Calls for Action Regarding Eligibility for Medicaid

Everyone is awaiting the Senate’s move regarding the proposed repeal of the Affordable Care Act (ACA). Earlier this year, the House of Representatives voted to replace it with a downgraded version of American Health Care Act, with the Trump administration recently revealing plans to cut budgets for Medicaid and Social Security Disability Insurance.

Whatever the Senate would approve on, however, there’s one thing that’s sure: healthcare cost is rising for states that widened their requirements for eligibility for Medicaid under the ACA. As uncertainties hover over the future of this federal-state program that was designed to provide services to low-income families, the elderly and people with disabilities, organizations are urging the authorities to protect it.

About 120 leading patient organizations wrote a letter to the Senate expressing concerns about Medicaid. They urged the Senate leadership to stop actions that would change Medicaid’s funding and stop its expansion. They want to keep Medicaid as a support line to patients with existing healthcare needs, stop the proposed switch into a per capita cap or block grant system, and maintain the program’s coverage expansion.

Protection for Eligibility for Medicaid, Expansion and Funding Urged

A Critical Lifeline

The organizations consider Medicaid as a critical lifeline for patients and consumers with ongoing medical conditions. About 50% of all births are covered by Medicaid, as well as treatments and therapies for more than half of children living with cystic fibrosis. Medicaid also covers cancer patients and those suffering from other medical issues such as asthma and diabetes.

Without Medicaid, these patients, especially low-income households, wouldn’t have other affordable sources of funding to take care of their health needs. They will have to rely on out-of-pocket payments, a serious step back since they are currently eligible under income-related and disability criteria of Medicaid.

Per Capita Caps a Hindrance to Breakthroughs

Under the proposal, federal financing of Medicaid would be reduced and switched into a per capita or block grant system. This would transfer the financial responsibility to states to make up the difference using their funds. If they don’t have the funds, they will be forced to reduce the number of people covered by the health assistance programs. This would also give states no other choice but to increase cost-sharing, narrow down eligibility, and cut provider payments. This could be devastating for families relying on Medicaid to treat their ongoing illnesses.

More importantly, the proposed system could hinder the development of groundbreaking treatments due to the lack of funds and affordable access to healthcare providers. Advanced treatments are necessary to treat a range of conditions such as cancer, cystic fibrosis and arthritis. If patients aren’t able to seek new treatments, breakthroughs won’t occur, preventing them from improving their quality of life and prolonging their lives.

Medicaid Expansion Crucial

Scrapping Medicaid expansion would put millions of people with chronic diseases at risk. Because it will limit their access to affordable care and treatment, their health would have a lesser chance of improving. Add to it the stress of high medical costs they would face.

Since almost half of adults under Medicaid expansion are dealing with permanent disability, they need ongoing treatments and maintenance. However, they might lose their coverage when states are required to remove the enhanced match for enrollees. Billions of dollars will be needed for states to continue covering this population, which would be a heavy financial burden on them. This could eventually make it impossible for them to provide affordable services to people with chronic conditions and disabilities that prevent them from working efficiently.

These were the concerns raised by leading patient organizations, which are also calling for a dialogue. Such concerns can also affect the revenue cycle management (RCM) of hospitals and healthcare facilities that utilize Medicaid. That’s also why RCM experts must find a way to deal with such issues to keep providing quality care to millions of Americans, including low-income families.

120 Patient Organizations Call on Senate to Defend Medicaid,
The Basis for Compromise on Medicaid Reform and Expansion,

Pete Ash

Pete is the Vice President of Sales & Client Services at DECO Recovery Management. He covers the Mid Atlantic region and specializes in Medicaid related topics. It is DECO’s Mission to maximize reimbursement to our clients by leveraging innovative technology, processes and compassionate advocates to provide exemplary service.

Categories: Medicaid