Advocates 'shocked' at Medicaid proposals' potential impact on nursing facilities

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Advocates for seniors were stunned when they learned that a Medicaid overhaul proposal may be included in a bill to replace the Affordable Care Act, one group leader reported Wednesday.

Howard Bedlin, vice president of public policy and advocacy for the National Council on Aging, spoke during a media call that brought together leaders of advocacy groups to discuss changes to the Medicaid program recently proposed by lawmakers. Groups on the call also included the National Association of Councils on Developmental Disabilities, the American Cancer Society Cancer Action Network and First Focus, a children's advocacy organization.

“Frankly we were shocked when we learned that the House wants to include a Medicaid proposal that represents the biggest change in the history of the program in the bill to repeal and replace the Affordable Care Act, since these issues are completely unrelated,” Bedlin said.

Those changes, including proposals that would move the program to a per capita limit or block grant system, worried all the groups represented on the call. They said they fear the possibility that the proposals could cut provider reimbursements or eligibility.

While the idea of a block grant or per capita cap system “makes a good sound bite,” the cuts would “hurt … end of story,” said Donna Meltzer, CEO of NACDD.

“Bottom line for us, Medicaid works,” Meltzer said. “Let's find a way to keep it working.”

Bedlin added that changes to the program would place more risk on states and governors, some of whom say the overhaul would give them more spending flexibility — flexibility that could allow them to make changes to the way nursing homes are regulated.

“We're fearful that if there is carte blanche flexibility, some states may reduce those nursing home quality standards,” Bedlin said. “But the devil's in the details, and we're anxiously awaiting seeing them.”

Medicaid is the largest payer of long-term care services, with more than 60% of LTC costs and roughly 7 million seniors covered by the program, Bedlin said.