Senate Health Bill Could Do Great Harm to Home-and-Community-Based Services
July 17, 2017 01:40 PM
The Better Care Reconciliation Act (BCRA), the Senate Republican plan to dramatically alter “Obamacare,” will, if it becomes law, endanger home-and-community-based services for millions of Americans due to severe Medicaid cuts, according to analyses by NAHC and other responsible and reputable sources.
Happily, the BCRA instructs the Department of Health and Human Services to encourage states to adopt or extend home-and-community-based services Medicaid waiver programs, which allow seniors and the disabled to remain in their own homes. However, the BCRA still includes steep Medicaid cuts of around $770 billion over ten years, which would equal a 26 percent cut in funding by 2026 and ballooning to a 35 percent reduction by 2036. It is very difficult to see how HHS can plausibly encourage states to increase home-and-community-based services (HCBS) in the teeth of such severe Medicaid spending reductions.
The BCRA would limit future Medicaid spending with a per capita cap – capping funding at a certain amount per beneficiary – and the amount of money allocated would rise year-to-year less than the current projection for Medicaid per capita costs, according to Congressional Budget Office (CBO) projections. That means the cuts would be real and would accelerate with time, likely growing larger every single year. According to the CBO, states struggling to pay the bills with a drastically reduced federal contribution would almost certainly be forced to restrict eligibility, cut provider payments, and eliminate optional services.
Elimination of optional services is of particular concern to the home health community, of course. (States currently increase or reduce funding for optional services based on budgetary concerns.) The biggest share of Medicaid funding for optional services provides home-and-community-based services (HCBS) to the elderly, disabled and ill.
Nursing home care must be provided to all eligible beneficiaries, but the same is not true of home-and-community-based services. Despite official HHS prodding of states to shift funding to HBCS and LTSS, state governments would inevitably be compelled to return to spending the bulk of Medicaid money on institutional care, forcing people out of their homes against their will.
The share of Medicaid funding for long-term services and supports (LTSS) rose from less than 20 percent in 1995 to 55 percent 20 years later, allowing three million people to remain in their own homes rather than be forced into institutional care. The need for HCBS will continue to grow as the population increases and ages. The Silver Tsunami – 10,000 people turning 65 every single day and many more people surviving into advanced old age, when health care costs grow faster – will not be cheap.
However, as noted above, the per capita caps on Medicaid funding would not rise to account for an increase in per beneficiary costs.
Additionally, the per capita caps will put similar pressure on hospice because it is also an optional service under Medicaid. Over 40 states offer hospice services through Medicaid, but, faced with per capita caps, those states might come to see nursing homes as a viable alternative to hospice.
This does not have to happen. Please use the NAHC Legislative Action Center to tell your members of Congress to reject Medicaid cuts in any health care reform legislation. It takes only a few moments and millions of home health patients and providers could be depending on it.