A proposed Medicaid policy announced Jan. 30 by CMS drew a swift, sharp response from the Academy, which recognized the change as one that would restrict rather than expand health care options for Americans.
The administration's "Healthy Adult Opportunity" proposal(www.medicaid.gov) would "upend the current Medicaid financing system in favor of a disruptive block grant financing mechanism," warned a statement issued the same day by AAFP President Gary LeRoy, M.D., of Dayton, Ohio.
The Academy's statement was followed on Feb. 3 by a similar warning from The Partnership for Medicaid,(www.partnershipformedicaid.org) of which the Academy is a member, that the proposal "could lead to significant benefit cuts and may require states to limit the number of beneficiaries receiving coverage," putting vulnerable populations at greater risk.
The change would let states seek federal approval to end their longstanding open-ended Medicaid programs. It also would strictly limit how much money states and the federal government spend on poor and disabled patients, in part by targeting the Patient Protection and Affordable Care Act's eligibility allowance for low-income childless adults -- whom opponents of Medicaid expansion often refer to as "able-bodied adults."
"This change, which would affect all adults who are not disabled or in Medicaid long-term care services, would reduce access to care in rural and other medically underserved areas; increase strain on state and local governments, physicians and other clinicians, and patients; and ultimately increase uncompensated care costs," the AAFP's statement said.
The Academy noted that Medicaid's expansion during the past six years has contributed to increased access to care for at-risk populations, including underinsured working families. More broadly, Medicaid remains vitally important to the health of some 70 million Americans, including children, pregnant women, seniors and people with disabilities.
Nearly two-thirds of family physicians accept new Medicaid patients.
"Moving to a block grant system will likely limit the ability of Medicaid patients to receive preventive and needed medical care from their family physicians, and it will only increase the health disparities that exist in these communities, worsen overall health outcomes and, ultimately, increase costs," the AAFP said.
"The current state-federal partnership that exists for Medicaid already allows states significant flexibility to shape the program to fit their needs," the statement added.
The Partnership for Medicaid noted that block grants would "represent a dramatic shift of the program's costs, financial risk and oversight onto already-burdened state and local governments, providers, plans, beneficiaries and local taxpayers, which may lead to financial uncertainty for other critical state priorities."
In Tennessee, a state that has not expanded Medicaid under the ACA, the legislature last year pushed through a block grant plan that drew national scrutiny(www.commonwealthfund.org) as a possible roadmap for other states wanting to reshape their programs.
CMS' proposed rule signals the administration's renewed effort to significantly alter Medicaid aside from the continuing legal struggle over the ACA -- a move that guarantees new political and court battles.
"Our legal team will be carefully assessing the enforcement and litigation options with respect to the guidance document," Jane Perkins, legal director of the National Health Law Program, told The Washington Post in a Jan. 28 story.(www.washingtonpost.com)
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AAFP, Chapters Caution HHS on Changing Medicaid Eligibility