of the fiscal 12 months, which is September thirtieth of this 12 months. As a way to use this course of for FY 2025, the invoice must cross each the Senate and the Home by the top of September. Now, management is saying that they actually need to end this up and cross the invoice and have it on the President’s desk by July 4th. That’s bold, however now we have to take them at their phrase that they’re transferring as quick as potential. So we have to be performing proper now to ensure that each senator, and the Home as effectively as a result of they should vote on this once more since it’ll change within the Senate, that each member of Congress understands what’s on this invoice.
And only a fast reminder that funds reconciliation is separate from the annual appropriations or authorities funding invoice course of. The federal government funding additionally expires on September thirtieth, and the FY ’26 appropriations is ongoing. You would possibly hear different references to the funds within the information, and simply know there are a few totally different processes occurring proper now. The primary factor once more although for that is it is a lengthy course of for funds reconciliation and it might drag on by the summer time. August recess, in addition to another issues taking place just like the expiration of the federal debt ceiling, might present further strain factors for Congress to behave. We have to once more be vigilant, be able to cease it if they will attempt to vote earlier than July 4th, but additionally know that we could possibly be preventing this by the remainder of the summer time.
Okay. We’ve been centered rather a lot on Medicaid, as a result of Medicaid has actually been underneath assault and we’ve recognized that from the start. However after we noticed the Home invoice come out, we noticed much more cuts to Medicare than we had initially anticipated. And this invoice takes goal at Medicare in a couple of alternative ways. Considered one of our mantras is {that a} reduce to Medicaid is a reduce to Medicare and we’ll speak extra about that later, about what this invoice means for people who find themselves duly eligible for Medicaid and Medicare. Nevertheless it additionally ends Medicare eligibility for a big swath of lawfully-present immigrants who’ve lived within the US and paid into the system for many years. As Amber talked about, it places Medicare’s future in danger by triggering $500 billion in cuts because of the enhance within the nationwide deficit that this invoice would set off. Specializing in that second bullet, this invoice takes protection away from many lawfully-present immigrants throughout packages, however together with in Medicare.
Proper now, US residents and lawfully-present immigrants might be eligible for Medicare. Their qualifying work historical past does have a special affect on non-citizens. So lawfully-present immigrants who’ve 40 quarters or 10 years of labor historical past can qualify for premium-free Half A. With out the complete 40 quarters, individuals who aren’t totally insured, solely lawful everlasting residents or inexperienced card holders who’ve 5 years of steady residency can enroll in Medicare they usually should additionally pay a premium for Half A. Immigrants may qualify based mostly on their partner’s work historical past. Very importantly for this dialog is that federal regulation already prohibits people who find themselves undocumented from enrolling in Medicare and prohibits Medicare cost for anybody with out lawful current standing. This invoice and the change I’m about to point out you has nothing to do with people who find themselves undocumented. It’s taking Medicare protection away from lawfully-present immigrants who’ve paid into the system.
Below the Home invoice, and this provision seems to be unchanged within the Senate texts that we noticed final evening, lawfully-present immigrants would solely be eligible for Medicare if they’re lawful everlasting residents, Cubans who entered underneath a household reunification program, or folks residing underneath the Compacts of Free Associations. These are residents of Micronesia, the Marshall Islands, and Palau. Each different class of lawfully-present immigrant, no matter being in any other case eligible for Medicare, will not be eligible. These embrace folks with work visas, short-term protected standing, refugees, asylees, survivors of home violence, spouses and youngsters of residents who’re right here with visas. Many classes of immigrants will not be eligible for Medicare, and those that are at present enrolled in Medicare may have their protection terminated after one 12 months. I simply need to be aware too that of the estimated 16 million people who find themselves going to grow to be uninsured if this invoice is enacted, over 90% of them are US residents and lawfully-present immigrants. There’s lots of rhetoric about what this invoice is doing and who’s going to lose protection. And immigrants who’re right here lawfully and lawfully current are completely going to be shedding protection.
