Friday, December 9, 2016

Preparing for the 2017 Legislative Session

from Indiana Assn of United Ways:

Preparing for the 2017 legislative sessionState Capitol
The Indiana General Assembly convened for the first time leading up to the 2017 legislative session on Organization Day last month.  The 2017 session will begin on January 3 and must end no later than April 29.  This session is a "long session" where lawmakers will decide the state's next two-year budget which is typically about $30 billion.  Legislators will make tough funding decisions on state government services, including education, infrastructure and public safety. Helpful links to help you follow are below: 
IaUW has started to monitor Third House Sessions and Meet Your Legislator events across the state.  These meetings are opportunities for constituents to talk to their legislators and learn about bills they are working on at the statehouse.  It is important that legislators hear input from their constituents and these events are a great way for you to connect and share your thoughts.  View our Third House Calendar that will be updated regularly over the next few weeks and throughout session.  Check back often for new events as they are scheduled!

Weigh in on issues important to you!
Submitting comments during rulemaking periods is an important way to shape policy. State and federal agencies appreciate specific comments about possible impacts and ways to improve proposed rules. Below are a few open comment periods in Indiana.
  • Department of Education is accepting public comments on the Every Student Succeeds Act to help shape the state plan. Learn more.
  • FSSA Department of Mental Health and Addiction is accepting written comments regarding the addition of psychosocial rehabilitation services offered in accredited clubhouse settings under the Medicaid Rehabilitation Option.  Learn more.

Wednesday, December 7, 2016

BDDS is now on Facebook

The Bureau of Developmental Disabilities Services is excited to announce that we are now on Facebook! We hope social media will be another way for individuals, families, providers and other valuable stakeholders to obtain timely information about the bureau, its services, updates, upcoming events, etc. 

You may access the page by clicking here: https://www.facebook.com/pg/Indiana-Bureau-of-Developmental-Disabilities-Services-318818311807579

Monday, December 5, 2016

Medicaid to Cover Topical Fluoride Varnish to Age 4

Effective January 1, 2017, the Indiana Health Coverage Programs (IHCP) will cover physician-administered topical fluoride varnish. Coverage applies to all IHCP programs, subject to limitations established for certain benefit packages.

Coverage applies to dates of service (DOS) on or after January 1, 2017.

Physician-administered topical fluoride varnish is a preventive procedure. Coverage is limited to members from the time of first tooth eruption until the age of 4. Topical fluoride can include varnish, gel, or foam. Coverage requires the service be provided by or under the supervision of a physician. 

The IHCP recognizes the following provider types as eligible to render the service: 
 Physicians 
 Physician assistants 
 Advanced practice nurses Before performing and billing for this service, eligible providers are required to complete the certified training course, Protecting All Children’s Teeth (PACT): A Pediatric Oral Health Training Program, available at the Children’s Oral Health page at aap.org. 

 Prior authorization (PA): None required. 

Helping Our Kids Find Their Voice

By Jan Labas                                           

Helping our children find their voice as they grow into self-advocates can be a challenging, yet rewarding, experience.  While there are many tools available, this is a very individual process with each child coming to readiness for self-advocacy at his own pace.  As parents we can be informed and prepared early to help steer them toward success.

While they are young children we can encourage them to make well-thought-out decisions.  Start small with choices, such as which coat to wear or what things to pack for an outing.  Practice role playing, and help them to see the possible consequences of the choice.  Though it is important to encourage good choices and reap positive benefits, remember that we also need to allow them to fail.  It’s hard to watch our children experience disappointment and failure, but those can be effective learning tools that can promote self-advocacy much better than any conversation.

Moving toward transition in school offers opportunities for children to participate in decision making and working with professionals.  This is great time to hone self-advocacy skills.  There are student centered tools that can be used to encourage students to make choices for their IEP and practice their communication skills.  Learning and voicing how things work best for them and why is the foundation for self-advocacy.  The child needs to be able to communicate needs like, “I need to sit on the left side of the classroom because I can follow the teacher better.”

