GOP budget eliminates nursing home funding through Medicaid

What Happens to Current Nursing Home Residents if the House Budget Resolution Becomes Law?
(Center for Medicare Advocacy)

Under the proposed budget resolution passed by Republicans in the House of Representatives, nearly a million nursing home residents could immediately lose coverage for nursing home care. Further, all of the standards that govern nursing home care today could disappear.

The House Republican Budget Resolution purports not to change Medicare for new beneficiaries until 2022. But, for current Medicare beneficiaries who live in nursing facilities, the overwhelming majority of whom rely on Medicaid for their nursing home coverage, the impact of the Budget Resolution would be immediate and devastating. With the repeal of Medicaid, fewer residents would be covered by Medicaid and more of the costs of nursing home care would be dramatically shifted to residents and states, and, for the first time, to residents' families. Residents could be required to pay for prescription drug coverage under Medicare Part D, whereas, under current law, those with Medicaid have no cost-sharing. And all current federal standards of care for nursing homes could be lost.

[...]

Since 1965, the Medicaid program has prohibited nursing facilities from requesting or requiring contributions from residents’ families. Adult children have never been legally responsible for their parents' nursing home care under the Medicaid program. That provision disappears if Medicaid is repealed. States could require residents' families to contribute to the cost of their relatives' care, even as they address their own health care needs or seek to help a child attend college.

Bullet points they discuss in their article:

• Nursing Home Residents Could Lose Medicaid Coverage of Their Nursing Home Care
  
• Even if states choose to pay for nursing home care under a block grant program, Medicaid's current financial rules and protections for residents and their families would disappear.
  
• Four of the most significant current financial protections that have been enacted over the more-than-45-year history of the Medicaid program could be lost under a block grant.
  
• Medicare and Medicaid Law Establish the Standard of Care in Nursing Facilities (this would be repealed)

Over a million nursing home residents are covered by Medicaid, not only will they lose their coverage, nursing homes in general will no longer be held to the current "Standard of Care".

The Republicans screamed "death panels" when Obama passed universal health care, but then they pass a budget that kicks the elderly on assistance to the curb. This is indeed Social Darwinism.

This is a death sentence for many in nursing homes.
Many families can't afford to take care of a loved one full time.

This is one of the reasons I can't be a Republican party member.
For a party that espouses religion. I'm baffled at how they hate other humans.
Except for fetuses of course.

Obviously all the residents of those nursing homes who arent footing their own bills and relying on "entitlements" like Medicare that hard working Americans have to get sucked out of their paychecks, were too LAZY to provide for themselves and need to get out of bed and get a new job!

Remember to show the OP to Grandma before the handi-bus comes to take her to the polls everyone...

All you need to know about that comical budget plan is that it actually INCREASES the budget in the long run

Everyone but the top 1% and military defence contractors suffer under Ryan's plan. Only a fool (or member of those 2 groups) should vote for that. If you are a member of those 2 groups, it's a complete no brainer if you're an non-ethical bastard

Can anyone give us a link and direct quote from the
proposal itself.

Maybe we need to see what this really is.

Then somebody can tell the Democrats in the Senate what to change.

Yawn

Name one Gop proposed legislation in the last 3 years that has ever became a law?

What's that you say? NONE!

Considering that the Gop only controls the House and the DNC controls the Senate and Potus getting tired of threads making mountains out of sinkholes.

Just to vilify the right if the Left cares so much about old people why the hell did they cut medicare and medicaid benifits?

hmmmm.

Originally posted by neo96
Yawn

Name one Gop proposed legislation in the last 3 years that has ever became a law?

What's that you say? NONE!

Considering that the Gop only controls the House and the DNC controls the Senate and Potus getting tired of threads making mountains out of sinkholes.

Just to vilify the right if the Left cares so much about old people why the hell did they cut medicare and medicaid benifits?

hmmmm.

edit on 4-4-2012 by neo96 because: (no reason given)

You do realize that everything passed is a compromise, right? You might wanna check who pushed for old people's benefits being cut...like now in the Ryan plan

reply to post by MrXYZ


Getting tired of this garbage a plan is NOT a law there is NO WAY the GOP will ever get anything passed in to law.

Originally posted by neo96
reply to post by MrXYZ

 

Getting tired of this garbage a plan is NOT a law there is NO WAY the GOP will ever get anything passed in to law.

edit on 4-4-2012 by neo96 because: (no reason given)

Let's hope they don't if they keep on piling garbage like the Ryan plan

Originally posted by xuenchen
Can anyone give us a link and direct quote from the
proposal itself.

Maybe we need to see what this really is.

Here's the official website for this new budget proposal. budget.house.gov...

The proposed changes mentioned in the OP take effect in 2022. There are no changes for those 55 years of age or over. And yes the amount of money spent actually increases. The cuts in the Republican plan are a cut in growth, not a cut off of what's currently being spent.

No one will be pushing grandma over a cliff if this gets passed into law. Of course this is an election year so expect the sensationalism to be ratcheted up to a foaming frenzy.

reply to post by dbates


Thanks.

Now we can analyze the real deal.

reply to post by the owlbear


We don't need any more trolls on ATS. We are all stocked up here.

Such a selfish, narrowminded view really disturbs me.

reply to post by nixie_nox


I think that his post was mostly sarcasm. At least that's the way I read it but then I tend to look at things that way in general. He does have a point about showing grandma the story before taking her to go vote. Of course these types of sensational headlines are meant to stir up anger by the AARP type folks.

