The Senate Health Reform Bill Slashes Medicaid Severely: Kansas Takes a Big Hit

The Senate Health Reform Bill Slashes Medicaid Severely: Kansas Takes a Big Hit


The Better Care Reconciliation Act (BCRA) now under consideration in the Senate would drastically alter Kansas’s Medicaid program. The proposed Senate bill would change the way the federal government currently funds Medicaid by limiting federal funding and shifting cost over time to both states and Medicaid enrollees. The BCRA would subject older adults, adults with disabilities, Medicaid expansion adults, and non-disabled children under age 19 to mandatory per enrollee caps beginning in 2020. State Medicaid programs would have the option to choose between block grants and per enrollee caps for non-elderly, non-disabled, non-expansion adults.

The Senate bill would start out using the medical care component of the Consumer Price Index (M-CPI)—a measure of the average out-of-pocket cost of medical care services used by an average consumer—as the growth rate for per enrollee caps through 2020. Between 2020 and 2024, a growth rate of M-CPI plus one percentage point would be used to trend costs for older adults and adults with disabilities. All other groups would have a growth rate of M-CPI. However, beginning in 2025, the BCRA would slash the growth rate for all populations by switching to the Consumer Price Index for all urban consumers (CPI-U)—a measure of general inflation that examines out-of-pocket household spending on goods and services used for everyday living. Importantly, CPI-U does not tie closely to medical costs—it’s common knowledge that such costs are increasing much faster than general inflation—and will not reflect population growth or the impact of aging. To be clear, none of the proposed growth factors—M-CPI, M-CPI+1, and CPI-U—keep pace with the growth in Medicaid spending. The cut would hit Kansas precisely at the time its aging population will be experiencing additional cost growth due to increasing need for services and supports.

By dramatically reducing the per capita cap growth factor beginning in 2025, we project that the Senate bill would cut between $11 billion and $22 billion from total (federal and state) Medicaid spending in Kansas over the 20-year period between 2017 and 2036 for the four non-expansion Medicaid enrollment groups: older adults, adults with disabilities, non-disabled children under age 19, and non-expansion adults (children with disabilities are excluded because the BCRA does not subject them to capped funding). A cut of this magnitude threatens the viability of Kansas’s Medicaid program in unprecedented ways and will likely increase the number of people who no longer have access to essential healthcare services and critical supports.

Previous analysis by the AARP Public Policy Institute discusses why capping Medicaid is flawed and would leave states—and the poorest and sickest Americans—holding the bag for the shortfalls that will most certainly occur.

Table 1 shows the cumulative 20-year cuts to Medicaid by eligibility group in Kansas under the Senate health reform bill for three growth rate projections.  The bill would cap per enrollee cost growth using two measures of inflation (M-CPI and CPI-U), which are highly variable and uncertain, though will fall well short of what is needed to maintain the integrity of Kansas’s Medicaid program.  It is difficult to plan for such uncertain growth rates, and reasonable projections are far apart.

We present the high, middle, and low case for M-CPI/CPI-U growth rates based on the following:

  • Low Case. Based on historical growth rates. Over the last five years (2012-2016), the M-CPI growth rate has averaged 3.0% per year, and the CPI-U growth rate has averaged 1.32% per year.

 

  • Middle Case. Based on projections from the Congressional Budget Office. CBO projects M-CPI to grow by 3.7% per year, and CPI-U by 2.4% per year.

 

  • High Case. Based on projections from 2016 CMS Medicaid Actuarial Report.  From 2019 onward, this report projects M-CPI to grow by 4.2% per year, and CPI-U by 2.6% per year.

 

In short, the lower the cap growth rate, the more severe the Medicaid cuts will be.

Table 1 above  demonstrates that for any projection of the bill’s cap growth rates, the BCRA will lead to significant funding shortfalls for older adults, adults with disabilities, and non-disabled low-income children under age 19  in Kansas. The end result is that the state will be left with severe funding shortages, forcing Kansas to cut eligibility, provider rates, or covered services—or very likely all three. Moreover, many of Kansas’s most vulnerable citizens will be left without access to the critical health care and long-term services and supports—like help with toileting, bathing, dressing, and eating—they rely on. Cutting between $11 billion and $22 billion from Kansas’s Medicaid program is not the way to go.

