Action Alert: Protect the ACA and Medicaid
This document was
developed to assist you in understanding how significant changes to Medicaid
and the Affordable Care Act (ACA) could affect you and your family. It is
important for you to understand what is included to help you make informed
decisions.
We know and are aware that for many families, the ACA was
cost prohibitive. There are still protections and benefits that affect many
children.
Family Voices of Indiana is gathering stories from
families to provide as education to our members of Congress. If you would like
to write a short story on how these changes would affect your family, please
email it with a picture to projects@fvindiana.org
By sending your story, you are granting permission
to submit to members of Congress.
Time is of the essence, they may well
start the process of attempting to make these changes after the spring recess.
Nearly 20 percent of U.S. children (14.6 million children
under age 18) have special health care needs, encompassing
a broad range of chronic illnesses and/or disabilities (e.g., cerebral palsy, autism, mental illness,
traumatic brain injury). Many of these
children rely on Medicaid and the ACA to get the care they need. One in five
families with children has at least one child with special health care needs
(CYSHCN). These families rely on Medicaid and/or the ACA to protect
them from medical debt or bankruptcy. Therefore,
Family Voices urges Members of Congress to do no harm to children:
¨
Reject
Medicaid per capita caps or block grants.
¨ Preserve ACA
protections and health benefits.
Medicaid is vital for CYSHCN and
their families:
Medicaid is an “entitlement” program, which means
that anyone who meets eligibility rules has a right to enroll in Medicaid
coverage. It also means that states have guaranteed federal financial support
for part of the cost of their Medicaid programs.
Currently, Medicaid
funding is a shared responsibility between the federal government and the state
government.
To receive federal funding, states must cover certain “mandatory” populations: low-income families and individuals, including children,
uninsured children (in IN that is Hoosier Healthwise),
parents, pregnant women, seniors, and people with disabilities. States may also
offer coverage for “optional” populations
including “carve-out”
waivers; such as The HCBS waivers: Aged & Disabled, Traumatic Brain
Injury, Family Supports, and Community Integration and Habilitation. These are Medicaid waivers that provide home
and community based services for eligible individuals who meet the necessary criteria.
They allow beneficiaries to receive
long-term health care benefits at home or in community settings outside of
institutional settings. If your child is on a Medicaid waiver, family income
guidelines under the traditional Medicaid program are waived. As a reminder, if you receive Medicaid, you are receiving
Medicaid under one of the options above. Many families are either income
eligible or receive Medicaid through one of the waivers listed above.
First
Steps (early intervention 0-3) is also funded by Medicaid. In schools, services
for children of school age receiving special education may be funded by
Medicaid. Medicaid also insures long term supports and services.
If Medicaid becomes a “block
grant” that means that states would receive a set funding level. This could have devastating effects on providing health care
to those in need (as listed above) and including not adequately paying
providers.
If Medicaid
becomes a block grant, it would be difficult for the state to provide adequate
coverage for our most vulnerable populations, whether they be income eligible
or eligible through a waiver. At this moment, the waivered services could go
away. Meaning, unless you are income eligible, you could potentially lose the
very services that assist you and your family.
For many; Medicaid is a “Lifeline”
·
About 43.4 % of Children and Youth with Special Health Care Needs
– 6.3 million – rely on Medicaid or CHIP. (For about 8 percent of these
children, Medicaid supplements private insurance, covering services and items
not covered by their private plan, such as eyeglasses, hearing aids, and
assistive devices.)
·
Medicaid allows Children and Youth with Special Health Care Needs to get
the medical treatment, medications, equipment, therapies, and other services
and supplies they need to stay as healthy as possible, thus avoiding excess and
costly hospitalizations or ER visits.
·
Medicaid covers
early and periodic screening, and diagnosis and treatment of developmental and
health problems early in a child’s life, helping to avoid more expensive
treatment or special education later on.
·
Medicaid protects
families of Children and Youth with Special
Health Care Needs from extraordinary medical debt or bankruptcy.
·
Medicaid allows
some parents to work and pay taxes by providing home health care for seriously
ill children who need it.
If Medicaid
is subject to per capita caps or block grants, states will have less money in
the long run, forcing them to significantly reduce Medicaid coverage and/or
services. Moreover, they will not be
able to respond to outbreaks (like microcephaly from the Zika virus), or to
cover new diagnostic methods, treatments or medications; with block grants
states also will be unable to respond to economic downturns.
