What is Medicaid?

Politicians and bureaucrats sometimes make it really hard to be interested in what’s happening in our nation’s capital. Lately I’ve been exhausted by all of the news headlines being dominated by rumor filled, he-said she-said, partisan posturing. Even we political scientists and recovering bureaucrats get fatigued by the political morass.

As you may be aware, Congress is strongly considering repealing the Affordable Care Act. While this is a nationally significant policy proposal and there will be ancillary impacts on people with intellectual disabilities, changes to Medicaid’s funding structure pose a much more significant threat for the health and wellbeing of people with intellectual disabilities.

Even though there is not a concrete Medicaid reform proposal on the table, sources say that congressional leadership and the Trump Administration are considering using block grants or per capita caps to reduce Medicaid spending.

In this unrelenting environment, it’s crucial we maintain our vigilance and robust advocacy efforts since programs for people with disabilities will quickly become part of the pivotal discussions occurring on Capitol Hill. In order to make sure people with disabilities have adequate support, we have to know how changes to federal funding might affect this vulnerable population.

But first: What is Medicaid and how does it work?

Medicaid provides health coverage to 70 million, or 1 in 5, Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Presidents Theodore and Franklin Roosevelt, Harry Truman, John F. Kennedy, and Lyndon Johnson were all instrumental is advocating for various concepts of national health insurance.

The Social Security Amendments of 1965, signed by President Johnson, who was heavily influenced by Kennedy, created the Medicare and Medicaid programs under Title XIX of the Social Security Act.

Medicaid is an entitlement (and entitlement does not mean what you think it means).

Programs are generally considered to be “entitlements” if legislation requires the payment of benefits to any person or unit of government that meets the eligibility required by law, and the program’s budget automatically increases as the eligible population grows. For Medicaid, if you qualify and meet eligibility, then you have a right to receive benefits that are funded by the government.

Medicaid is a safety net.

Medicaid is the main source of long-term care coverage for people with intellectual disabilities. People with disabilities account for 15 percent of Medicaid enrollees and for 42 percent of its expenditures.

Medicaid is a partnership between states and the federal government.

People with intellectual disabilities rely on Medicaid for healthcare, long-term care, residential services, day services, and other meaningful support. States rely on federal funding to implement programs that serve people with disabilities in their state. The federal government relies on states to implement quality programs.

Medicaid programs are administered by states, according to federal requirements. The federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

Because the federal guidelines are broad, states have a great deal of flexibility in designing and administering their programs. As a result, Medicaid program eligibility and benefits can vary from state-to-state.

Medicaid is a lifeline.

Medicaid entitlement funding sustains critical services and supports for people with disabilities. Previous block granting and per capita cap proposals have sought to remove Medicaid as an entitlement and limit Medicaid spending.

If this happens funding for critical services and supports for people with disabilities will likely be reduced and not all people qualifying for Medicaid may receive benefits. This will lead to a regression in the progress people with intellectual disabilities have made in the last 60 years.

This is the first blog in our Medicaid Matters series, explaining how Medicaid services provide valuable resources and supports for people with intellectual disabilities. Our next post will go into more detail about how Medicaid helps people with intellectual disabilities lead meaningful lives in their communities.

To learn more about advocating for and with people with intellectual disabilities, sign-up for Mosaic Allied Voices.

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