Issues and Views

A more vulnerable target than Medicare?

Medicaid Budget Proposal Threatens
Safety Net for Elders, People with Disabilities

Though Medicare is most often seen as the elders' healthcare program at political risk, it is Medicaid, the major provider of long-term in-home services and nursing home care for older adults and people with disabilities, that may be the more vulnerable target. Proposed plans to reshape Medicare have proved extremely unpopular in polls and have Republicans backtracking. But the recent proposal by the House Committee on the Budget to change Medicaid into a program financed through block grants has been identified as a serious threat in analyses by the National Senior Citizens Law Center, the Urban Institute, and the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. In May, some 150 national aging and disability advocacy organizations and a group of democratic governors signed letters to Congress decrying the plan, but awareness among the general public is low.

By changing the way Medicaid is financed and overseen, adoption of the budget proposal would jeopardize the safety net for elders and people with disabilities as well as for the low-income children and families who receive healthcare through Medicaid, the analyses have shown. Currently, Medicaid is a federal and state program in which the federal government makes the rules and shares the cost. With the new plan, states would receive a fixed amount of money and would have flexibility in determining how to spend it.

Bob"Trying to balance the federal budget by shifting risk to the states is like a game of musical chairs, with too few chairs and everyone trying to ensure that when the music stops, they are not the one left standing," says Robert Applebaum, a long-term-care expert and professor at Miami University's Scripps Gerontology Center.

"It's the Feds saying to the states, 'Here's your money, but if healthcare costs go up, that's your problem.' And it will be a problem because grant amounts are tied to the rate of inflation, though healthcare costs have gone up more than that every year. States could reduce eligibility or curtail services," Applebaum says. "As always, the people at the bottom, the most vulnerable, bear the brunt. With Medicaid block grants, it is elders and disabled people who need long-term care and poor children who need medical care who will suffer."

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Copyright © 2011 Trustees of Boston University. All rights reserved. This article may not be duplicated or distributed in any form without written permission from the publisher: The Institute for Geriatric Social Work, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, U.S.A.; e-mail: igsw@bu.edu.