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Senate ACA-Repeal Knocks Down House, Builds Shack

July 14, 2017

Over 90% of older adults say that they want to remain in their homes as they age, rather than going into a nursing home. A successful and popular program, Community First Choice (CFC), lets people do just that.

The revised Senate health care bill brings an idea that should be a hard sell for the over 3 million older adults and people with disabilities who rely on Medicaid for in-home care. On top of a massive almost $800 billion cut to Medicaid that guarantees shrunken programs and eliminated services, the Senate bill kills CFC and replaces it with an inferior version that provides fewer services for a limited time only.

Are there problems with CFC?  No, not at all, but it was created as part of the Affordable Care Act of 2010, and that fact presumably has marked it for extinction.

CFC is up and running in eight states: California, Connecticut, Maryland, Montana, New York, Oregon, Texas and Washington.  Another four states either have submitted applications or are considering applying, and CFC Is open to accepting applications from any other state.

Under a “community first” model, CFC incentivizes states to provide services that keep older adults and people with disabilities with their families, and in their homes and communities, instead of isolating them in nursing homes. The Senate bill proposes to terminate CFC at the end of 2019, and replace it with a limited, temporary stand-in. Under the Senate proposal, the federal government would provide unspecified funding for states to continue to provide, and improve the quality of, Medicaid at-home services — not including expiring CFC programs. Instead of giving the states flexibility to decide, participating states would be selected by the federal Medicaid program, with priority given to the 15 states with the lowest population density.

Crucially, the new program only would be in existence from 2020 through 2023.  Total federal financing would be capped at $8 billion, compared to the $19 billion that otherwise would have been spent for CFC from 2020 to 2026.

This proposal would be layered on top of the Senate bill’s almost $800 billion in Medicaid cuts and caps, which will force states to limit services, restrict who can get services, and eliminate services altogether in the case of optional services like at-home care. It is estimated that the proposal’s $8 billion would replace only about 4% of the money that states otherwise would have spent on HCBS.

Together, these cuts to services older adults rely on are threats to older Americans’ health and well-being. By destroying successful CFC programs in eight states, and replacing them with a temporary, underfunded program, the Senate bill degrades at-home care for older adults.

The Senate’s perverse proposal is the health care equivalent of a temporary shack, offering only a distraction from the demolition required by the bill’s other Medicaid provisions. The Senate bill continues to hurt older adults, their families, and all Medicaid beneficiaries, as well as the nation’s health care system.

Image courtesy of Nick Kocharhook on flickr

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