From this morning’s post on Medicaid, Ohio Mom asks an excellent question:
But don’t most states also use Medicaid to support adults with disabilities? As I’ve noted before, a year in a group homes costs $30,000-40,000 in my area, and it is Medicaid that pays for it.
For me, as a mom of a kid with autism, this aspect of Medicaid is BIG. Can you address this, David?
So often, adults with disabilities get overlooked.
Yes, Medicaid is often a payer for adults with significant challenges. Medicare will pay the medical costs of individuals who qualify for SSDI payments but that is not the entire universe of people with challenges. Medicaid is the payer of last resort for individuals on Supplemental Security Income (SSI). This is a cohort of people with significant medical and behavioral health challenges. States have been pushing over the past two generations to move people out of institutional and in-patient settings to supportive housing and supporting services within the community.
The challenge is that SSI qualified individuals as a cohort are expensive because their needs are numerous. Here is where service limits will often come into play. The service limits can either be hard counts that an individual can only get 10 units of service per time period even if the medically necessary recommendation is for 22 units of service or for the creation of wait lists. Adults who are SSI eligible will get some assistance. The policy challenge is that adults, especially those with significant but not visibly obvious and sympathetic conditions are weak claimants with strong cases. They are one of the groups that will get whacked whenever the states are facing a funding crunch due to either a decrease in tax revenue, an increase in enrollment or per capita caps with a policy or social shock.
rikyrah
Thanks for the info.
smintheus
I have different Medicaid question. SCOTUS turned federalism on its head when it ruled that whenever they wish states can just ignore changes that federal legislation makes to the Medicaid program and instead continue under the older rules governing Medicaid programs.
So if Ryan changes the law to reverse the ACA’s rules about Medicaid, can states now choose to ignore the new Medicaid rules and force the federal government to allow them to continue under their existing Medicaid programs? Or does the opt-out from federal laws just apply to Republican governors?
Gary Ratner
My recollection is:
Medicare benefits for the disabled Social Security recipient do not kick in until the beneficiary has received 24 months of disability payments. Medicaid also pays for nursing home care, notably for care which is “custodial” rather than “skilled” or for care which, though “skilled”, exceeds Medicare’s service limits for skilled nursing.
TriassicSands
Random observation: The CBO has scored Chumpcare and it’s a whopper. They say the GOP’s health care bill will reduce the number of insured Americans by 24 million over the next ten years. That means the country will be worse off after the introduction of the AHCA than it was before the ACA took effect. A huge step backward.
Good job Republicans.
pk
I’m thinking that the republicans are now going to say that the CBO consists of Obama supporting traitors who are trying to sabotage Trump. Pretty sure Trump will start to trash tweet the CBO before the end of the week.
Suzan
I have a question about the lottery. Isn’t Medicaid means tested now? How is it you could win the lottery and still get Medicaid?
David Anderson
@Suzan: It depends — Medicaid Expansion tests for income not assets. Other parts of Medicaid tests for assets as well.
David Anderson
@pk: Given that Sec. Price highly recommended the current head of the CBO that is going to be a challenge.
Barbara
@smintheus: The federal government can refuse to fund Medicaid whenever it wants to. But when it offers the states the opportunity to get money, it’s supposed to be a choice for the states whether to take it or not. The purported reasoning of the SCOTUS was that the penalty associated with declining to expand was so draconian (loss of all Medicaid funds for all populations) that it did not provide the state with a meaningful choice. It wasn’t voluntary, in other words. It was also complete bullshit, but the point is, the states can’t force the federal government to fund Medicaid any more than the federal government can force the state to fund Medicaid.
Eljai
I just attended a healthcare town hall with my rep, Jared Huffman, in a solid blue part of Northern California. I was encouraged that over 1000 people showed up on a weekday afternoon. I think the CBO score actually only touches the surface of the bad repercussions that would follow Trump-RyanCare.
Pogonip
I hope those witches are working on hexing Ryan out of office. We who have autistic relatives should probably sew up voodoo dolls and jump in and help.
The thing that really angers me about Ryan is he doesn’t appear to do these things for money. Sheer meanness seems to be his motivation.
Eric NNY
My niece with cerebral palsy lives in a group home in Ohio. It is wonderful she gets to live in a small home with a couple friends with similar ailments and still be as independent as is possible.
They cut her, I cut them……
smintheus
@Barbara: In other words, SCOTUS said that states get to hold onto a Medicaid program of their own liking, whatever the federal government might say Medicaid now consists of, if the states think any federally legislated changes in Medicaid are too draconian. So does that still apply, can states refuse to accept any of Trump’s changes to Medicaid?
Alex
NPR’s Marketplace has a program on this evening on the effect of potential Medicaid cuts on adults with severe disabilities.
Alex
@Suzan: Apparently there is some Medicaid accounting rule that requires the income to be attributed only to the month it was received, so you could maybe be disqualified for only a month if you took the lump sum payout option. But I think you’d likely still run afoul of the asset limit, unless you got very tricky with trusts.
Snarki, child of Loki
” So does that still apply, can states refuse to accept any of Trump’s changes to Medicaid?”
With John “lawless” Roberts on the court, expect that he’ll find a teeny tiny footnote in the ruling that says “IOKIYAR, no backsies”.
Ohio Mom
I just got home from a very long afternoon and evening and saw this post — thank you so much. Today is my birthday and this feels like the best present.
It’s very clear. I can show it to people who don’t quite get it, and I think it will help them understand. I especially like the line: “those with significant but not visibly obvious and sympathetic conditions are weak claimants with strong cases.”
Ain’t that the truth. To the unsophisticated and uneducated eye, adults with DD can be very unappealing.
Ohio Mom
@Gary Ratner: There is a difference between SSDI and SSI.
SSDI is for people who have worked and contributed to Social Security for at least 40 quarters. It’s for people who have been injured and can no longer work, and as I understand it, also people with terminal illnessses like Stage IV cancer.
You are right, after 24 months, you are also eligible for Medicare (what you are supposed to do in the interim is a mystery to me).
SSI is for anyone over age 18 who is too impaired by their disability to fully support themselves — say someone with cognitive impairment and behavior issues. There is no minimum work history requirement.
In Ohio, if you are impaired enough to qualify for SSI and you also have a developmental disability, you will probably be eligible for a Medicaid Waiver, which provides both medical coverage and funding for living expenses. The catch is, there is a limited number of Waivers and long waiting lists.
I believe that even if you do not qualify for a Waiver, you may be eligible for Medicaid for medical coverage.
If you find you are able to work, you can earn money and your monthly benefit is reduced accordingly.
People in my state who have significant mental illness but no other disability are not eligible for Medicaid Waivers. SSI might be their only means of support, and the highest level of funding you can be awarded is $700-something a month.
These people are in a very, very tough spot.
At least this is my amateur understanding of these programs.
Ohio Mom
I am reminded of what a family friend who is a retired tax attorney and the father of a very involved autistic thirty year old said to me once: “Nobody understands SSI.”
Meaning that the entire SSI process is completely opaque. Many of their decisions seem arbitrary; many people who appear to meet the criteria in every way are turned down. If an attorney with a lifetime of advocating for a very autistic son can’t completely crack their code, who can?
It’s not a great system but it will be horribly worse if/when Trump, Ryan and McConnell set their sights on Social Security. We’d better win the ACA fight so they’ll be too spooked to go after anything else.