This transformation is surprising and really regarding for various causes. It’s taking Medicare away from older adults and folks with disabilities who once more have labored within the US and paid into the system for many years, and it’s decoupling social safety eligibility and Medicare eligibility. Basically, it’s breaking Medicare’s promise. On this nation, once you work and pay taxes, you count on to have well being protection once you retire or can’t work as a consequence of incapacity. Sadly, most of the individuals who lose Medicare will grow to be uninsured as a result of the Senate can be proposing to exclude the identical classes of lawfully-present immigrants from Medicaid, in addition to excluding them from tax credit to purchase their very own protection on {the marketplace} in order that they received’t have any reasonably priced well being protection obtainable. This harms US residents as effectively. There’s the common affect of including to the uninsured charge, but additionally many individuals who will lose protection.
Many of those immigrants work as paid caregivers to older adults and likewise play necessary roles in their very own households and households. They allow different folks of their household to work, and that is simply going to develop the direct care workforce disaster that we have already got as 1 in 4 direct care employees are immigrants and should not have a path to citizenship open to them. All proper, transferring on to Medicaid. I’m first going to supply a fast overview. We’ve been utilizing this slide to point out the several types of Medicaid cuts that we’ve been looking for. And sadly, this invoice consists of almost each kind of reduce that we have been fearful about and much more cuts have been included that weren’t initially on our radar. It does reduce the federal help proportion, it restricts supplier taxes, it provides work necessities, it repeals rules and minimal high quality necessities, and offers much more eligibility and enrollment restriction.
Once more, these cuts whole to just about $800 billion. There’s an extended listing of cuts, however the whole affect is absolutely huge. Though we haven’t but seen block grants or per capita caps, I feel the entire affect of those cuts remains to be almost the identical. I do need to additionally be aware that the rationale why this invoice doesn’t use block grants or per capita caps is due to our advocacy, our collective advocacy. Everybody on this name talking up, elevating the significance of Medicaid, ensuring that members of Congress perceive that they can’t intestine this program. Our key messages from the highest, all of those Medicaid reforms are cuts. It’s inconceivable to chop a whole bunch of billions of {dollars} with out taking folks’s healthcare away. Over 10 million folks may have Medicaid taken away. 16 million folks will grow to be uninsured. And once more, the express purpose is to generate federal authorities financial savings to pay for tax breaks that primarily profit the very rich.
The prices will likely be pushed to states, and states will likely be compelled to fill their funding gaps by chopping advantages and/or eligibility. Medicaid is already very lean and price environment friendly so when these cuts come by, older adults and folks with disabilities will likely be harmed. We’re going to stroll by once more a number of the provisions within the Home invoice. As we talked about, the Senate textual content adjustments a few of these provisions. We’ll attempt to level out a couple of locations the place it does, however know that we are going to have extra evaluation of that quickly. The invoice actually assaults immigrants in a number of methods and can make it inconceivable for a lot of who’re lawfully current to seek out any protection. One of many methods it does that is by penalizing states that select to cowl immigrants no matter their immigration standing, threatening them with chopping funding for his or her growth inhabitants by 10% in the event that they proceed to supply this protection with their very own state funds.
15 states could be penalized as a result of they supply well being protection no matter immigration standing, together with a number of states that present protection to older adults no matter immigration standing. And it might, as written, affect as many as 38 states that cowl immigrants paroled into the US. The invoice would additionally finish an additional 5% FMAP incentive or federal funding incentive for states that haven’t but expanded protection. Along with attacking immigrants, one other theme of this invoice is absolutely discouraging any new states from increasing Medicaid. The invoice additionally restricts supplier taxes. And this, regardless of being a wonky problem, poses a extremely critical menace to residence and community-based companies particularly. Each state however Alaska makes use of supplier taxes to fund their share of prices. And as a reminder, the FMAP works as a reimbursement. So states should spend their very own cash first earlier than they will obtain the federal match.
Proscribing these taxes is one other approach of shrinking state Medicaid spending with the purpose, once more, of chopping folks off to scale back federal spending. So, cuts by one other title. The Home-passed invoice would prohibit states from establishing any new supplier taxes or growing current taxes. This is applicable no matter what number of taxes or whether or not the state is already taxing up to what’s at present a 6% protected harbor quantity. That acts sort of like a cap on these taxes. The Senate truly deepens these cuts, so they’d drop that protected harbor from 6% to three.5% for states which have expanded Medicaid. The ten states that haven’t expanded Medicaid would nonetheless not be capable of institute any new supplier taxes, however their protected harbor would stay at 6%. The invoice additionally would prohibit state-directed funds and managed care. That is simply one other approach too that there’s a discrepancy in how the invoice treats growth and non-expansion states.
