The Ryan Budget Outlines Medicaid Reform
April 4, 2014 10:08 AM
Representative Paul Ryan (R-WI) recently released The Path to Prosperity: A Responsible Balanced Budget - The House Republican Fiscal Year 2015 Budget Resolution (The Budget). Rep. Ryan’s budget does not provide a concrete policy on Medicaid, stating instead that, “the exact contours of a Medicaid reform…will be determined by the committees of jurisdiction.” The Budget does, however, highlight two broad reform goals.
The Budget calls for greater state flexibility on Medicaid in the form of a “block-granted program like SCHIP.” It also calls on the federal government to support Medicaid waivers, which it praises as producing “innovative reforms” that brought about “cost savings, quality improvements, and beneficiary satisfaction.” The Budget estimates that pursuing these broad agenda items will bring $732 billion in savings to the federal budget over 10 years.
Repeal Medicaid Expansion
The Budget also calls for a repeal of Medicaid expansion under the Affordable Care Act. It argues that the current Medicaid expansion programs will result in the Medicaid eligible population growing by one-third, while spending will grow by $792 billion over ten years. Therefore, the Budget estimates that repealing Medicaid expansion will save the federal government $792 billion over ten years.
For the Budget’s full position on Medicaid, see pages 53-56, here.
For more analysis on Rep. Ryan’s budget from NAHC, please see NAHC Report, April 3, 2014.
Given the lack of specificity regarding Medicaid, it is too early to tell what effect the Budget will have on the program if adopted. The National Council on Medicaid Home Care – a NAHC affiliate - is wary of the Budget upon first glance. The Council opposes block grants and instead advocates for an increased Federal Medical Assistance Percentage (FMAP) to the states so that these states are given more funds for home and community-based services (HCBS) to enable them to better uphold the Olmstead decision.
The Council supports HCBS waiver programs, but only if they do not reduce benefits for current beneficiaries. The Council also opposes an unmitigated repeal of Medicaid expansion, as it would eliminate HCBS programs such as Community First Choice, Money Follows the Person, and State Balancing Incentives Program. The Council is concerned that such program cuts, without alternatives put in place of equal or higher caliber, would compromise rebalancing.
For details on the Council’s positions mentioned here, see pages 21-22, 24 and 29 of the Council’s 2014 policy blueprint, here. Home care companies are encouraged to keep abreast of national Medicaid reform initiatives, and to contact the Council with any questions or concerns.