 

Susan Reinhard is a senior vice president at AARP, directing its Public Policy Institute, the focal point for AARP’s public policy research and analysis. She also serves as the chief strategist for the Center to Champion Nursing in America, a resource center to ensure the nation has the nurses it needs.

 

 

 

Jean Accius is vice president of livable communities and long-term services and supports for the AARP Public Policy Institute. He works on Medicaid and long-term care issues.

 

 

 

 

Lynda Flowers is a Senior Strategic Policy Adviser with the AARP Public Policy Institute, specializing in Medicaid issues, health disparities and public health.

 

 

 

Ari Houser is a Senior Methods Adviser at AARP Public Policy Institute. His work focuses on demographics, disability, family caregiving, and long-term services and supports (LTSS).

 

 

 



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Family Caregivers Need Support From Hospital to Home

Family Caregivers Need Support From Hospital to Home


Having a loved one in the hospital can be a stressful and emotional experience — especially if you don’t have the support you need. Each day, 40 million family caregivers help older parents, spouses, children with disabilities and other loved ones live independently at home. They help with bathing and dressing, manage finances, stand by their loved one’s side when they go into the hospital, care for them when they return home, and so much more.

Some family caregivers, like Jerry, who cared for his wife, Faith, receive the support they need to smooth out the transition from hospital to home.

“Prior to discharge the charge nurse told me I would need to watch and listen, because I would be the caregiver at home. My wife had shoulder replacement, so I needed to know how to assist in removing and attaching the shoulder brace. She reviewed all medications with me as far as to when my wife needed to take them etc. She changed my wife’s dressing and told me to do it the same way and told me I needed to go to a pharmacy and purchase 4″ x 4″ gauze and 2 in. wide paper tape. She made sure I understood it was paper tape so the tape didn’t irritate the skin etc.”

Unfortunately, this isn’t the experience of all family caregivers.

Mary didn’t receive instructions on her mother, Eartha’s, medications after a hospital stay. After a medication that was supposed to be short term was given to Eartha long term, she suffered irreversible kidney damage. Mary was then given the choice to put her 82-year-old mother on dialysis or take her home on hospice.

When Cheryl’s husband Alphus was discharged, the family was given no instruction on the medical tasks they needed to perform, including managing multiple medications and cleaning his PICC line. Cheryl learned by trial and error — and unfortunately one of these errors led to Alphus being hospitalized, again.

The consequences can be grave when family caregivers don’t have the support they need as their loved ones go into the hospital and as they transition home.

That’s why AARP developed a model bill called the CARE Act, short for Caregiver Advise, Record, Enable Act. This commonsense, no-cost solution is now law in 32 states, D.C., Puerto Rico and the U.S. Virgin Islands. The CARE Act calls upon hospitals to:

  1. Record the name of the family caregiver when a loved one enters the hospital.
  2. Notify the family caregiver prior to the loved one’s discharge.
  3. Provide the family caregiver simple instruction of the medical tasks they will be performing when their loved one returns home — like managing medication.

 

State update
As the 2017 state legislative sessions progress, states continue work to pass the CARE Act:

  • In Kansas, Kentucky, Montana and North Dakota, the CARE Act has passed one chamber of the state legislature and is being considered by the second chamber.
  • In Iowa and Missouri, the bill has been introduced in the state legislature.
  • In Tennessee, regulations are in progress that would put the CARE Act into effect.


In the states that have already passed the CARE Act, we’re educating family caregivers about this new law and how it can help them when a loved one goes into the hospital. We’re also continuing our advocacy by making sure caregivers know whom to contact if their loved one doesn’t receive the benefits of the CARE Act, and we are making sure that state agencies are notifying hospitals about the law and are effectively implementing it. In addition, we’re studying how leading hospitals are putting the CARE Act into action and sharing these promising practices with others hospitals.

Stay tuned throughout the year for more updates on how the CARE Act is helping family caregivers nationwide.

Check out where your state stands


Elaine Ryan is the vice president of state advocacy and strategy integration (SASI) for AARP. She leads a team of dedicated legislative staff members who work with AARP state offices to advance advocacy with governors and state legislators, helping people 50-plus attain and maintain their health and financial security.



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