Partnership Calls for Congressional Intervention to Block Medicaid Cuts

The diverse member organizations of the Partnership for Medicaid, (3-page PDF; About PDFs) including founding member AAFP, are urging Congress to block several proposed and current CMS regulations that would terminate coverage for thousands of recipients now covered by Medicaid and the State Children's Health Insurance Program, or SCHIP, by tightening eligibility requirements for the two programs.

In a Feb. 12 letter to House and Senate leaders, the partnership, which is a nationwide coalition dedicated to preserving and improving Medicaid, said it is "particularly disturbed by a series of proposed and current Medicaid regulations and guidance by CMS that threaten to narrow the ability of states to disregard some portion of family income, such as earnings or child care expenses, in determining Medicaid and SCHIP eligibility."

"These actions could result in significantly fewer low-income individuals and families being eligible for these important programs," said the letter.

CMS also is applying an SCHIP policy directive to Medicaid to limit the ability of states to cover children in families with incomes totaling more than 250 percent of the federal poverty level. This move will undermine access to care for thousands of children and lead to much higher health care costs down the road, predicted Dan Hawkins, policy director of the National Association of Community Health Centers, which coordinates the partnership's activities.

"This is going to mean that kids who are much less expensive to care for when they receive good preventive and primary care are going to be sicker and more costly to the health care system when they get sick," Hawkins said in an interview with AAFP News Now.

He added that the partnership has joined with many congressional leaders, governors and policy experts in claiming that the Bush administration is implementing measures without the consent of Congress, even though that congressional approval is required.

"We are arguing that Congress needs to say to the administration, 'You do not have that authority,'" Hawkins said.

For example, CMS is proposing nearly $6 billion in budget cuts by reducing access to community-based services under the rehabilitative services option and by eliminating transportation and administrative support services for children with disabilities enrolled in special education programs. At the same time, the agency is putting forth rules that would slash the targeted case management program by $1.2 billion by shifting the cost of case management services to cash-strapped state and local governments, according to the letter.

"These regulations -- when combined -- include hundreds of pages of regulatory requirements with scant statutory justification, and the recipients harmed are some of the most vulnerable patient populations in our society -- low-income pregnant women, children with developmental disabilities, persons with severe mental illnesses, youngsters in the foster care system, and individuals living with HIV and AIDS," the letter said.

In addition, there are other regulations that "threaten the already fragile viability of the nation's health care safety net," according to the letter, including rules that would "impose sweeping Medicaid funding cuts that will force safety net hospitals and other safety net providers to eliminate vital community services for patients."

Proposed graduate medical education payment cuts, in particular, will "obstruct the ability of teaching hospitals to provide essential services, including the education of the next generation of medical professionals despite a shortage of medical professionals around the country," said the letter.

The partnership, meanwhile, is concerned that the Congressional Budget Office, or CBO, could include the savings produced by the CMS proposals and rules in the nation's budget through the CBO's "scoring" process. This would force Congress to provide offsets in the budget to reverse the cuts.

"Congressional efforts to stop these Medicaid rules through statutory moratoria should not be scored, because Congress is only attempting to extend existing Medicaid policy and reassert its constitutional responsibility by halting the unilateral rewriting of federal health policies that impact over 55 million low-income Americans," the letter said.