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Medicaid caps pitched by GOP could shrink seniors’ benefits

Stephanie O’Neill | California Healthline | 3/23/2017, midnight
Before nursing home patient Carmencita Misa became bedridden, she was a veritable “dancing queen,” says her daughter, Charlotte Altieri. “Even ...

“Federal payment for Medicaid would drop sharply, resulting in fewer services for everyone who relies on Medicaid, including older adults who account for more than 22 percent of all Medicaid spending,” the report predicted.

In 2015, Medicaid spending topped $552 billion nationwide, including more than $85 billion spent on Medi-Cal enrollees, according to the Kaiser Family Foundation. (California Healthline is produced by Kaiser Health News, which is an editorially independent service of the foundation.)

Under the GOP proposal, nursing care in a facility would remain a guaranteed Medicaid benefit, though states could reduce how much they spent on it if they were forced to economize. And Republicans might well attempt to loosen or undo federal program requirements with subsequent legislation that would give states more control.

Such a shift would “decimate Medicaid’s current guarantee of adequate and affordable care,” according to the Justice in Aging paper.

In the meantime, states could do away with benefits not guaranteed under federal law, which include at-home nursing, personal care — which Medi-Cal covers for qualified beneficiaries — and even inpatient and nursing care in mental health facilities for the elderly.

A report released last week by the nonpartisan Congressional Budget Office suggests states might cut provider payments or eliminate some of their optional services to fill the funding gap left by the restricted flow of federal money.

Oren Cass, a senior fellow with the Manhattan Institute who specializes in anti-poverty law, doesn’t believe that means the GOP plan would necessarily harm elderly Medicaid beneficiaries.

“A state that wants to continue the spending it does on the elderly can do that if it would rather make cuts elsewhere,” he said. “Or it can put up more of its own money.”

Cass said that having more flexibility might appeal to California legislators and health care leaders.

“If you ask California today whether it would rather have Donald Trump run its Medicaid program or run it itself, I think most people there, especially liberal people, would say they would rather have the state making the rules,” he said.

For now, however, the debate over the GOP bill is largely speculative, since there may be enough Republicans with serious concerns about the legislation to sink or significantly amend it.

The CBO report shows the bill would reduce federal budget deficits by a cumulative $337 billion over a decade. The CBO also projected that the bill, if passed, would leave 14 million more people uninsured next year than under current law and 24 million more by 2026.

The cost savings may not be enough to overcome the reluctance of many conservative Congress members who call the bill “Obamacare Lite” because it retains some of the most popular features of the Affordable Care Act.

As the debate heats up in Washington, Charlotte Altieri of Long Beach remains hopeful that her mother’s nursing home care will be spared any cuts.

“We’re not at some grandiose nursing home right now,” she said, “Where are we going to find one that costs less than this one?”