When appropriate encourage the student to be responsible for collecting information by making phone calls and requesting information from professionals.  Some students may benefit from role play in the classroom before taking on this type of responsibility.  These types of self-advocacy goals can actually be written into the IEP.  These actions contribute to making informed decisions and taking responsibility for oneself.

When we raise healthy, typically developing children many of these skills seem to happen by osmosis.  When we have to be intentional about making sure we expose and create opportunities for our children with special needs to learn advocacy skills, we can be caught off guard.  I know as a parent I was.  I felt as if I got to the party late.  I had moments of being overwhelmed that I had not prepared my child for to advocate for himself in adult life.  I found the saying that “We don’t often learn the hard things until we have to,” to be true.  If I had to do it all over, I would have started earlier.  I have never met someone and felt that they were far too young to be self-advocating!  Awareness to the opportunities that exist in our everyday lives is a good place to start. 

These sites offer further information regarding self-advocacy.

Kids as Self-Advocates (KASA): http://www.fvkasa.org/index.php
 
Wrightslaw: http://www.wrightslaw.com/info/self.advocacy.htm
 
Self-Advocates of Indiana (SAI): http://www.arcind.org/self-advocates-of-indiana/

 

Medicaid Block Grant Would Slash Federal Funding, Shift Costs to States, and Leave Millions More Uninsured

BY

If confirmed, President-elect Trump’s nominee for Health and Human Services Secretary — House Budget Committee Chair Tom Price — will be well-placed to advance a proposal that he’s previously supported as part of recent House Republican budget plans to fundamentally change the structure of Medicaid by converting it into a block grant.[1] Trump[2] and House Speaker Paul Ryan[3] also have supported converting Medicaid into a block grant, which would likely eliminate the guarantee that everyone who’s eligible and applies for its benefits would receive them and probably give states sweeping new authority to restrict eligibility, cut benefits, and make it harder for people to enroll.  The incoming White House and Republican congressional leaders are reportedly planning to pursue such a block grant in 2017, in addition to repealing the Affordable Care Act (ACA).[4]
A MEDICAID BLOCK GRANT WOULD LEAD TO DRACONIAN CUTS TO ELIGIBILITY, BENEFITS, AND PROVIDER PAYMENT RATES.A Medicaid block would institute deep cuts to federal funding for state Medicaid programs and threaten benefits for tens of millions of low-income families, senior citizens, and people with disabilities.  To compensate for these severe funding cuts, states would likely have no choice but to institute draconian cuts to eligibility, benefits, and provider payments.  To illustrate the likely magnitude of these cuts, an analysis from the Urban Institute of an earlier block grant proposal from Speaker Ryan found that between 14 and 21 million people would eventually lose their Medicaid coverage (on top of those losing coverage if policymakers repeal the ACA and its Medicaid expansion) and that already low provider payment rates would be reduced by more than 30 percent.
A block grant would cap federal Medicaid funding in order to achieve savings for the federal government.  Under current law, the federal government picks up a fixed percentage of states’ Medicaid costs: about 57 percent, on average (outside of the ACA’s Medicaid expansion).  In contrast, under a block grant, states would receive a fixed dollar amount, with states responsible for all Medicaid costs in excess of the cap.  Because a Medicaid block grant is explicitly intended to produce significant federal budgetary savings, block grants are designed in ways that give states considerably less federal funding each year than they would receive under the current financing system.  That is typically accomplished by basing a state’s initial block grant amount on its current or historical spending and then increasing it annually at a considerably slower rate — such as general inflation — than the currently projected annual growth in federal Medicaid spending.  The resulting federal funding cuts would thus grow steadily larger each year.
The likely magnitude of the federal funding cuts and resulting cost-shift to states would be very large.  The House Republican budget plan for fiscal year 2017, for example, would have cut federal Medicaid funding by $1 trillion — or nearly 25 percent — over ten years, relative to current law, on top of the cuts the plan would secure from repealing the ACA’s Medicaid expansion.[5]  By the budget plan’s tenth year (2026), federal funding for Medicaid and the Children’s Health Insurance Program (CHIP) would have been $169 billion — or about 33 percent — less than under current law (see Figure 1).  The size of the cuts would have kept growing after 2026.  
Moreover, the actual cut in federal funding for states, relative to current law, would be even greater in years when either enrollment or per-beneficiary health care costs rose faster than expected.  For example, as people lose their jobs and access to employer-sponsored insurance during a recession, many become newly eligible for and enroll in Medicaid.  In addition, developments in new treatments that improve beneficiaries’ health but raise costs, and the onset of epidemics or new illnesses like Zika (or HIV/AIDS in the 1980s), can produce significant unexpected increases in medical costs.[6] 
Currently, the federal government and states share in those unanticipated costs.  Under a block grant, however, states alone would bear them.  Furthermore, while all states would face substantial reductions in federal funding under a block grant, some would likely be hit particularly hard — such as states whose current Medicaid spending levels are already relatively low and states whose spending is expected to rise relatively quickly in future years due to demographic, economic, or other factors.[7]

