Disability rights activists and care advocates hold a vigil in October 2021 outside the Capitol in Washington to urge Congress to approve additional funding for home and community-based services. (Larry French/Getty Images for The Arc of the United States)
With Republicans poised to take control in Washington, disability advocates warn that proposals are in the works to dramatically reshape Medicaid and undermine the nation’s system of home and community-based services.
President-elect Donald Trump and his allies on Capitol Hill are reportedly seeks to squeeze money from Medicaid and other safety net programs while looking for ways to offset the cost of expanding tax cuts passed during his first term.
The measures are ringing alarm bells among disability advocates who have spent years calling for greater investment in the long-fought Medicaid home and community services program, which serves as a backbone of support for people with disabilities in the state. development in this country.
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“We are extremely concerned about Medicaid right now,” said Nicole Jorwic, head of advocacy and campaigns for Caring Across Generations, an organization that advocates for caregivers and the people who depend on them. “We have already heard that Republican leadership is looking for ways to cut Medicaid, as they proposed in 2017 and again in the fight over the 2023 debt ceiling, whether with draconian work requirements or block grants. Either of the two would put the entire infrastructure of domestic and community services at risk.”
Traditionally, the federal government has provided matching grants to states to help pay the cost of care for anyone eligible for Medicaid, no matter how expensive.
However, during his first term, Trump and Republicans in Congress repeatedly pushed to transform Medicaid into a “per capita cap” or “block grant” system. Under those models, the federal government would provide a set amount of money to states each year for the program.
Such a change would pressure states to limit spending and jeopardize funding for disability services, advocates say.
“If Congress were to block the grant of the Medicaid program, it would eliminate minimum standards, leaving all decisions about eligibility criteria and the scope and duration of services to states,” said Katy Neas, executive director of The Arc of the United States. . “Such changes could force impossible decisions to be made. Would states decide to fund health and developmental services for children with disabilities or fund only nursing home care for older adults? Would states pay for services that allow an adult to live at home, or would that adult be forced into a nursing home or hospital?
Concerns about Medicaid come at a time when the program’s services for people with developmental disabilities are already under great strain. According to The Arc, nearly 700,000 people nationwide are on waiting lists for Medicaid waivers, which provide home and community-based services. And even those with exemptions can’t always access the services they need.
A survey of hundreds of disability services providers late last year found that widespread staffing shortages had led 77% of providers to say they were declining or no longer accepting referrals and 44% to indicate they had discontinued their services. offers. More than 60% reported that they were considering closing more programs or services.
“We are preparing to defend Medicaid against any proposals that cut services and supports,” said Kim Musheno, vice president of public policy at the Autism Society of America. “People with disabilities suffer from the collapse of the service system. “The federal government should increase Medicaid funding to develop the direct care workforce, not (cut it).”
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