In The Politics of Autism, I discuss Medicaid services for people with intellectual and developmental disabilities.
New Jersey and many of the 30 other states that also expanded Medicaid would face similar challenges. Pennsylvania, though, could be particularly hard-hit.
Pennsylvania’s Medicaid program historically has been more generous than most to people with severe intellectual and physical disabilities. For decades, the state has found options that were “really creative to keep people with disabilities out of institutions,” said David Mandell, a psychiatry professor and disabilities-policy expert at the University of Pennsylvania. He cowrote a commentary last week in the New England Journal of Medicine, Care for Autism and Other Disabilities — A Future in Jeopardy.
New Jersey has one of the most comprehensive Medicaid programs in the country but balanced by one of the stingiest reimbursement rates for doctors. With the state's budget woes, provider pay "will probably be frozen at that rate," said Raymond Castro, senior policy analyst at New Jersey Policy Perspective.
Lawmakers in Harrisburg are also in a bind. "Seventy-two percent of our Medicaid spending is going to seniors and adults with long-term disability," said Kristen Dama, an attorney who focuses on Medicaid policy at Community Legal Services of Philadelphia.At Pacific Standard, David M. Perry writes of a recent panel at The Center for American Progress:
Ari Ne’eman, who participated in the CAP panel, has an even grimmer view. “Medicaid will be annihilated,” says Ne’eman, who served as a disability appointee in the Obama administration and currently runs MySupport.com. “There is no scenario,” he says, “with cuts of this level and scope, in which people with disabilities won’t be substantially hurt.”
Amber Smock, director of advocacy at Access Living, posted on a closed Facebook group (quoted with her permission) that the Hill was “busier than I have ever seen it.” She notes that lots of different groups are lobbying against the bill, including Paralyzed Veterans of America (who have been tweeting out their meetings). Even the AARP, which is not always known for taking disability rights position, mentioned long-term supports and services as an issue.
Ne’eman agrees. “The entirety of the disability community, people with developmental disabilities, physical disabilities, psychological disabilities, veterans, seniors, are are all coming to the table to condemn and push back against these utterly wrongheaded proposals,” he says.
“The disability community is a hand with many fingers,” Ne’eman says, “but what’s happening right now is that they are all closing together into a fist.”