The American Health Care Act (AHCA), now being considered by Congress as a purported replacement for the Affordable Care Act (ACA), jeopardizes Medicaid's guarantee of health care to low-income people of all ages. Among those most at risk are the 40 percent of Marylanders with disabilities who rely on Medicaid and the Children's Health Insurance Program ("Horsey: The joke is on voters who trusted Trump's health care promises,") March 21.
Since 1965, the federal government has matched state expenditures for all Medicaid recipients. The AHCA instead offers two options — limiting federal funds to a certain amount per enrollee or to a set amount for a group of enrollees — that would divorce federal funding from actual Medicaid costs. States would have to make up the difference or face impossible choices in cutting services, enrollment, or provider rates.
In particular, many people with disabilities rely on Medicaid's optional home- and community-based services, which are at higher risk of funding cuts than mandatory nursing facility services. Community-based services can enable people with disabilities to live at home with the independence others take for granted. For instance, Maryland's developmental disabilities waiver funds group homes, day programs, and supported employment. The ACA's Community First Choice (CFC) program covers personal care aides who support over 7,200 Marylanders in living at home. Beyond overall Medicaid cuts, AHCA ends extra federal CFC funding that incentivizes such community-based services over more costly institutions.
Finally, AHCA allows states to implement work requirements for adult Medicaid enrollees who are not disabled, elderly or pregnant. This policy undermines rather than furthers Medicaid's purpose, which is why the Obama administration denied states' requests to impose such requirements. The Kaiser Family Foundation reports that 59 percent of non-disabled adult Medicaid recipients already work and more than one-third of those not working attributed it to illness or disability. Many people need health insurance to obtain medical documentation for proving disability while others need medical care to be healthy enough to work in the first place.
AHCA's Medicaid cuts shift costs to states and impose counterproductive requirements that threaten many Marylanders' access to needed health care.
Sarah Steege, Baltimore and Jeananne Sciabarra, Potomac
The writers are, respectively, an attorney for Disability Rights Maryland and executive director of Consumer Health First.