Washington, D.C. – Today, the Centers for Medicare and Medicaid Services announced guidance to states allowing them to pursue drastic changes in how they administer Medicaid to many program recipients, including people with disabilities, family members, direct support professionals, and other allies of people with disabilities. The guidance encourages states to cap their federal funding for the Affordable Care Act’s (ACA) Medicaid expansion and weaken federal protections for the low-income adults it covers.

The program would block grant or put a per person cap on the federal government’s payment to states with a pre-set formula that may not consider growth in cost or need. A per capita cap would limit the amount spent per enrollee in the program. Both are now options for states to pursue that are harmful to the structure and funding levels of the Medicaid program.

States would be allowed to restrict eligibility, provide limited health care benefits, reduce access to prescription drugs, impose burdensome work requirements, and make other changes that are detrimental to Medicaid beneficiaries.

“Medicaid equals access to health and wellbeing for millions of people, including people with disabilities, their family members, and their direct support professionals. This decision is a blow to the entire disability community. It also begs the question – once they block grant one part of the program, what’s stopping them from moving on to the home and community-based services that make independence and community possible for people with intellectual and developmental disabilities?” said Julie Ward, Senior Executive Officer for Public Policy, The Arc.

This guidance does not appear to directly impact the portion of the Medicaid program that funds home and community-based services for people with intellectual and developmental disabilities (IDD). However, people with disabilities, including people with IDD, are part of the Medicaid expansion population and could be directly impacted. In addition, the restructuring of the program will impact all aspects of the Medicaid program if states are not able to operate their programs under the cap.  States would be responsible for any shortfalls in funding, and to make up the difference states may cut eligibility, limit services, reduce provider rates, or other spending reductions that hurt beneficiaries.

The guidance allows states to operate the Medicaid program with limited federal oversight and few beneficiary protections. If harmful or discriminatory policies are implemented by the state, there are few avenues to address the issue. The limited public review and comment ensures that people with disabilities, their family members, providers and other advocates have little influence over how policies are developed and whether they will meet their needs.

“This effort is a major change to the Medicaid program as we know it, and we are very concerned that it’s just the beginning of bad news for Medicaid in 2020,” said Ward.

The Arc advocates for and serves people wit­­h intellectual and developmental disabilities (IDD), including Down syndrome, autism, Fetal Alcohol Spectrum Disorders, cerebral palsy and other diagnoses. The Arc has a network of over 600 chapters across the country promoting and protecting the human rights of people with IDD and actively supporting their full inclusion and participation in the community throughout their lifetimes and without regard to diagnosis.

Editor’s Note: The Arc is not an acronym; always refer to us as The Arc, not The ARC and never ARC. The Arc should be considered as a title or a phrase.