So, how does one thing like a supplier tax affect older adults? The primary takeaway right here is that it’s going to shift prices to states and states will likely be compelled to chop spending, they usually’re going to chop Medicaid spending as a result of Medicaid is such a big portion of their funds. Not solely is Medicaid federal funding being reduce and states having their budgets shrink from that, but additionally there’s going to be lots of further strain from administering work necessities. There are $300 billion in cuts to SNAP and lots of that funding goes to be shifted onto the states for the primary time ever, in addition to the expiration of American Rescue Plan Act funding that particularly helps residence and community-based companies. So when states are going through these pressures, their choices are to chop optionally available advantages or eligibility classes, reduce enrollment or reduce supplier cost charges. And these all hurt older adults and particularly residence and community-based companies.
The reason being as a result of 86% of what are thought-about optionally available Medicaid spending on Medicaid companies help older adults and folks with disabilities. Residence and community-based companies accounts for 51% of all optionally available spending. So greater than half of states spending, that’s discretionary is one other mind-set of that, is on residence and community-based companies. And it accounts for nearly a 3rd of all Medicaid spending. We all know from historical past this implies each state will reduce residence and community-based companies ultimately. Following the nice recession, after 2010, each single state reduce a number of of their packages. These spending cuts averaged 10 to 12% for waivers and private care companies and 22% for residence well being. The reductions within the variety of folks served ranged from two to fifteen% throughout states. And these cuts additionally led to longer ready lists for residence and community-based companies.
I’m certain you all see it in your personal states, when the budgets are tight, cuts to HCBS get proposed. However now we have an instance right here of when a considerable amount of federal funding was taken out, that is what occurred and so we will count on related cuts, if not even worse, if this invoice is enacted. With that, I’m going to show it over to Gelila.
Gelila Selassie: Thanks a lot, Natalie. As Natalie talked about, it is a actually horrible invoice, made worse by the Senate invoice from yesterday. One of many greatest provisions and most dangerous provisions are the work necessities that might be imposed on all states and the District of Columbia. And it requires them to implement work necessities, which they name group engagement actions, for all adults ages 19 to 64. It might require Medicaid enrollees who’re very, very low earnings to report 80 hours of labor, group service, job coaching or education or some sort of schooling program. Below this invoice, the states will not be required to supply automated exemptions and there’s nearly no flexibilities for states to supply exemptions within the Home invoice. The Senate invoice does give a bit little bit of leeway for states who’re performing in good religion for a time restricted exemption. So even then, it’s very, very restricted and it’s on the discretion of the secretary of Well being and Human Companies.
It makes it very tough for folks to obtain any sort of exemptions based mostly on the wants of their state. So it actually forces states in a tricky place the place they’re having to impose these actually burdensome necessities, and we’ll go into extra element of how tough it’s for states, on prime of the burden and the challenges it poses for people. The work necessities have to be glad for at the least one month previous to enrollment. Somebody has to already be assembly these necessities earlier than getting Medicaid. After which it may be verified by 6-month re-determination durations, and people states can require extra frequent ones. That’s one other problem that we’ve seen in states that did implement work necessities is the reporting course of, how tough it may be, how burdensome it may be. So folks, even when they’re following the foundations, the reporting necessities and the frequency of it may additionally simply make it harder to report it, and they also lose protection although they’re doing what they’re purported to underneath the necessities.
This invoice successfully targets the Medicaid growth inhabitants. For the 40-41 states and the District of Columbia that expanded Medicaid, that is actually focused towards that inhabitants. Nonetheless, it might nonetheless apply past the growth populations to sure teams who’re getting Medicaid underneath explicit waivers. Wisconsin has one that gives protection to childless adults. We’re nonetheless making an attempt to determine what this implies. However mainly should you’re in a non-expansion state, that doesn’t imply that you’re within the clear from work necessities. There are explicit Medicaid teams, necessary teams like somebody in a incapacity pathway or somebody who’s receiving Medicaid as a pregnant individual. There are exemptions for that or they’re not topic to this provision in any respect. However apart from that, there are different pathways the place this might apply. That’s simply one thing to remember and one thing that we’ll be very carefully as we dive deeper into the Senate invoice. Subsequent slide.
