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No Cuts to Medicaid!

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No Cuts to Medicaid!

Medicaid is the primary payer for long-term services and supports (LTSS) in the United States. It pays for more than two-thirds of the LTSS delivered in home and community-based settings (HCBS). If large cuts happen, it could mean pulling back on HCBS services because they are not government mandated.

A colorful cartoon graphic with a header in bold letters reading Medicaid already under funded! Below are four panels the first panel says now. It has a bold word "now" and the number 710,000 on waitlist circled. There’s a long weaving line of people coming up to a sign that says stop no services wait years. And a path to hooray, with a person in a wheelchair, it says finally eligible and then an arrow with a sad face saying sorry you can’t get staff with the rate Medicaid pays . Some doodles of money and thumbs down. The second panel says fraud and has colorful text saying detected by, below that is says each state and fed and arrows drawn to different agencies Medicaid fraud units, program, error, rate, monitoring, healthcare, fraud, and abuse, MCO‘s, managed care, organizations, DOJ, Attorney General and a little clip art of a detective . Then there is the word improper payments below. It says make up 5.1% of all payments and $31 billion then under that it says 79% are errors and missing documentation. There’s an arrow that points to a pie chart. It says 5.1% and the pie chart shows small slice of improper payments and the larger dark blue area says 94.9% are proper payments. The third panel has a small graphic of the dome of the capital over bold letters of word Congress and annually 88 billion cut. There’s a pair of scissors. There’s arrows pointing from cuts up to the frame that says fraud. Under that it says minimum reduction to energy and commerce committee budget and below that is a pie chart showing 38% Medicaid $618 billion and it says the year 2024 and the other part of the pie chart shows 60% Medicare $838 billion and the year 2024. There’s also some highlighted text with a little warning symbol that says if Medicare isn’t touched, the math doesn’t work without deep cuts to medicaid. Below that is a Post-it note on it the words "cuts are almost 3 times greater than government data on improper payments" a yellow arrow ppoint back up to improper payments in panel 2. The fourth panel is the word outcomes bold, and a blue, sad, crying, smiley face. Below that is a clipboard with a image of the Grim Reaper, and a list titled increased, and then checkmarks next to waitlist, abuse, neglect, seclusion, poor health, institutionalize millions of people, death. To the right of that, it says home and community based services HCBS provides waivers as alternatives to more costly pay or funded institutions! Under that says first to be cut with a red line ubder it. Below that is a little protest sign that says disability rights are civil rights. At the bottom there’s a stamped "bad news" in red. Next to that it reads federal cuts of $880 billion over 10 years ($88 billion a year) would represent 29% of state finance Medicaid spending per resident.
Medicaid is already underfunded!

Waitlists of Over 710,000 Already Exist

  • Many individuals wait years without any services

Waiting lists provide an indication of people who may need services they are not receiving, but they are an incomplete measure of unmet needs because they don’t include people with unmet needs in states that do not cover the applicable services.

  • Those who become eligible still face difficulty getting services due to staff shortages

All 50 states have reported shortages for any type of Home and Community Based Services (HCBS) worker.

See Also:
“A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2024″

“Number of People Waiting for Medicaid Home Care (HCBS), by Target Population and Whether States Screen for Eligibility”

HCBS Workforce

Fraud as Measured by Government Sources

  • Government Information and Data
      • Total “Improper payments” are $31 billion, which is 5.1% of all Medicaid payments
      • 79% of improper payments are errors and missing documentation
      • Outright fraud is estimated to be $6.5 billion (A fraction of the $88 billion of proposed cuts)
  • Fraud is Detected by Multiple Federal and State Oversight Bodies
      •  Medicaid Fraud Control Units are required in each state
      •  State auditors
      •  MCO’s Managed Care Organizations
      • CMS Centers for MEdicare and Medicaid Services
          • Program Error Rate Monitoring
      •  HHS Office of Inspector General (OIG)
          • HHS-OIG Healthcare Fraud and Abuse Control (HCFAC)
          • Medicaid Fraud Control Units (MFCU)
      • U.S. Department of Justice (DOJ)
      • Government Accountability Office (GAO)
      •  Attorney General

