Need to Protect Medicaid
October 14, 2005
Background
The battle to protect Medicaid
is currently in the Senate Finance and House Energy and Commerce
Committees. This year’s final budget resolution requires
those committees to make at least $10 billion in cuts from
programs within their jurisdiction -- all or most of which
will come from the Medicaid program. Recently, GOP fiscal conservatives
and the White House called for even deeper cuts in Medicaid
to help offset unexpected spending for hurricane relief efforts.
The committees must report their specific Medicaid cuts by
late this month, and the cuts would be rolled into a final
budget reconciliation bill. The massive budget reconciliation
process would simultaneously cut many entitlement programs
while making over $70 billion in new tax cuts, targeted principally
at the wealthy. GOP leaders and the White House want the process
completed before the end of the year. NASW and a variety of
health advocacy organizations have staunchly opposed cuts in
Medicaid and are working in coalition to defend economic justice
principles in the reconciliation process.
In addition to advocacy groups, a DHHS Medicaid Commission
and the nation’s governors are actively involved in the
Medicaid debate. A new DHHS Medicaid Commission has been formed
and charged with looking broadly at the future of the program,
but its membership was stacked with supporters of the Administration’s
view that large cuts are necessary in the program. Acting for
the states’ governors, the National Governors Association
(NGA) has adopted a new policy on Medicaid cuts that would
reduce benefits to eligibles, such as significantly increasing
cost-sharing and allowing providers to turn patients away if
they cannot afford care. The NGA also advocates allowing states
to offer different benefit packages to different groups of
people and/or in different parts of a state; allowing states
to make major Medicaid changes without a waiver; and reducing
the ability of the courts to enforce federal Medicaid law.
Special Social Work Concerns
This
summer the White House recommended that Congress narrow the
definition of services that can qualify for Medicaid funding
through the rehabilitation services and targeted case management
optional funding categories. Adoption of these Administration
proposals would severely damage community mental health and
social work service delivery. It is imperative that Congress
reject these dangerous Administration recommendations.
Restrictions on rehabilitation services: The
rehabilitation services option currently authorizes Medicaid
reimbursement for "other diagnostic, screening, preventive,
and rehabilitative services, including any medical or remedial
services (provided in a facility, home, or other setting) recommended
by a physician or other licensed practitioner of the healing
arts within the scope of their practice under State law, for
the maximum reduction of physical or mental disability and
restoration of an individual to the best possible functional
level." The Administration would limit reimbursement to
those rehabilitation services that are (1) "necessary
for the achievement of specific, measurable outcomes" related
to reduction of physical or mental disability or restoration
to the best possible functional level; (2) both prescribed,
AND provided by, or under the direction of a physician or other
licensed practitioner; and (3) billed under a fee schedule;
AND, prohibit Medicaid funding for rehabilitative services
that (1) could be funded through other Federal, State or local
programs; (2) are being provided without charge to non-Medicaid-eligible
individuals; or (3) are not provided to a specific individual. The
combined impact of these changes would make it virtually impossible
to bill for mental health services under this key optional
benefit category.
Restriction on the use of targeted case management (TCM)
services: The TCM option is used by many states
to link beneficiaries to mental health and other services.
TCM services are defined in current law as "services
which will assist individuals in gaining access to needed
medical, social, educational, and other services." Thus,
a key feature of this option that distinguishes TCM from
other types of case management that may be funded through
Medicaid is that TCM services may be used to help Medicaid
beneficiaries gain access to non-Medicaid services and supports
including food stamps, energy assistance, and emergency housing.
The Administration would cut the option by limiting reimbursement
to services that achieve specific, measurable outcomes for
specific individuals; and prohibiting funding for case management
services that (1) could be provided through any other programs
or services; (2) are being provided without charge to non-Medicaid-eligible
individuals; or (3) are not provided to a specific individual.
Again, the impact of these changes would be to eliminate
TCM care under Medicaid for individuals with disabling mental
illness.
Conclusions
Medicaid is under assault by
fiscal conservatives in Congress and by the Administration.
Policy changes being considered would effectively block grant
the program and dramatically curtail the individual protections
in the program. Social work services would be particularly
hard hit by the Administration’s recommended cuts.
Fiscal conservatives in Congress and the White House argue
that it’s fiscally necessary to cut Medicaid, a low-income
program; however, tax cuts of far greater dollar value are
included in the reconciliation bill that could support these
services. Advocates for low-income programs continue to lose
out in a Congress that places greater value on tax cuts for
key constituents than on basic services for low-income individuals
and families.
NASW, through its legislative network and field organizing
activities, is aggressively opposing these budget changes. Members
from throughout the country will participate in a national
call in day on October 17 and 18 to tell their Senators and
Representative that, “the right priorities
are protecting people from sickness and hardship, investing
in housing, jobs, and other services that families need – not
squandering billions on tax cuts for the well-connected.” |
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