FIGURE 1
Medicaid Cuts Would Grow Over Time Under House Budget Committee Block Grant

Such a block grant would push states to cut their Medicaid programs deeply.  To compensate for the federal Medicaid funding cuts a block grant would institute, states would either have to contribute much more of their own funding or, as is far more likely, use the greater flexibility the block grant would give them to make draconian cuts to eligibility, benefits, and provider payments.  For example, Speaker Ryan’s “Better Way” health plan would give states the choice of a block grant or a Medicaid per capita cap; both would appear to enable states to make sizeable cuts directly affecting beneficiaries that states can’t make now.  This could include using waiting lists or capping enrollment; under current law, all eligible individuals who apply for Medicaid must be allowed to enroll.  States also could be allowed to no longer provide children with a comprehensive pediatric benefit known as EPSDT (Early Periodic Screening, Diagnostic, and Treatment), under which children enrolled in Medicaid receive both regular check-ups and coverage for all medically necessary treatments that the check-ups find a child needs. 
In addition, states could be permitted for the first time to impose a work requirement and terminate coverage for people deemed non-compliant.  This could result in people with various serious barriers to employment — such as people with mental health or substance use disorders, people who have difficulty coping with basic tasks or have very limited education or skills, and people without access to child care or transportation — going without health coverage.[8]  States would also likely be able to begin charging significant premiums, deductibles, and co-payments at levels that research suggests would likely cause poor people to forgo coverage entirely or go without needed care. 
Medicaid is already efficient and innovative.  Block grant supporters, including House Republican leaders, often argue that states could compensate for the substantial losses in federal funding they would experience under a block grant by using added flexibility to cut costs without harming beneficiaries.  That claim doesn’t withstand scrutiny.  Medicaid costs per beneficiary already are far below those of private insurance, after adjusting for differences in health status, due to lower payment rates to health care providers and lower administrative costs, even though Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries.  And over the past three decades, they have also grown much more slowly, on average, than private insurance per-beneficiary costs.[9]  They are expected to continue growing more slowly than costs under private insurance in coming years, according to the Medicaid and CHIP Payment and Access Commission.[10] 
In addition, states already have substantial flexibility in how they deliver Medicaid services.  For example, they have dramatically expanded the use of managed care over the last two decades, instituted cost-containment strategies in areas like prescription drug spending, and in recent years, have adopted numerous innovative reforms in how they deliver care to Medicaid beneficiaries that improve quality of care while lowering costs.[11]
A Medicaid block grant would thus lead to draconian cuts to eligibility, benefits, and provider payment rates.  As the Congressional Budget Office concluded in 2012 when analyzing a Medicaid block grant proposal from then-House Budget Committee Chairman Paul Ryan: “the magnitude of the reduction in spending . . . means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both.  Cutbacks might involve reduced eligibility, . . . coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries — all of which would reduce access to care.”[12]  The Urban Institute estimated that the 2012 Ryan proposal would lead states to drop between 14.3 million and 20.5 million people from Medicaid by the tenth year (in addition to the effects of repealing health reform’s Medicaid expansion).[13]  That’s an enrollment decline of 25 to 35 percent.  Urban also estimated that the 2012 Ryan block grant would lead states to cut reimbursements to health care providers by more than 30 percent, even though, as noted, provider payments are already much lower than what private insurance and Medicare pays.  That could result in many fewer providers and health plans participating in Medicaid, making it far more difficult for beneficiaries to obtain needed care.
http://www.cbpp.org/research/health/medicaid-block-grant-would-slash-federal-funding-shift-costs-to-states-and-leave