See Also:
“5 Key Facts About Medicaid Program Integrity – Fraud, Waste, Abuse and Improper Payments”

Budget passed by Congress effectively cuts billions from Medicaid

  • $880 Billion in cuts from the committee overseeing Medicaid
      • $880 billion over 10 years, or $88 billion cut annually from The Energy and Commerce Committee
          • Government data estimates “improper payments” at $31 billion (of which $6.5 billion may be fraud). Cutting $88 billion a year will cut services and benefits for those in need
      • Medicaid makes up 38% or  $618 billion off the committee’s budget
      • Medicare makes up 60%  or $838 billion of the committee’s
      • If Medicare isn’t touched, the math doesn’t work without deep cuts to Medicaid
      • Congressional Budget Office says, without cutting Medicaid, that level of cuts is mathematically impossible

See Also:
Read the budget text: Concurrent resolution on the budget for fiscal year 2025

Mandatory Spending Under the Jurisdiction of the House Committee on Energy and Commerce

GOP Budget Would Force the Largest Medicaid Cuts in American History

Outcomes would greatly harm people

  • Any action that reduces Medicaid will harm people, especially those with disabilities
      • Home and Community Based Services (HCBS) a would be the first to be cut
      • States are not mandated to fund HCBS
      • HCBS provides alternatives to forced institutional care
      • Waitlists would grow
      • Abuse and Neglect would increase with greater staff shortages and less funding for basic services
      • Increased seclusion and isolation
      • Forced institutionalization, as that remains mandatory funding
      • Increased in deaths
  • Cuts, Caps, Blockgrants  – All are arbitrary!
      • “If states do not offset federal Medicaid cuts by picking up the new costs, they would have to reduce Medicaid spending by covering fewer people, offering fewer benefits, or paying providers less” a new KFF analysis found.

Options for enacting cuts to Medicaid include:

        • Block grants or per capita caps — states would receive a fixed lump sum for Medicaid per enrollee, regardless of costs or inflation. States would have to pick up the difference, resulting in cuts to services and/or programs. Per-capita grants would limit the state to a set amount of money per Medicaid enrollee. Both strategies shift costs to states.
        • Reducing the federal match (Federal Medical Assistance Percentage or FMAP). All states currently receive a minimum of 50% in federal matching funds. Many states receive 90% in FMAP under Medicaid expansion, allowing them to bring more programs and services to older adults and provide coverage for unpaid family caregivers. Lifting the minimum 50% cap shifts more costs to states, forcing an overall cut in Medicaid spending. Ending the enhanced 90% FMAP for Medicaid Expansion, would automatically end expansion in several states and force other states to scale back Medicaid programs and services that older adults rely on.
        • Restricting allowable provider and insurer taxes, which every state uses to help fund all of their Medicaid programs, would reduce state budgets and force Medicaid cuts.
        • Cutting provider payment rates would result in fewer providers accepting Medicaid dorsening direct care workforce shortages for both people with disabilities. and seniors. Reducing access to care for seniors and potentially resulting in some nursing home closures.
        • Cutting medicaid funding won’t help people with disabilities. Reducing or eliminating federal funding for the Medicaid expansion population would not free up money for people with IDD or others disabilities. It just means less funding overall for the entire program.
  • 29% decrease in state-financed Medicaid spending per resident, with loss of matching dollars. 

      • Potential Federal Medicaid Cuts Represent 29% of State Medicaid Spending Per Resident, 6% of State Taxes Per Resident, and 19% of Education Spending Per Pupil

See Also:
Putting $880 Billion in Potential Federal Medicaid Cuts in Context of State Budgets and Coverage

Medicaid cuts, block grants and per capita caps would decrease federal spending, creating a choice between increased state spending and enrollee coverage.

Medicaid allows people to stay healthy, employed, and in their homes and communities. It is part of the core fabric of the U.S. health care system.  Cuts will have a ripple effect and impact hospitals, schools, nursing homes, families, employment, and more.  Medicaid is part of a foundation that supports people, it should be one of the very last things to be considered for reducing spending. People with unmet needs will increase costs for everyone.

See also:
What are the implications of Medicaid per capita caps?

Take Action! National Organizations Oppose Cuts to Medicaid