The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities. Home and Community-Based Services (HCBS) are particularly important. Congress has voted to slash Medicaid.
Federal law deems most home- and community-based services as optional, so they are often targeted when states have to tighten their belts. When temporary Great Recession increases in Medicaid funding expired in the early 2010s, for example, every state reduced home care by limiting enrollment or lowering spending on existing recipients.
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Health care experts anticipate cuts to home- and community-based care in some states because the new law limits provider taxes. Almost every state taxes hospitals, then uses the revenue to pay the hospitals for treating Medicaid patients. That increases Medicaid spending on paper and triggers more federal matching funds, which states use to cover various Medicaid services.
The 22 affected states where provider taxes are higher than the new law’s cap — 3.5 percent of net patient revenue — will lose federal money. The White House argued that this would not affect home- and community-based care because states could make up the difference by paying hospitals less for Medicaid services, reducing the rates to match those of its sister program, Medicare.
Experts said the White House’s argument was unrealistic. Not all states pay higher prices for Medicaid than for Medicare, and even for those that do, the numbers don’t add up, Dr. [Benjamin] Sommers said. Many states will have to find money somewhere else, too, and each state will have to choose whether that somewhere is home- and community-based care or another part of their budget.
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Reductions could come in several forms. States could place further restrictions on who qualifies for coverage, cover fewer hours of care or lower pay for home health workers. Or they could eliminate waiver programs altogether. Even at existing funding levels, hundreds of thousands of people are on waiting lists for waivers, and those lines could get longer.