Friday, December 2, 2016

HHS Secretary Nominee Price’s Health Plan Would Severely Weaken Health Coverage and Consumer Protections

BY

President-elect Trump’s selection of House Budget Committee Chairman Tom Price for Secretary of Health and Human Services should focus attention on Price’s health plan,[1]which to date has received little scrutiny.  THE PRICE PLAN WOULD REPEAL THE ACA AND REPLACE IT WITH HIGHLY INADEQUATE FINANCIAL HELP TO ENABLE FAMILIES AND INDIVIDUALS TO BUY HEALTH COVERAGE. Like other Republican congressional health plans, it would repeal the Affordable Care Act (ACA) and replace it with highly inadequate financial help to enable families and individuals to buy health coverage — likely leaving many of the 20 million people who have gained coverage under the ACA uninsured or without needed care.[2]
By repealing the ACA, the Price plan would eliminate its market reforms and consumer protections and even likely result in states having weaker insurance regulations than before the ACA.  It would let insurers once again exclude coverage of many people’s pre-existing conditions and charge them much higher premiums.  And it would likely seriously disrupt employer-based coverage by encouraging employers to drop coverage on the assumption that workers would buy it on their own.  Finally, as explained below, the Price plan includes a series of misguided proposals, such as expanding high-risk pools, expanding Health Savings Accounts, allowing insurers to sell coverage across state lines, and expanding Association Health Plans.

Eliminating Market Reforms and Consumer Protections

The plan would eliminate the ACA market reforms guaranteeing that a broad array of people — including those with pre-existing health conditions — can buy insurance that meets minimum coverage standards in the individual and small-group private health insurance markets.  Those markets would effectively revert to pre-ACA rules, meaning, among other things, that insurers could once again:
  • charge higher premiums to people who have health conditions, are women, or for another reason such as their industry or profession;
  • drop or severely limit benefits such as maternity care and prescription drugs, which they now must cover as “essential health benefits”;
  • reinstate annual and lifetime limits on their reimbursements for an enrollee’s health care costs; and
  • charge deductibles, co-insurance, and co-payments without limits.

Providing Inadequate Subsidies to Buy Individual-Market Coverage

Under the ACA, people with low or modest incomes can receive premium tax credits to help defray the cost of private coverage they buy through the marketplaces.  The Price plan would replace the ACA credit, which is based on family income, with a modest tax subsidy that varies by age — not by income.  As a result, lower-income people would have to pay a much greater share of their income on premiums than they do now — and a greater share than people with modestly higher incomes would pay.  The poor and near-poor who now qualify for coverage under the ACA’s Medicaid expansion (which the Price plan would repeal) and generally pay little if any premiums now would be hit especially hard, and many of them would likely end up uninsured. 
Moreover, unlike under the ACA, the credit wouldn’t be based on what decent-quality coverage costs where the recipient lives; it would be uniform nationally.  It wouldn’t adjust for the higher premiums that people in poorer health would now have to pay under the Price plan.  Nor would it fully account for differences in people’s premiums based on their age, as insurers in the individual market could charge older people much more, relative to younger people, than under the ACA.
Finally, the Price plan would eliminate the ACA’s cost-sharing reductions, which help cover deductibles and co-payments for those with lower incomes, and would provide no financial assistance for cost-sharing charges, even for people below the poverty line who now qualify under the Medicaid expansion and pay only very modest co-payments.  As a result, even if some low- and moderate-income people were able to obtain coverage through the Price plan’s tax credit, many would likely forgo some needed care because they couldn’t afford the deductibles or cost-sharing charges or they lacked coverage of critical benefits.

