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Medicaid Funding Caps Would Harm Older Adults

Aging and Disabilities

Medicaid Funding Caps Would Harm Older Adults

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Per capita caps would result in devastating cuts in Medicaid funding. Because care for seniors and people with disabilities makes up 72% of Medicaid spending in Pennsylvania, the deep federal cuts would lead to drastic reductions in services or coverage for these vulnerable populations. Tell your U.S. Senators and Representatives that Cutting Medicaid Hurts Seniors!

Older adults should receive access to affordable health care and long term care services to enable them to live safely, with dignity and in their own homes whenever possible.  Congress is currently considering a bill that threatens to drastically reduce health care coverage and access for seniors.   The bill would roll back Pennsylvania’s Medicaid expansion and impose per capita caps, or per-person limits, on Medicaid funding.  Here are five ways the bill would harm older Pennsylvanians:

  1.  Per capita caps would result in devastating cuts in Medicaid funding.  Through per capita caps, the federal government would pay states a fixed amount to cover each Medicaid enrollee based on a formula.  Pennsylvania would receive significantly less federal funding than under current law and less than state’s actual health care costs. Increases in future years would be capped at low rates that do not keep up with inflation in health care costs.  State losses would increase every year, adding up to billions of dollars over time and creating state budget shortages which would force reductions in covered services or the number of people who qualify.  Because care for seniors and people with disabilities makes up 72% of Medicaid spending in Pennsylvania, the deep federal cuts would inevitably lead to drastic reductions in services or coverage for these vulnerable populations. 
  2.  Seniors would likely lose services they need to live at home. Services to help frail older adults continue to live in their homes would be at especially great risk of cuts.  States have made great strides in using Medicaid to provide services such as personal care, nursing, home modifications, and meal delivery to older adults in their own homes so that they can avoid having to enter a nursing home.  However, the drastic funding cuts that would result from per capita caps would create tremendous pressure on states to cut back on these programs, either by serving fewer people or by limiting the services available.
  3.  Seniors could lose access to nursing home care.  State budget shortfalls created by the loss of federal funding would create pressure to reduce nursing home costs by dropping coverage for optional coverage groups or requiring enrollees to be more disabled in order to qualify for care.  Long term care in a nursing home care is not covered by Medicare and is staggeringly expensive.  As a result, most nursing home care is paid for by Medicaid, including for middle class seniors who qualify after exhausting their savings.  If states cut back on nursing home coverage, families will be left to find a way to pay huge nursing home bills or provide 24 hour care for their loved ones at home.
  4. Seniors could also face higher Medicare cost-sharing bills.  The Medicare program requires beneficiaries to pay for a significant amount of their care through substantial premiums, copayments, deductibles and the Part D “donut hole”.  Under current rules, Medicaid covers this cost sharing for low-income older adults for whom it would be unaffordable.  States facing huge Medicaid deficits are likely to ask for federal approval to cut these benefits.  If approved, it would make health care unaffordable and decrease access to care for older adults who are already struggling to make ends meet.
  5. Millions between age 55 and 64 would lose Medicaid coverage.  The bill Congress is currently considering would freeze enhanced federal funding for the Medicaid expansion starting in 2020.  Starting in 2020, states could cover new enrollees, but they would get much less federal funding.  Most states would be forced to stop offering coverage due to budget reasons.  Millions of adults between the ages of 55 and 64 who receive Medicaid through the expansion would lose their coverage.    People in this age group are at especially great risk of not having employer-sponsored insurance due to disability, age discrimination, and downsizing from the recession.  And purchasing insurance in the individual market is likely to be unaffordable for them because insurers can charge much higher premiums for older adults.   Without Medicaid coverage, many of these individuals will be left uninsured and without access to health care.

Speak up for Pennsylvania Medicaid!

Tell your U.S. Senators and Representatives:

  • Keep Medicaid expansion; and
  • No Medicaid per capita caps.



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