The Misunderstood Medicaid Program Behind Yesterday’s Disability “Die In”

https://goo.gl/aUHdVJ

Watching coverage of ADAPT’s “die-in” in front of Sen. McConnell’s officeyesterday, it seemed a lot of people were a bit confused about what, exactly, the people on the screen getting dragged out of their wheelchairs were protesting. They were opposed to the Senate health care bill because… something about Medicaid cuts?

In their statements and interviews, protesters mentioned a specific, and widely misunderstood, set of Medicaid services that many seniors and people with disabilities rely upon to live independently.

Medicaid policy can get really complicated, so here is my best attempt at a simple explanation.

When most people think about health care, they think about doctors and hospitals and tests and meds. But what if you are getting older and you need help with daily tasks like bathing and cooking? Or you live with a physical disability and need help getting out of bed and getting dressed for work in the morning? Or you have an intellectual disability and need a little help with a variety of daily tasks?

If you need these kinds of “non-medical” services, you generally have a few options:

  1. get services from informal caregivers (usually family)
  2. pay out of pocket (this usually requires a lot of money)
  3. live in a nursing home
  4. try to get services from community providers

Insurance and Medicare don’t cover the last two options, so if you don’t have a lot of money or family/friends able to help, then Medicaid is probably your only option.

The cost of Medicaid is shared between the federal government and states. Imagine that the federal government is a mom and her teenage son, who works a few hours a week after-school, is a state. At the end of every month, Mom looks at how much her son spends on gas and pays him 60% of the total cost. This is (very roughly) how Medicaid works now. If he drives more, he gets more gas money, if he drives less he gets less.

Suppose Mom decides that she’s going to try something different. Last month she paid him $200 for gas, so from now on she’s going to pay $200 a month no matter how much gas he uses. Think of this as the Medicaid proposal in the House and Senate health care bills. Right now, a state is reimbursed for any given Medicaid recipient based on how much that person’s care actually cost. The American Health Care Act would give states a set amount per Medicaid recipient, regardless of how much that person’s care cost in a given year. As with all health care policy, the actual structure is more complicated, but this is the general idea.


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