AAHD has significant concerns about the Medicaid block grant proposal announced by CMS today and what it would mean for people with disabilities. Block grants may seem like they will provide greater flexibility to states, but in the end if the goal is to save money, it only means one thing – cutting enrollment or cutting benefits. While CMS does say that the block grants would not apply to people with disabilities, this protection only applies to people with disabilities who are enrolled on the basis of their disability and not those who receive coverage due to the Medicaid expansion which is based on income. One of the great successes of the Medicaid expansion under the Affordable Care Act (ACA) was the fact that it provided greater flexibility to people with disabilities in how they could enroll in the Medicaid program. No longer did people with disabilities need to forgo employment to enroll in Medicaid as they could qualify for the Medicaid program while working, provided their income was still under the limits of the Medicaid expansion. The proof for this flexibility was evident when employment rates were shown to be higher for people with disabilities in states where Medicaid had been expanded verses where it had not been expanded (see our blog post on this). If states choose to take up CMS’s offer to turn their program into a block grant, we fear that it will return people with disabilities into the unenviable decision of choosing between Medicaid coverage or work. Therefore, we oppose the Medicaid block grant proposal announced by CMS.
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