With Billions In Proposed Cuts, Medicaid Waivers May Be At Risk

The health care proposal in the U.S. Senate would slash $772 billion from Medicaid in the next decade, the Congressional Budget Office said, seriously compromising services for people with disabilities.

The nonpartisan budget office said Monday that, if adopted, the Senate bill will trigger continuing disparities in federal support for Medicaid.

By 2026, annual spending on the program would be 26 percent lower than under current policy, according to the projections. And that gap would continue to compound over time.

“Despite the uncertainty, the direction of certain effects of this legislation is clear. For example, the amount of federal revenues collected and the amount of spending on Medicaid would almost surely both be lower than under current law,” the Congressional Budget Office found.

The cuts would be especially significant to people with disabilities who represent just 15 percent of Medicaid beneficiaries, but account for 42 percent of the program’s costs, according to the Kaiser Family Foundation. In addition to traditional health care services like doctor and hospital visits, Medicaid provides assistance for people with disabilities to live and work in the community.

Both the Senate bill and a version passed by the House of Representatives in May call for historic changes to Medicaid. Traditionally, the program has operated as an entitlement meaning services are provided to anyone who meets eligibility requirements, with the federal government providing matching grants to states to help cover the cost.

Under the Republican plans, however, Medicaid would shift to a per capita cap system where the federal government would provide a fixed amount for each beneficiary no matter how much their care truly costs. States would be left to make up the difference.

“With less federal reimbursement for Medicaid, states would need to decide whether to commit more of their own resources to finance the program at current-law levels or to reduce spending by cutting payments to health care providers and health plans, eliminating optional services, restricting eligibility for enrollment through work requirements and other changes or (to the extent feasible) arriving at more efficient methods for delivering services,” the Congressional Budget Office determined.

States would likely resort to a “mix of those approaches,” the budget office said.

Disability advocates have warned that home and community-based services for people with disabilities would be the first to go because they are considered optional under Medicaid policy.

“Hundreds of billions of dollars of cuts in Medicaid are never acceptable,” said Julia Bascom, executive director of the Autistic Self Advocacy Network, who indicated that the budget office’s projections are just the tip of the iceberg.

“If you look at the bill, you can see they’ve hidden the deepest cuts in the years following CBO’s 10-year window,” Bascom said. “People with disabilities cannot afford this bill."