Other considerations that would have an effect if a Medicaid
Block Grant would take place is states would no longer have these options for
the long term: Creating the Community First Choice Option- allows States to provide home and
community-based attendant services and supports to eligible Medicaid enrollees
under their State Plan.
Extending
the Money Follows the Person Rebalancing Demonstration- allows Medicaid funding (services) to follow a
person from an institutional setting to housing in the community. Even though
these services are provided by different entities, the Medicaid funding pays
for the costs of services in the community.
Creating the
Balancing Incentives Program provided
financial incentives to States to increase access to non-institutional
long-term services and supports (LTSS) in keeping with the integration mandate
of the Americans with Disabilities Act (ADA), as required by the Olmstead decision.
Current
talks on Medicaid reform if it is moved to a block grant, could lose $800
billion over ten years, seriously affecting children with disabilities without
having any coverage.
Affordable Care Act
(ACA) -
Many provisions of the ACA are being looked at to
be repealed and replaced. These changes may not
only affect the ACA and Marketplace policies but also could impact employer
based policies.
The ACA’s consumer protections and benefits are of particular
importance to the 53.3 percent of Children and Youth with Special Health Care Needs
(7.7 million) with private insurance. In ND this could include 20,000 or more
children.
ACA benefits that are being reviewed to possibly be eliminated
include:
·
Protections for children with pre-existing
conditions, without which they would
never be able to get insurance, would be charged higher premiums, and/or would
be denied coverage for their pre-existing conditions.
·
Elimination of annual and lifetime
benefit caps, and caps on
out-of-pocket expenditures, ensuring that children can get the care they need
without imposing unsupportable costs on their families.
·
Allowing young adults to stay on their
parents’ insurance policies until age 26,
and providing Medicaid to former foster children until age 26.
·
Critical health benefits, including
“habilitation” services
needed to acquire and maintain skills (e.g., physical therapy for children with
cerebral palsy so they can learn to walk, or speech therapy for children with
hearing impairments). The ACA also
ensures that children get critical oral and vision care and behavioral health
services.
·
No-cost preventive care, including check-ups and screenings to detect and
treat health or developmental problems early in a child’s life, helping to
avoid more expensive treatment or special education later on.
·
Medicaid expansion to all individuals
with incomes up to 138% of the federal poverty level, which helps young adults and others with chronic
illnesses or disabilities who do not have access to employer-based insurance.
The ACA provides non-discrimination provisions for all insurance
policies. If repealed, the loss would be drastic and could include:
·
Bans the exclusion of
people from health insurance coverage based on pre-existing conditions
·
Prevents insurers
from charging people with disabilities and health conditions significantly more
for health insurance coverage
·
Prevents insurers
from charging people with disabilities and health conditions significantly more
for health insurance coverage
Replacement being
considered would:
*Gut the protection against health insurers hiking premiums
for people with pre-existing conditions by repealing the "community
rating" provision.
*Allow insurance companies to charge more for those with pre-existing conditions, or force
enrollees to enroll in High Risk pools. These High Risk Pools are often
unaffordable for families to pay for.
*Eliminates the prohibition on
health insurance companies putting annual or lifetime limits on how much they
pay for care.
*Keeps the provisions that raise
premiums for older individuals, lower tax credits, eliminate cost-sharing
reductions.
Currently,
the ACA provides an essential benefit package, that unless the plan you are on
was grandfathered in, most insurance companies have adopted these benefits.
These are:
Outpatient
services
Emergency
services
Hospitalization
Maternity
and newborn care
Mental
health and substance use disorder services, including behavioral health
treatment
Prescription
drugs
Rehabilitative
and habilitative services and devices, laboratory services
Improves accessibility of medical diagnostic
equipment
Preventive and wellness
services and chronic disease management. Cancer screenings such as mammograms and
colonoscopies, Blood pressure and cholesterol screenings, Tobacco cessation
counseling and interventions, vaccinations
Replacement being considered would allow states
to waive or remove the essential health benefit requirements so insurers
wouldn't have to cover hospitals, doctors, prescriptions, lab tests, mental
health, maternity and newborn care, and care for substance use disorders.
These are dangerous considerations that will affect
all of our families of children and youth with special health care needs as well
as adults with disabilities.
US Capitol Switchboard (202) 224-3121. Senators for Indiana are
Senator Donnelly and Senator Young. Find your Representative here: http://www.house.gov/representatives/
Thanks to Family Voices North Dakota for allowing
us to use this document.
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