So, why are work necessities so dangerous? 5 million individuals are estimated to grow to be uninsured underneath the work necessities. One actually necessary factor to notice is that almost all people who find themselves on Medicaid are working or caregiving. They might have a incapacity or they’re in class. That’s the reality. Most Medicaid enrollees are working or are doing one thing else or have one thing else that stops them from working. That’s a extremely, actually necessary distinction. That is particularly dangerous for older adults aged 50 to 64 and folks with disabilities who’re disabled however will not be eligible for Medicare or Medicaid due to very strict incapacity guidelines. We’re going to undergo this by a couple of examples, however getting disability-based packages might be very lengthy. It may well require lots of paperwork, it may require lots of medical visits, and so making an attempt to get on these packages is, like I mentioned, very tough.
Medicaid growth can present a bit little bit of aid for people who find themselves disabled. That’s an enormous be aware. Thousands and thousands of people who find themselves disabled are receiving Medicaid by Medicaid growth as a result of the opposite pathways are so tough, so no matter form of picture that may be offered of the typical Medicaid enrollee is fake. That is particularly too as folks age. We’re particularly involved about that 50-up inhabitants who usually tend to have continual circumstances or a incapacity that stops them from working. The exemptions are extraordinarily slender and burdensome. One fast be aware between the Home and the Senate invoice is the exemption for caretakers or caregivers. The Senate language has household caregiver as an exemption, which underneath the statute it’s referencing refers to individuals who is caring for a member of the family or different particular person who offers a broad vary of companies for a continual well being situation or incapacity or purposeful limitation.
On this Home invoice, there was a really restricted definition of a guardian or caretaker who may be exempted from this invoice, whereas now it may be a bit bit broader. However once more, it’s one thing that we’re diving into. After which simply once more to reiterate, the huge administrative burden impacts all Medicaid enrollees together with older adults. Georgia has a restricted Medicaid growth program by their waiver and that has work necessities. And 90% of the $26 million of that program went to administrative prices, which that cash would’ve been higher spent on truly offering companies. On prime of that, purposes for Medicaid, help with Medicaid, redeterminations, all that took longer for all Medicaid enrollees as a result of so many employees have been wrapped up within the administrative course of for these work necessities. As soon as once more, there actually isn’t any solution to carve out any inhabitants. Subsequent slide. We’re going to speak a bit bit about this paradox of getting to show your incapacity for functions of getting a piece requirement exemption. The invoice makes use of the language of medically frail as one group that’s exempt from work necessities, which that language isn’t nice.
However as a result of that’s what’s in invoice, that’s what we’ll discuss with. And it’s successfully offers a listing of individuals with sure forms of continual sicknesses or disabilities who could be exempt. This class of exempt people are those that, like I mentioned, will not be enrolled in a selected incapacity pathway like Medicaid should you’re receiving SSI or Medicaid underneath the blind and disabled classes. As a result of it’s not well-defined and since we aren’t certain what that course of is, we’re very involved that individuals who have disabilities are going to be successfully instructed that, “Since you’re not proving to us that you just’re disabled, we’re not going to grant you an exemption.” I’ll present a few examples, however successfully to point out that you just’re disabled can create this huge catch-22. As a result of oftentimes you’ll want healthcare, you want medical documentation, you want entry to a doctor, you would possibly want some medical varieties stuffed out, you would possibly want medical information. All of that may be wanted to point out why you might be medically frail or have a continual situation or no matter else. However how will you get that should you don’t have healthcare to start with? Subsequent slide.
