Medicaid Is a Lifeline for Older Adults
Almost 80 million individuals, together with almost 13 million older adults and other people with disabilities, depend on Medicaid for well being and long-term care. With out Medicaid, most older adults who need assistance with day by day actions wouldn’t have the ability to afford home-based or nursing facility care. Medicaid helps tens of millions of older adults pay their Medicare cost-sharing and in addition covers very important advantages that Medicare doesn’t, resembling dental, imaginative and prescient, listening to, and non-emergency medical transportation. Many paid and unpaid caregivers for older adults additionally depend on Medicaid for their very own well being protection.
Medicaid “reform” proposals that goal to take federal funding away from states or prohibit eligibility would all result in the identical consequence: older adults dropping entry to well being and long-term care. Right here’s what’s in danger for older adults if policymakers implement these proposals.
Cap or Lower Federal Medicaid Funding to States
Medicaid is a state-federal partnership that ensures federal monetary assist to each state to supply important well being and long-term care to older adults and different individuals with restricted earnings and financial savings. Because the variety of older adults who want long-term care grows and state Medicaid prices improve, the federal authorities helps meet these rising prices by matching a share of every greenback the state spends. Listed below are 3 ways proposed “reforms” would reduce Medicaid funding:
- Below block grants or per capita caps, states would obtain a hard and fast quantity of federal Medicaid funding, no matter precise prices. This implies federal funding would now not sustain with elevated prices, shrinking Medicaid over time for all populations, together with older adults, and stopping satisfactory response throughout emergencies resembling pandemics or pure disasters when Medicaid has traditionally been a key useful resource.
- Decreasing the federal match (Federal Medical Help Proportion or FMAP), together with eradicating the minimal 50% FMAP, would shift prices to states, forcing them to chop general Medicaid spending. Ending the improved 90% FMAP for Medicaid Growth, which covers tens of millions of older adults beneath age 65 in addition to paid and unpaid caregivers, would robotically finish growth in a number of states and drive different states to reduce Medicaid packages and providers that older adults depend on.
- Proscribing allowable supplier and insurer taxes, which each state makes use of to assist fund all of their Medicaid packages, would cut back state budgets and drive Medicaid cuts.
All of those proposals would starve Medicaid, forcing states to cut back spending by slicing packages and providers that federal regulation doesn’t require to be lined. The first goal would be the dwelling and community-based providers (HCBS) that older adults and other people with disabilities depend on day by day as a result of these packages account for a big share of Medicaid spending. Different advantages like dental, imaginative and prescient, and listening to, in addition to expanded eligibility for Medicare Financial savings Applications and nursing amenities would even be on the chopping block.
With decreased Medicaid budgets, states would additionally reduce supplier cost charges, lowering supplier entry and worsening direct care workforce shortages. In consequence, older adults would have a tougher time discovering HCBS suppliers and other people dwelling in nursing amenities can be at elevated threat of poor care.
Restrict the Variety of Eligible People Who Enroll in Medicaid
As a result of Medicaid eligibility and enrollment is sophisticated, many older adults who’re already eligible for HCBS, Medicare Financial savings Applications, and different advantages should not enrolled. Some proposed Medicaid “reforms” goal to capitalize on this complexity to forestall enrollment and take away protection from eligible individuals. Listed below are two methods imposing further purple tape would reduce Medicaid:
- Repealing the not too long ago finalized Streamlining Medicaid Eligibility and Enrollment guidelines and different laws would threaten federal actions at present underway to assist eligible people entry and preserve Medicaid. These guidelines assist older adults with low, mounted incomes and few belongings by simplifying asset verification, limiting the frequency of eligibility redeterminations, robotically enrolling individuals on SSI into the Certified Medicare Beneficiary program, and permitting individuals with disabilities to challenge their HCBS bills when spending right down to Medicaid eligibility.
- Including purple tape resembling work necessities would make it tougher for older adults and their caregivers to maintain Medicaid. Expertise reveals work necessities will take away protection from older adults and other people with disabilities who’re already working, are retired or have issue discovering work, and household caregivers. Such purple tape additionally places older adults age 65 and older liable to gaps in entry to well being care by slowing down program administration, together with well timed processing of Medicaid purposes for all populations.
The first goal of those repeals and purple tape can be to remove Medicaid to chop spending, regardless of growing prices to manage needlessly complicated eligibility and renewal processes.
Any Measurement Medicaid Lower Will Take Care Away from Older Adults
No matter what form or measurement these “reforms” take, they’re all cuts with the identical specific purpose: to cut back Medicaid spending to pay for different priorities resembling tax cuts for the rich and companies. The results of each reduce can be the identical: taking away well being care and HCBS from older adults, individuals with disabilities, and their caregivers.
Justice in Ageing Sources
Medicaid Work Necessities: Purple Tape That Would Lower Well being Protection for Older Adults (2023)
