from Consortium for Citizens with Disabilities CCD:
The new federal bill, the American Health Care Act (AHCA), will make it much more difficult for
people with disabilities to exercise our right to live in the community.
The Olmstead Supreme Court decision, whose original plaintiffs were Lois Curtis and Elaine
Wilson, established the right of persons with disabilities to live in the community with
supports, not in a nursing home or institution. Medicaid has been the main pathway for
improving access to home and community-based services (HCBS).
Regarding HCBS, the disability community emphasizes:
No to per capita caps for Medicaid
No to the termination of the 6% enhanced FMAP for the Community First Choice Option
We need to see an amendment that extends the Money Follows the Person program, so
that funds can be appropriated later
No to savings-account style healthcare that force people to pay out-of- pocket for
expenses that insurance will no longer cover
For those who rely on Medicaid funding, the AHCA’s proposal for per capita caps offers no
flexibility for supporting people with disabilities whose HCBS costs may require flexibility. As
each year goes by, there is no way a per capita cap system will be able to keep pace with growth,
shifting extra costs to states. Disability advocates fear the AHCA provision that starting in 2020,
the Federal government could actually make big Medicaid cuts to a state, if that state spends too
much on people with disabilities.
An overall reduction in federal Medicaid funding could mean that Medicaid providers won't get
paid and people with disabilities won't have access to supports needed to stay in the community.
Those people could be forced into a nursing home or institution, even though it costs more,
because under Medicaid institutional placement is an entitlement. States may also use new
flexibility under the AHCA to restrict eligibility, or change/eliminate Medicaid waivers in a way
that shuts people with disabilities out of access to HCBS.
It will also be harder to get OUT of a nursing home because the bill does not contain language to
extend Money Follows the Person.
The AHCA also eliminates the 6% enhanced Federal match for the Community First Choice
Option (also known as the K Plan or 1915(k)). This program has enabled six states to expand
access to HCBS through the extra federal funding.
Access to healthcare, especially specialists, is important for people with disabilities and seniors.
If Medicaid funds shrink, specialists will drop clients. If people have to pay more out of pocket,
while healthcare costs skyrocket, they will die.
*The above information is based on initial information about the AHCA. While we recognize that
many parts of the AHCA could negatively affect millions of Americans, our purpose on this sheet
is to highlight home and community based services used by people with disabilities.