Latest block grant proposal carves out people with disabilities; targets Medicaid expansion population

Highlights:

• CMS announced a new Medicaid block grant proposal specific to the Medicaid expansion population; people with DD should not be affected.
• States would have to opt in to this proposal, and the Ohio Department of Medicaid has said it is not interested.
• OACB does not see an urgent advocacy need at this time on this topic.

At the end of January, the Centers for Medicare and Medicaid Services (CMS) announced a plan that would allow states to request capped funding for poor adults covered by the Affordable Care Act’s (ACA) Medicaid expansion.

The proposed program, which CMS is referring to as “Healthy Adult Opportunity,” would function similarly to the block-grant proposal included Republican-led ACA repeal effort in the summer of 2017. OACB opposed that proposal on the grounds that it could put Ohio’s DD system at odds with other human services systems for state funding.

The federal plan unveiled January 30, however, specifically targets federal funding covering low-income people who became newly eligible for Medicaid as a result of the ACA (i.e. the Medicaid expansion population). In its announcement, CMS stated that “low-income adults, children, pregnant women, elderly adults, and people with disabilities will not be directly affected.”

This new funding structure for Medicaid expansion coverage would not be automatic. State governments would have to request this new structure from CMS. This week, the director of the Ohio Department of Medicaid, which expanded the state’s Medicaid program under former Ohio Governor John Kasich, has stated publicly that Ohio is not considering this option.

Given the differences between this program and former block grant proposals and ODM’s decision not to take part in it, OACB is currently neutral on “Healthy Adult Opportunity” and does not see an urgent need for advocacy on this topic. Concerns about the program’s structure remain, however. At this time, it is not clear how or if Medicaid expansion dollars can be separated from Medicaid’s core funding.

If it becomes apparent that the Trump administration’s recent proposal will put the Mediciad program at financial risk despite CMS’ assurances, OACB will reassess its stance and communicate updates to members.

The association is seeking additional information from ODM and CMS, and updates will be shared in future editions of the PolicyBrief. Members with questions about this topic can contact Erich Bittner (ebittner@oacbdd.org).