Weakening Protections for People With Pre-Existing Health Conditions

The ACA prohibits insurers from denying coverage to people with pre-existing health conditions, charging them higher premiums, or refusing to cover benefits related to a pre-existing condition.  The Price plan would again allow insurers to exclude coverage of a pre-existing condition for lengthy periods of time or charge much higher premiums unless individuals had maintained continuous coverage for at least 18 months.  This would protect people far less than under the ACA and only modestly more than the rules in place before the ACA. 
Many people would fall through the cracks.  Some 36 percent of Americans aged 4 to 64 — 89 million people — went without coverage for at least one month between 2004 and 2007, and about one-quarter of this group lost coverage more than once.[3]  Consider, for example, a mother with diabetes whose work hours are reduced in the summer and decides to go without health insurance for the rest of the year to afford basics such as food and rent.  Insurers could deny coverage of her diabetes and charge a much higher premium than she likely would be unable to afford. 

Expanding High-Risk Pools

In part to help people with pre-existing conditions and significant medical expenses who don’t have continuous coverage, the Price plan would expand high-risk pools.  Experience shows, however, that high-risk pools are a failed approach to providing affordable coverage.  Because they pool sick people with even sicker people rather than pooling sick and healthy people together, as regular insurance does, they tend to charge extremely high premiums that people can ill afford.
States’ experience with state high-risk pools before the ACA shows that even the high premiums that the risk pools charged covered only about half of the cost of operating the pools.  The rest had to come from public support, such as state general revenues or premium assessments on insurers.  Unless that support was substantial and rose significantly over time, states eventually had to scale back these pools to keep costs from spiraling out of control.  States sharply restricted enrollment in the high-risk pools, set premiums further above what many families could afford, and/or scaled back coverage.  Only a little over 200,000 people in the entire country were enrolled in such pools in 2011. 
One credible estimate found that it could easily cost more than $1 trillion over ten years to support an adequately funded national high-risk pool system.[4]  The Price plan doesn’t come anywhere close to that amount.  It includes just $1 billion annually in seed funding to support existing state high-risk pools and help start new pools for just three years, and no funding for ongoing operations thereafter.

Disrupting Employer-Based Coverage

The Price plan’s tax credit to buy individual-market coverage, described above, would be available to anyone not enrolled in other coverage, including those offered job-based coverage.  This could encourage employers to drop health coverage on the assumption that their workers could instead buy coverage on their own.  (By fully repealing the ACA, the Price plan would eliminate its requirement that large employers offer coverage or pay a penalty.) 
Moreover, the tax credit would be available irrespective of income, including to higher-wage workers and the owners or managers who decide whether their firms should continue offering health coverage.  This would almost certainly result in “adverse selection,” or the separation of healthier and less-healthy people into different insurance arrangements.  Healthier employees would be the most likely to find that using the tax credit to buy individual-market coverage would cost less than staying in their employer-based plan, where the premiums reflect the higher cost of the less-healthy individuals with whom they are pooled. 
As healthy individuals opted out of employer-sponsored insurance, the pool of workers remaining in employer plans would become sicker, on average.  That, in turn, would drive up the per-beneficiary cost of the employer-sponsored plans, raising the premiums for the workers still in those plans and inducing still more healthy workers to abandon them for lower-cost plans in the individual market.
The Price plan would also cap the tax exclusion for employer-paid health insurance premiums, which encourages employers to offer coverage to their workers.  This would further encourage employers to stop providing health benefits.  Many older workers and those in poorer health who lose job-based insurance would be at significant risk of ending up uninsured or underinsured, as they would have to use an inadequate tax credit in a largely unregulated individual market.