Listed below are 2 examples that we’ll make the most of simply to match the conditions of somebody who will get Medicaid underneath growth versus anyone who has to undergo these extremely arduous work requirement exemptions. Maya needed to stop her job as a result of she has extreme ache following an accident. She utilized for SSI, which is thru Social Safety for folks with disabilities, however was denied and instructed that she might attraction. However that attraction course of can take as much as 2 years. Thankfully, her state has Medicaid growth so she will entry essential remedies throughout that 2-year interval whereas she’s ready for her SSI. So not solely will Medicaid cowl her therapy in order that she will get rehabilitation companies, she will get medicines, she will go to her physician, however she will additionally acquire medical documentation of her incapacity for her SSI listening to. There’s 2 advantages there. Not solely does she have entry to healthcare, but it surely’s going to assist her get different advantages as effectively to point out her incapacity.
After which examine that with somebody like Neil who needed to in the reduction of his work due to his diabetes wasn’t effectively managed, so he had excessive nerve ache. His state will solely give him Medicaid if he exhibits that he’s medically frail, which requires intensive medical information and documentation. As a result of he’s uninsured, he’s unable to point out that he’s medically frail as a result of he can’t afford the out-of-pocket value to go to the physician. After which, after all, he can’t afford remedy as effectively. Over time, his well being finally deteriorated to the purpose the place he was hospitalized for gangrene and imaginative and prescient loss. Though he later certified for Medicaid underneath the blind and disabled pathway, the protection arrived too late for him to return to the job that he actually cherished. These are 2 hypotheticals that have been altered a bit bit, however based mostly on actual people who had related experiences in going by this course of. So should you have a look at a scenario like Neil, how can he get protection if he has to show all this? And ready to the purpose the place he can not work is a large, large problem.
It simply exhibits why the able-bodied language that we’ll speak about in a bit bit is absolutely inadequate for capturing that Medicaid growth inhabitants. It isn’t phrase and it simply doesn’t seize who is definitely on Medicaid. If we flip to the subsequent slide, we’ll talk about a bit bit extra about who’s with a few of our messaging suggestions. One factor to notice is that work necessities are additionally job loss penalties, on prime of all of the challenges and difficulties I discussed on the executive burden and the challenges for folks with disabilities. For those who’re on Medicaid growth and also you’re fulfilling the work necessities, should you lose your job, you lose Medicaid as effectively as a result of you possibly can solely get Medicaid should you show you might be working. So it successfully penalizes you for shedding your job, which might be very problematic if we’re in a precarious economic system or if the kind of business an individual is in is dwindling and how much employment they’ve.
It’s actually necessary to push again that the one individuals who deserve healthcare are people who find themselves working or working a specific amount or working paid jobs. Medicaid shouldn’t be a luxurious and, as Natalie mentioned, it covers a variety of companies that individuals have to be wholesome. So the extra necessities we add on this group is once more, who’re very low earnings, is absolutely taking away one thing so extremely important to ensure that they’re dwelling wholesome lives. After which as I discussed, there’s been lots of disparaging of Medicaid enrollees by supporters of the invoice and by members of Congress with the implication that individuals can work and received’t. And that’s extremely deceptive. As I discussed, most Medicaid enrollees are working or disabled caregiving in class. After which it’s actually necessary to notice who’s going to lose their protection underneath this horrible in a position bodied language that, as you talked about, doesn’t totally seize the wide selection of individuals with disabilities who’re enrolled in Medicaid growth.
One factor to notice is that 4 in 5 of growth enrollees are ladies. 1 in 4 are age 50 and over. Most individuals left work to take care of a guardian or grownup with disabilities. All of them are low earnings by advantage of being enrolled in this system and half could be eligible for SNAP, that are meals stamps. And 1 in 4 dwell in rural areas, in order that they already could have some challenges accessing healthcare being in a rural space. Many older adults and folks with disabilities and continual circumstances, as I discussed, are going to be enrolled in Medicaid growth. One other large concern is the affect on each paid care employees in addition to unpaid caregivers. As a result of lots of people can not work to take care of a member of the family, unpaid caregivers might lose their very own healthcare protection. So, what does that imply for the older grownup or the disabled individual that they’re caring for?
