Capitol Correspondence - 07.22.19

Patient Groups Pre-emptively Protest Upcoming Medicaid Block Grant Proposal

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ANCOR is sharing this letter by a group of patient organizations so our members can see the broader policy discussions in Washington, DC surrounding an as-yet-unreleased proposal by the Centers for Medicare and Medicaid Services (CMS) to block grant Medicaid through administrative means. The proposal is pending review at the Office of Management and Budget (OMB) in the White House right now. ANCOR shared our concerns about block granting Medicaid in a meeting with OMB last month because Medicaid funds the majority of supports for people with intellectual / developmental disabilities (I/DD) in the United States.

As written in the group letter:

“Per capita caps and block grants are designed to reduce federal funding for Medicaid, forcing states to either make up the difference with their own funds or make cuts to their programs that would reduce access to care for the patients we represent. With support from the Centers for Medicare and Medicaid Services (CMS), states like Utah and Tennessee are already moving forward with deeply troubling proposals in anticipation of new federal guidance promoting such capped financing arrangements. While still lacking many key details, these proposals confirm that some states are actively working to pursue policies such as enrollment caps and changes to prescription drug benefits as part of block grant or per capita cap proposals.

The effects of these cuts are very serious for the patients we represent. States under a block grant or per capita cap would struggle to respond to changes in standards of care, such as the development of a ground-breaking but expensive treatment, and would have a greater incentive to impose additional barriers for treatments to manage their overall costs. Our communities have already had experiences, some dire, in which Medicaid programs have denied patients needed therapies because of budget constraints. Additionally, per capita caps and block grants would cut Medicaid most deeply when the need is greatest, as these financing structures do not protect either states or patients from financial risk as the result of an economic downturn or other unexpected event. As the gap between the capped allotment and actual costs of patient care increases over time, states will likely limit enrollment, reduce benefits, lower provider payments or increase cost-sharing for patients.”