Better Care Reconciliation Act Update 6/28/17

While there is a great deal of uncertainty right now, it seems clear that the proposed American Health Care Act (AHCA) poses great risk to individuals with disabilities who use Medicaid funds for vital services and supports. We encourage all Imagine! stakeholders to do their best to keep up to date on this fast moving process, and to participate in the process as they see fit.

To do our part to keep you up to date, we’ll be sharing updates on this blog as necessary.

As of 6/28/17, here’s what we do know about the AHCA (now called the Better Care Reconciliation Act of 2017) and the bill’s potential impacts on services for people with intellectual and developmental disabilities.

On June 22, the Senate released its version of the American Health Care Act, now called the Better Care Reconciliation Act (BCRA) of 2017, 142 pages of proposed legislation that built off the House passed version from May. On June 26, a slightly revised version was released. Check it out here.

Meanwhile, the Senate has delayed its vote on the BCRA until after the July 4th recess due to lack of support among both moderate and conservative Republican senators.

Analysis of the BCRA in its current incarnation indicates that:

The acute workforce crisis in our field is likely to worsen with the bill as written.

• According to the Medicaid and CHIP Payment and Access Commission (MACPAC), the Medicaid growth rate in the AHCA/BCRA’s per capita caps proposal will continue to be lower than the expected growth rate of costs for services and supports. 
• There is already a 45 percent national turnover rate among Direct Support Professionals (DSPs), who offer front-line supports to people with intellectual and developmental disabilities. Turnover is high because low Medicaid rates make it difficult for providers to be competitive employers, and they cannot negotiate rates. Staff members often leave for other industries with better wages. 
• Without enough employees, providers cannot meet rapidly increasing demand for supports, leading to large in-state waiting lists and putting quality of care at risk. 

States may be hurt by the AHCA/BCRA as written and programs for individuals with disabilities may not be protected.

• By removing more than $800 billion from Medicaid, the BCRA passes the financial burden of the program onto state budgets that are already strained. Colorado’s budget faces an additional unique challenge in budgeting to meet the needs of individuals with I/DD because of TABOR restraints. 
• Reduced funding means Colorado may have to make hard decisions regarding eligibility or services provided, and Colorado is already rated at very nearly the bottom in the nation when it comes to fiscal effort for I/DD services.  

So how big of an issue is this?

• 10 million people with disabilities in the U.S. rely on Medicaid for the services that help them live and work in the community, known as Home and Community Based Services (HCBS). 1.2 million people in Colorado are enrolled in Medicaid, and close to 11,000 receive comprehensive services through HCBS. 
• Many people with disabilities are unaware that the services they receive are part of Medicaid. Services funded through Medicaid may have different names depending on the state. If a person with a disability receives any community-based support, it’s very likely through Medicaid. 

We’ll continue with the updates as we gather more information, so check back often.

Sources: ANCOR, Center for Public Representation