Expanding Health Savings Accounts (HSAs)

The Price plan includes several proposals to expand HSAs, which are tax-favored accounts that people with high-deductible health plans can use to save money for out-of-pocket health expenses.  HSAs offer unprecedented tax sheltering benefits to high-income individuals.  Contributions (up to $3,350 for individual coverage and $6,750 for family coverage in tax year 2016) are deductible, earnings grow tax free, and withdrawals are tax exempt if the money is used for health expenses. 
The Price plan would dramatically increase HSAs’ tax sheltering benefits by raising the annual contribution limit by more than 60 percent.  This would primarily benefit high-income individuals, who are more likely to make the maximum annual contributions.  They also receive the largest tax benefits from HSAs, since a tax deduction rises in value with an individual’s tax bracket.  Households with incomes of at least $100,000 already account for most tax returns claiming an HSA deduction and the large majority of the total amount of HSA contributions, according to data from the Joint Committee on Taxation.[5] 

Allowing Insurers to Sell Across State Lines

The Price plan would permit insurers to offer health plans to people or small businesses in other states, even if the plans don’t comply with the other states’ requirements.  The out-of-state plans would need to comply only with consumer protections in the state where they are licensed.  That would encourage insurers to seek licensure in states with very weak regulations and consumer protections and where they exert substantial political influence.
The few states that tried to open their markets to out-of-state insurers before the ACA had little to show for it, as insurers had problems establishing networks of providers outside their own states.  But, if out-of-state insurers did enter other state markets to a significant degree, less healthy individuals and small businesses whose workers are older or in poorer health would likely face much higher premiums as state consumer protections and market reforms would be effectively undermined.   Out-of-state plans would mainly attract healthy people with low health care costs, since they have less need for consumer protections such as requirements to cover certain benefits or limits on insurers’ ability to charge higher premiums based on age or gender.  Meanwhile, sicker-than-average people would generally remain in plans offered by in-state insurers, which would push up premiums for the in-state plans by saddling them with sicker beneficiary pools.

Establishing Association Health Plans (AHPs)

The Price plan would allow the establishment of AHPs that could offer health insurance to small business members and individuals (though the AHPs for individuals would be called independent health pools) and would be exempt from most state regulations applying to the individual and small-group markets.  Like plans offered across state lines, AHPs would primarily attract individuals and small firms whose workers are healthier than average and least need strong consumer protections and market reforms.  They could secure lower premiums through AHPs because they would be separating themselves from plans whose coverage pools contain less-healthy beneficiaries (along with healthy ones) and thus must charge higher premiums.  The result would be to drive up premiums for non-AHP coverage, making coverage less affordable for those who are older and sicker.

http://www.cbpp.org/research/health/hhs-secretary-nominee-prices-health-plan-would-severely-weaken-health-coverage-and