Relatedly, even paid care employees, nurse aides and CNAs, they make little or no and their hours differ rather a lot, so they may lose their Medicaid as a result of they could not capable of hold with the reporting necessities mandatory. Work necessities actually have an all-encompassing affect on older adults, however significantly so for the Medicaid growth inhabitants. Subsequent slide. After which we’re going to undergo another provisions of the invoice which can be significantly regarding. One is the repeal of actually necessary rules that have been revealed within the final couple of years, that have been aimed toward bettering entry and high quality of care from Medicaid enrollees. The primary is the eligibility and enrollment guidelines, which streamlines the method for folks to get on and hold their Medicaid, and it was aimed toward stopping folks from shedding protection for these varied processing boundaries. There have been additionally lots of protections underneath these guidelines for seniors and folks with disabilities who’re duly enrolled in Medicaid and Medicare underneath the Medicare Financial savings Program or MSPs. That helps low-income Medicare enrollees pay for his or her Medicare premiums or their Medicare out-of-pocket prices.
Though it’s referred to as a Medicare Financial savings Program, it’s truly accomplished by Medicaid and so it really works collectively. The principles would’ve ensured that people who find themselves enrolled in MSPs, significantly people who find themselves very low-income and enrolled in SSI, will be capable of get enrolled in that protection extra rapidly and with out all of the boundaries that may occur when coping with these 2 huge packages. After which the rule additionally set up some parity for people who find themselves on HCBS to permit them to spend down their prices to allow them to get Medicaid extra rapidly, which is one thing that’s allowed for nursing facility residents however was not supplied for individuals who make the most of residence and community-based companies. Below this invoice, if this invoice would grow to be regulation and these rules are repealed, 2.3 million folks would lose Medicaid per the Congressional Price range Workplace, greater than 1.3 million duly eligible Medicare Medicaid enrollees would lose cost-sharing help by these MSPs.
As I discussed, it is a very low-income group with very restricted property, simply barely above federal poverty stage, who wouldn’t be capable of entry their Medicare as a result of they will’t afford it with the lack of MSPs. After which a pair states that basically would endure losses, Florida with 120,000 folks would lose protection for MSPs and it might be 75,000 in Texas. Once more, very low-income seniors and folks with disabilities who could be affected. The invoice would additionally rescind the nursing residence minimal staffing rule, which requires a minimal variety of nurses and nurse aides within the amenities. And that’s as a result of under-staffing is the most important purpose for the preventable deaths and accidents that we regularly see in nursing houses. This rule is estimated to avoid wasting 13,000 lives that are actually in jeopardy as a result of the invoice would successfully by delaying implementation to rescind the rule.
Subsequent slide. After which I’m going to skim by a few of these different eligibility restrictions. First is freezing the utmost allowable residence fairness restrict at $1 million. Presently, it’s between 730 and a bit over 1 million. That is adjusted for inflation and that is managed by states. States can set this restrict between 730 and slightly below 1.1 million. However it’s adjusted for inflation as a result of property prices rise. This invoice wouldn’t permit that adjustment for inflation would cap it at 1 million. It does have exemptions for agricultural lands, but it surely makes it actually exhausting for older adults who would possibly want long-term care. There are a lot of seniors who’re Home wealthy, money poor, could have purchased property many years and many years and many years in the past for a small fraction of what it’s at present. So even when they’re having fastened incomes which can be very low, their home is absolutely their solely asset. And if they’ve this residence fairness restrict, then that might affect their means to get long-term care by Medicaid.
The invoice would additionally restrict retroactive protection. The Home invoice was going to scale back the retroactive protection for Medicaid, from 3 months to 1 month earlier than the month of utility. Now, the Senate invoice adjustments that to 2 months for all Medicaid enrollees besides the growth inhabitants, so it nonetheless reduces it from the present 3-month stage. After which the growth inhabitants solely will get one month of retroactive protection, and that is particularly necessary as a result of retroactive protection is one device that helps folks entry nursing facility care. Suppliers are going to be more likely to supply help and assist folks out and settle for them in the event that they know that they will apply for Medicaid later after they get handled after which get the price of care coated earlier by this retroactive provision.
