Tabak, Aranson: Medicaid in Our Homes

Republicans in the U.S. Senate have pulled back their “repeal and replace” health care bill in the hope of preparing a new version for a vote shortly after their Fourth of July recess.

One of the most controversial pieces of the House plan and the Senate bill being reworked is the proposal to cut Medicaid. Through Jewish Home Life Communities and Jewish Family & Career Services, we represent the two populations most affected by the Medicaid debate, the elderly and the disabled.

JF&CS and JHLC are not political organizations. As nonprofit agencies, we are apolitical and do not support or oppose any particular party, candidate or person in office. That said, it is incumbent upon us to educate our community about changes that could affect people we serve.

Of the three possible results of the impending Senate vote — pass, don’t pass or continued delay — we hope the outcome is delay so more input can be shared and potential alternatives can be considered to the Medicaid cuts that have been proposed in both the House and Senate versions.

Rick Aranson

Regardless of which side of the political aisle to which one might lean, it would be helpful to know that Medicaid is the largest funder of skilled nursing homes in our country. Medicaid accounts for one-sixth of all health care spending in the United States, and 67 percent of that is focused on older and disabled adults, primarily through spending on long-term-care services such as nursing homes and support for adults with intellectual and developmental disabilities.

More than half Georgia’s Medicaid dollars go to the elderly or people with disabilities, according to the state’s Department of Community Health.

Most of the clients in the JF&CS Zimmerman-Horowitz Independent Living Program and in the agency’s IndependenceWORKS day and vocational programs rely on the Medicaid waiver for critical support. Changes to Medicaid could affect participants’ ability to receive services and harm their independence and quality of life.

Harley Tabak

One such client is Evan N., a self-advocate who relies on Medicaid waiver services to support him in his home, his job and his community. Evan lives an independent and fulfilling life in large part because of his family and friends, as well as critical support that he relies on from the waiver.

Medicaid is growing exponentially, and our elected leaders are urgently searching for a politically palatable solution to controlling the growth. Americans want a simple answer to a very complex problem.

Putting politics aside, if you don’t think the Medicaid debate affects you, think again. Many Americans think Medicaid is only for low-income adults and their children — for people who “aren’t like us.” But Medicaid is insurance for many of our mothers and fathers and, eventually, for ourselves.

This anecdote is a typical scenario at JHLC.

Your dad needs to move into a nursing home. It’s going to cost him almost $100,000 a year. Medicare does not cover long-term nursing home or assisted living care. Very few people have private insurance to cover this. Your father will most likely run out his savings until he qualifies for Medicaid.

This is not a rare event. Roughly one in three people now turning 65 will require nursing home care at some point, and 67 percent of these nursing home residents will eventually be covered by Medicaid — not because of irresponsibility or not saving enough, but because of living so much longer than expected.

With longer life spans and spiraling health care costs, older adults increasingly find themselves running out of money and dependent on Medicaid.

Medicaid-funded nursing home residents are not your stereotypical lower-income families. These are elderly or chronically health-impaired people who have exhausted their savings for care and now need the highest level of care, which is also the most expensive. At the William Breman Jewish Home, 50 percent of the long-term beds are reserved for Medicaid recipients.

JF&CS works with coalition partners to monitor pending legislation and to represent the voices of our clients. One such organization is the Georgia Budget and Policy Institute. It has provided JF&CS with the following guidance, which we wanted to pass along to you as either an FYI or a call to action if you are so inclined:

The Senate is trying to bring the bill to repeal the Affordable Care Act to the floor for a vote as soon as Republicans have the votes to pass it. Medicaid funding is part of that bill.
In the bill pulled back June 28, Medicaid has a new per capita cap, which essentially means that increased need doesn’t mean increased funding for individuals.
States will potentially have to make up the difference between the per capita cap and the funding that people are getting. Georgia did not expand Medicaid, so further cuts will go to the core of services provided. If the states can’t make up the funding, reimbursements will be cut while the waiting list for the Medicaid waiver continues to grow.
The best strategy would be to push the bill passage back so Congress has more time to hear from stakeholders and experts to understand the implications of Medicaid changes.

Regardless of the outcome of this health care debate, the number of elderly and disabled will continue to increase, thanks to our country’s outstanding medical expertise and advances in research and technology. It is our hope that the delay allows for greater input into an issue that affects the most vulnerable members of our society.

Whatever your perspective is on the matter, the best way to make your voice heard as a Georgia citizen and constituent is to call our senators and the committees working on the bill: