Medicaid Changes Still on the Table
No matter what happens with the Affordable Care Act or tax reform, all signs point to significant changes coming to Medicaid that will profoundly impact the services ORA members provide to Oregonians with disabilities.
While Republicans on Capitol Hill and CMS Secretary Seema Verma continue to espouse "unprecedented flexibility" for states in how they administer their Medicaid programs, it's become increasingly obvious that in practical terms that freedom will come with far fewer resources (i.e. dollars).
“We want to get to the point where we are making the whole waiver process easier,” Verma said during a discussion at the Cleveland Clinic’s annual medical innovation summit. “We’re not going to tell the states what their priorities are. They are going to come and tell us what their priorities are.”
“Imagine you’re trying to run this program that is the number one program in your state in terms of costs, and every time you want to make a change you have to go check in with the federal government and see what they think,” Verma said. “To me it starts with resetting that [relationship], so that states are actually in control of their program and making those decisions.”
Greater control and power over the waiver process could be a boon for Oregon, but it can't erase the fact that funding for Oregon's safety net programs is very likely to decrease in the years ahead.
Bills to repeal the Affordable Care Act may have failed – repeatedly – but Veerma continues to see the Medicaid expansion it engendered as a problem. No one can argue that rising enrollment under Obamacare didn't raise costs, but not everyone thinks it is money well spent. Verma's answer is to place new federal caps on Medicaid spending and/or enrollment and to require buy-in from recipients through health savings accounts or plans.
“We’ve seen these programs grow and grow and grow,” Verma says. “We want to make sure we have a stable program over the long term and make sure that there’s some type of a growth rate that we can all agree to.” Paring down who receives benefits is at the core of the plan. “The goal of the program should be to help people rise out of poverty,” Verma says. For able-bodied adults, the program should be “a stepping stone, not a long-term plan. We should be aiming higher.”
While tax reform won't directly impact Medicare or Medicaid, make no mistake: it's integral to Republican efforts to lower tax rates. The 2018 federal budget and tax reform plan that passed the Senate this month includes massive cuts over the next 10 years — $473 billion from Medicare and another $1 trillion from Medicaid. Those "savings," to be applied through a block-grant approach, are essential to reducing the net fiscal impact of tax reform.
Clearly, this is an issue of great concern to all providers of Medicaid services. Oregon is not exactly the only state struggling with funding, and the staffing and retention issues that come with rates inadequate to support quality services. ORA and its national partners such as ANCOR will continue to monitor this situation closely, and will alert you when opportunities arise to advocate for strong, stable and adequate Medicaid funding.