Tyler Williamson: Attack on Medicaid harms the intellectually disabled – Virginian-Pilot




MEDICAID is vital for the care and support of intellectually disabled individuals. In addition to medical services, they rely on Medicaid for home- and community-based services, which allow families to keep and care for loved ones in their homes without going bankrupt.

The Medicaid waiver program waives the requirement that dependent disabled people be placed in group-care settings, such as institutions, instead of in-home care. This is a win-win because these services are cheaper than institutions, and families may keep their loved ones at home.

Traditional Medicaid has been under constant threat as a result of efforts to “reform” health care. Traditional Medicaid refers to Medicaid as it has existed and evolved since it was signed into law by Democratic President Lyndon Johnson in 1965 and passed on a bipartisan basis. It provides benefits for children of low-income families, pregnant women, the disabled and the elderly.



In 1981, Republican President Ronald Reagan signed into law a bipartisan bill expanding Medicaid to cover home- and community-based services for individuals with intellectual disabilities.

The congressional majority seeks to describe its various bills as merely repealing and replacing Obamacare, but Americans should look closer. While the public discussion focuses on the repeal and replacement of Obamacare, the most profound effect and intent is to transform the traditional Medicaid of Johnson and Reagan into a per-capita block grant to the states.

I have formed my opinions on this issue as the brother of a person with autism, as a local attorney and as an advocate for the disabled. I oppose the restructuring of traditional Medicaid from an open-ended reimbursement to a per-capita cap, which would affect 50 to 60 million people, including those with profound disabilities.

A per-capita cap would cause federal Medicaid financing to grow much more slowly than under current law. For example, the American Health Care Act passed by the House was estimated by the Congressional Budget Office to cut $834 billion from Medicaid funding over a 10-year period.

Per-capita caps would shift funding away from home- and community-based services toward institutional care because HCB services are optional, while institutional care is mandatory under Medicaid. States spend more on HCB services than on any other optional benefit, making it a target of cuts during funding shortfalls. This will decrease services and increase Medicaid waiver waiting lists, which are already long.

Dismembering traditional Medicaid and giving free rein to states will result in uncertainty for intellectually disabled individuals and their families. Programs will be inconsistent among states. Parents will be forced to consider uprooting their families to move to states that provide better care.

Intellectually disabled individuals are dependent on these services, and these stealth attacks on traditional Medicaid are directed at our most vulnerable citizens.



I have seen first-hand how crucial HCB services are to families.

At age 2, my brother Brian was diagnosed with autism. My parents tried balancing their careers while raising a child with special needs. This proved an impossible task due to the severity of Brian’s intellectual disability (he was completely nonverbal), and his propensity for trouble (he loved sneaking off any time my parents looked away), so my mom gave up the career she had built to care for us.

Even with Mom around full time, we needed outside help to get Brian proper behavioral therapy and supervision. My family turned to Medicaid for the support we needed. Brian is only 26 and will need Medicaid-funded behavioral therapy and supervision for the rest of his life.

Large numbers of families in Tidewater rely on home- and community-based services. Families of Autistic Children in Tidewater (F.A.C.T.), a local nonprofit organization, has helped more than 2,000 individuals with autism, including Brian, through support programs and summer camps. Currently, more than 50 percent of F.A.C.T. families are low income. This population is particularly dependent on HCB services provided under Medicaid.

Though the battle over the Graham-Cassidy health care bill may be over, the war to protect traditional Medicaid is by no means won. As House Speaker Paul Ryan told Rich Lowry, editor of National Review: “So Medicaid, sending it back to the states, capping its growth. We’ve been dreaming of this since I’ve been around — since you and I were drinking at a keg.” Ryan’s dream is a nightmare.

If you agree, contact your representatives in Congress. They are all up for re-election in November 2018.






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