After which lastly, the invoice additionally eliminates the requirement for protection throughout an affordable alternative interval the place older adults would have their immigration statuses verified. And older adults usually tend to have lacking knowledge from Social Safety or the Division of Homeland Safety, which requires longer time to confirm their eligibility. That is additionally very problematic and, is also one other factor like Natalie mentioned, is aimed toward punishing immigrants. So just a few key messages, if we will go to the subsequent slide. As I discussed, there aren’t any carve-outs, no solution to protect older adults from hurt. It’s actually necessary to clarify that seniors and folks with disabilities are harm. Medicaid is necessary for all populations. We can not hit Medicaid teams in opposition to one another as a result of, as we’ve seen with all these different provisions, a reduce to at least one individual is a reduce to all.
After which if I can leap over, for functions of time, a few slides, for what you are able to do. It’s actually necessary you educate coverage makers and the general public on the significance of Medicaid for older adults. Plenty of folks learn about Medicare, however Medicaid can be a extremely necessary program for seniors. So make sure you share assets and also you’re welcome to make use of Justice in Ageing assets, after which ensure everybody is aware of that this tax invoice that the Senate goes to be voting on quickly cuts Medicaid and Medicare. Polling exhibits that about half of voters will not be conscious of the implications of Medicaid and different healthcare cuts on this invoice. And when they’re knowledgeable, they drastically oppose it.
Subsequent slide. What else you are able to do? One other factor you are able to do is storytelling, which is extremely highly effective. Members of Congress love tales, they usually and their workers don’t all the time perceive how necessary Medicaid is for older adults. That’s actually necessary to share by information media, by op-eds or opinion items, blogs, social media, rallies, digital or in-person, in addition to simply particular person conversations. After which if we come to the subsequent slide, there’s additionally simply direct advocacy. Just be sure you let your member of Congress know as a constituent that you just oppose these cuts, and see if now we have a hyperlink the place you possibly can see what states are saying concerning the affect of Medicaid and the way it’ll affect your state and even your explicit district. One different factor I’ll be aware is when speaking about Medicaid, it’s actually necessary to make use of the title of your native Medicaid program.
Generally it’s known as BadgerCare or SoonerCare or Wholesome Residing, and so folks on these packages may not understand that that program is what’s getting reduce. On the subsequent slide, now we have some methods to get entangled by becoming a member of our listserv and getting our alerts, in addition to becoming a member of the Defending Medicaid Area listserv and utilizing their toolkits. After which I’ll simply spotlight once more, these key messages, that each one of those efforts, these reforms are cuts to Medicaid to supply financial savings for these tax cuts. It’s going to shift huge prices to the states who will likely be compelled to make cuts to advantages or eligibility. So because of this, folks lose protection. It cuts Medicare too, and there aren’t any carve-outs or shields for older adults or folks with disabilities. The subsequent couple of slides are some actually useful assets from Justice in Ageing, in addition to another assets as effectively. With that, I don’t understand how a lot time now we have for questions. I apologize for that.
Amber Christ: I feel I’m truly going to show it over to Natalie to do some final minute reminders.
Gelila Selassie: Excellent.
Natalie Kean: All proper, certain. Yeah, thanks all people for sticking with us. I’ll level out actual fast this prime useful resource on the Justice in Ageing slide, the evaluation of HR 1’s Medicaid and Medicare provisions impacting older adults. That’s our latest useful resource, going by the provisions of the invoice in additional element. So should you’re actually wanting to know what’s on this invoice, encourage you to verify that out and we will likely be updating it as quickly as we will with adjustments that the Senate may be making. All proper. Simply our ultimate reminders. Medicaid is in style, however now we have to inform folks about it. As Gelila mentioned, schooling is so necessary. Name the Medicaid program by the title and your state, the waiver by the title so that individuals know you’re speaking about Medicaid, and inform them that Medicaid is being reduce within the tax invoice that Congress is contemplating.
It’s not intuitive that Congress could be chopping Medicaid in a tax invoice, so we have to get the phrase on the market. Seize any alternatives it’s a must to speak about Medicaid. Make it private. We all know that’s weak and it may be exhausting to inform your story, however everybody has older adults of their lives. And Medicaid is our long-term care system, so I’m certain all of us have a connection to this system. Sharing these tales and making it private actually helps. The battle remains to be removed from over. It’s lengthy, however we will nonetheless cease this collectively. So actually, because of our advocacy. Medicaid is on the prime of thoughts, and we’re breaking by. Thanks all for being with us.
