Our Medicaid matters – STLtoday.com


The Affordable Care Act is a complex, multipronged health care package. Most of the anti-ACA vitriol has focused on the mandatory health insurance exchanges. Very little attention has been given to the Medicaid component of the ACA — except to just plain cut it back severely.

As part of the battle to repeal the ACA, congressional leaders have stated that Medicaid benefits are on the table. This would include eliminating funds for the 31 states and District of Columbia that opted to expand eligibility for Medicaid and to convert the non-expanded Medicaid program from an individual benefit to a state “block grant” while also capping benefits, services and payments an individual could receive.

Before taking any action, Congress should know who are the Missouri Medicaid beneficiaries: overwhelmingly low-income people with disabilities who were too poor to participate in the ACA exchanges and qualified only for Medicaid because they are disabled.

As of December 2015, there were about 133,248 Missouri disabled people classified as “blind and disabled,” of whom 21,755 are disabled children (under 18 years) and 99,044 are disabled adults (18-64) who receive their health care, according to Social Security Disability statistics, through Missouri’s Medicaid program. Of the total statewide, in St. Louis County there were 3,777 disabled children and 11,592 disabled adults who received Medicaid benefits.

Medicaid benefits are absolutely essential for people with disabilities, and a reduction in federal reimbursements — one proposal would slash Medicaid by $860 billion over 10 years — would not only significantly cut state revenue, but would be disastrous for all individuals involved and especially people with disabilities.

Here is what’s at stake:

• Medicaid is currently the primary health insurance that pays for community-based services for the disabled. It is also the primary payer that provides long-term care services that keep people with disabilities (and residents older than 65 who receive Medicaid) in their own homes with their families instead of them being sent to nursing homes or other institutional settings.

• Medicaid block grants and capping benefits and services will disproportionately affect people with the most serious and expensive health care needs — people with disabilities and many people over 65. Block grants will result both in reduced benefits and reduced payments, pitting all people with serious impairments against one another for their health care needs. Providers, whether doctors, clinics or hospitals, will opt out of the program. They would not participate in a program where they lose money.

• The impact on hospitals will be disastrous. Before the ACA, hospitals wrote off uncompensated care — bad debt — for people who could not afford to pay. The ACA’s Medicaid expansion allowed hospitals to increase the number of Medicaid patients, and this offset the hospitals’ previous losses. Cuts would mean the loss of expanded Medicaid population and the compensation for their coverage. Who will pay for these costs, since the need doesn’t go away just because the budget gets cut?

But that’s not all. There is something else to consider. Due to the dramatic improvements brought about by the disability rights movement in the U.S., we now have better access than ever to businesses, public transportation, infrastructure, schools and universities, housing and public accommodations. More and more businesses are seeking a diverse and inclusive workforce. In 2014 the Office of Federal Contract Compliance Programs issued regulations requiring federal contractors to have a workforce that includes 7 percent employees with disabilities. All of this combines to create the best climate we’ve ever experienced to welcome people with disabilities into the workforce.

An increasing number of young people with disabilities are now going to college and gaining the educational degrees needed to work in corporate America. Many of them, however, rely on Medicaid for their health insurance and personal assistance services (attendants) for their daily needs. Under the current Missouri Medicaid program, if they earn over 300 percent of poverty, approximately $36,000, they will lose their health care and attendant services. So why would they even go to work?

If we reform Medicaid by letting people on Medicaid go to work, earn what they are capable of, pay taxes and a reasonable monthly premium for their health insurance and attendants, everyone wins. Without reform, nothing comes back into the Medicaid program.

During our national debate over the ACA, we must keep in mind Medicaid’s most vulnerable beneficiaries: people with disabilities and low-income seniors. Let’s hope Missouri’s elected representatives in Congress do not act to injure these citizens.

Colleen Kelly Starkloff is founder and co-director of the Starkloff Disability Institute.


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