Thursday, December 1, 2016

Top Five Threats to Children and Families Posed by a Medicaid Block Grant

Many questions remain about what the new administration and Congress have in store for vulnerable children and families. Of course, the president-elect and congressional leaders have indicated repeal of the ACA will be a top priority early next year and, among other things, would end the Medicaid expansion and children’s coverage protections. But what other changes to Medicaid might be expected? President-elect Trump has said he will block grant Medicaid, a proposal consistent with proposals that some in Congress have put forth in some form reaching back to the 90s—they haven’t been successful yet. But House Speaker Paul Ryan has promoted the Medicaid block grant approach, accompanied by very substantial cuts in federal spending, as recently as this past summer.
With block grants appearing yet again in the public discourse, we figured it might be a good time to remind readers of our top five reasons why transforming the successful Medicaid program into a block grant is still a bad idea. Here’s our list.
  1. It’s a cut. No matter how you slice it, a block grant means cuts. Medicaid is a federal-state partnership — states are guaranteed to receive federal matching funds to run the program within federal guidelines and provide health care to their residents. Today, as long as an eligible person enrolls in Medicaid, federal matching funds will be there to support their care. A block grant caps the federal share, with states left to determine how to spend much more limited dollars. Medicaid is already a very lean program, so those cuts will impact services that children and families need to thrive. Congress’s most recent proposal from earlier this year would cut $1 trillion from Medicaid, or one-third of the program over the next decade.
  1. Jeopardizes the nation’s progress in covering kids. Today, an all-time high of 95% of the nation’s children have health coverage thanks to Medicaid, CHIP and the ACA. Medicaid is by far the MVP here — children make up nearly half of Medicaid beneficiaries. If states were forced to take on more of the cost, it would be nearly impossible to maintain the same benefit and enrollment levels. During the most recent economic downturn, Medicaid and CHIP worked exactly as intended: more kids got coverage even as child poverty rose. Capping Medicaid undermines the point of the program—it would place an arbitrary ceiling on funds that could run out just as more kids and families need it. Medicaid’s unique structure protects children and families from losing coverage during economic downturns or when states face budget shortfalls.
  1. Leaves states holding the bag when a new disease strikes or a new treatment is discovered. A block grant puts an arbitrary cap on what the federal government will pitch in. Under a block grant, once the cap on federal funds is reached – whether tomorrow or down the road—the state is left responsible to either cut off services to those in need or put up a much larger share of the cost. Fundamental restructuring of Medicaid’s financing structure puts states on the front lines for unanticipated growth in health care costs either from a new virus like Zika or a new block buster drug that provides great new treatment options for those suffering from Alzheimer’s, breast cancer or other common and serious medical conditions.
  1. Diminishes state flexibility to respond to changing economic circumstances. Block grant proponents tout additional flexibility for states. In reality, a block grant ties state officials’ hands when Medicaid is needed the most: during economic downturns or unexpected population or health challenges that create additional need. For example, when the economy slows, more people need Medicaid and yet states have fewer resources to cover them due to decreasing revenue. Under a block grant, no additional federal support is available to help states get by. States are also left without options in times when a state experiences larger-than-anticipated population growth or a natural disaster like Hurricane Katrina that places more families in need. Medicaid’s strength lies in its ability to respond to changing need. A block grant sets states up for failure at the exact time when more families will need help. 
  1. Endangers key features of Medicaid that work for kids – namely its strong benefits and cost-sharing protections. Cuts to federal funds coupled with more “state flexibility” would undermine states’ ability to meet Medicaid’s Early, Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirement for children, a core benefit that ensures all children have the screening and treatment services needed to grow and thrive. (Not to mention, federal guarantees like EPSDT could be explicitly repealed.)
Block grants are sold as innovation and opportunity for states. But we know that any substantial changes to the Medicaid financing structure (read: cuts) would have a significant impact on the health and economic security of families and communities across the country— children, people with disabilities, seniors, parents and many others who have come to rely on the program would no longer be guaranteed enrollment. This raises the unfortunate but very real potential for the most vulnerable Americans to compete for scarce healthcare dollars. It would dismantle the social compact we have across generations and abilities to take care of each other, and our own. No one wins when the most vulnerable are competing against each other for a smaller and smaller share of the pie.
Elisabeth Wright Burak http://ccf.georgetown.edu/2016/11/22/top-five-threats-to-children-and-families-posed-by-a-medicaid-block-grant/
Elisabeth Wright Burak is the Senior Program Director at the Center for Children and Families