Originally posted by dbates
reply to post by nixie_nox

 

I think that his post was mostly sarcasm. At least that's the way I read it but then I tend to look at things that way in general. He does have a point about showing grandma the story before taking her to go vote. Of course these types of sensational headlines are meant to stir up anger by the AARP type folks.

Either way, it doesn't change the fact that this clownish plan adds $4 trillion to the budget, and it's a VERY one sided approach the cost cutting. The only ones not getting their growth cut are the defence contractors and the top 1%

Originally posted by MrXYZ

Originally posted by dbates
reply to post by nixie_nox

 

I think that his post was mostly sarcasm. At least that's the way I read it but then I tend to look at things that way in general. He does have a point about showing grandma the story before taking her to go vote. Of course these types of sensational headlines are meant to stir up anger by the AARP type folks.

Either way, it doesn't change the fact that this clownish plan adds $4 trillion to the budget, and it's a VERY one sided approach the cost cutting. The only ones not getting their growth cut are the defence contractors and the top 1%

A few real quotes would be helpful....

ones that we can analyze rationally.

don't you think ?

reply to post by neo96


Republicans have obstructed every act and bill they can, and offered nothing else in return.

Even their own fellow Republicans dismiss their solutions.

Connie Mack disses Paul Ryan budget as "a joke." (miamiherald.com)



The changes wont be in effect until 2022 for new beneficiaries, but will go into effect once passed for current beneficiaries. Turning the program into a voucher program is itself a joke.

Ryan Republican Budget Reduces Medicaid and Threatens Seniors (ncpssm.org)

Jeopardizing Access to Nursing Homes and Long-Term Services and Supports

under a block grant system, the federal government would provide each state with a fixed dollar amount. States must find additional funding if they do not have resources to pay for an increase in the number of patients enrolled in Medicaid or the cost of medical treatments. States could address their funding shortfalls in any number of ways, including:

• Scaling back quality and service in nursing homes, endangering the lives of vulnerable seniors.
  
• Asking patients' spouses, children or other family members to cover the cost of nursing home care, exhausting much or all of their savings.
  
• Reducing access to home and community-based services, resulting in more individuals moving into nursing homes.
  
• Establishing waiting lists once funding for the year has been exhausted, requiring spouses or family to care for the patient in their homes

Rationing Health Benefits

• Placing caps on the number of individuals who could enroll in Medicaid and defer people to waiting lists once the cap is reached, leaving many people with no health benefits.
  
• Increasing the amount program participants must contribute for services and limiting the type of services available, making it harder for patients to obtain and afford the treatment their health care providers recommend.
  
• Reducing payments to providers such as doctors and hospitals, resulting in providers no longer accepting Medicaid patients and possibly leaving the program. Medicaid already pays providers less than Medicare or private health insurance.

Impairing Low-income Seniors Ability Pay for Medicare

• Diminishing Medicaid benefits and a loss of their Medicare coverage if they are unable to pay the premiums.
  
• Foregoing necessary care if they are unable to afford the deductible or the copayment

If Republicans really want to balance the budget they can stop funding endless wars and ask oil companies to pay their fair share, instead of "glorifying them" with more tax breaks.

reply to post by Blackmarketeer


Are all those points actually in the proposals ?

Seems a bit specific for just a proposal.

Starting on page 91 of the proposals:

FUNCTION 550: HEALTH
Function Summary

The principal driver of spending in this function is Medicaid, the
Federal-State low-income health program. It represents more than
70 percent of the function total, and is growing at a rate of 5 percent
per year—far faster than the growth of the overall economy.
The Congressional Budget Office [CBO] projects federal spending
on this program to be $258 billion in fiscal year 2012. This is expected
to more than double within the next 10 years, reaching $622
billion by fiscal year 2022.
But this represents only the Federal share of Medicaid. State
spending on the program is expected to follow these same trends.
According to the Centers for Medicare and Medicaid Services’ December
2010 Actuarial Report on the Financial Outlook on Medicaid,
total State spending will rise from $133.5 billion in 2010 to
$327.6 billion in 2019.
While these spending trends are clearly unsustainable, Medicaid
also has fostered a two-tiered hierarchy in the health care marketplace
that stigmatizes Medicaid enrollees. Its perverse funding
structure is exacerbating budget pressures at the State and Federal
level, while creating a mountain of waste. With administrators
looking to control costs and providers refusing to participate in a
system that severely under-reimburses their services, Medicaid
beneficiaries are ultimately finding it increasingly difficult to obtain
even the most basic medical care. Absent reform, Medicaid will
not be able to deliver on its promise to provide a sturdy health-care
safety net for society’s most vulnerable.
Medicaid’s current structure gives States a perverse incentive to
expand the program and little incentive to save. For every dollar
that a State government spends on Medicaid, the Federal Government
pays an average of 57 cents. Expanding Medicaid coverage
during boom years is tempting and easy to do—State governments
pay less than half the cost. Yet to restrain Medicaid’s growth,
States must rescind a dollar’s worth of coverage to save 43 cents.
The recently enacted health care law adds even more liabilities
to an already unsustainable program. CBO estimates the new law
will increase Federal Medicaid spending by $931 billion. This is
due to the millions of new beneficiaries that the law drives into the
program. In fact, CBO estimates that over the next 10 years, no
fewer than 30 million new enrollees will be added the Medicaid
program.
For all these reasons, this budget recommends a fundamental reform
of the Medicaid Program. One potential approach is described
below.
(91)

continued...

page 92

In addition to Medicaid, this budget function includes spending
for the State Children’s Health Insurance Program [SCHIP], health
research and training, including the National Institutes of Health
[NIH] and substance abuse prevention and treatment; and consumer
and occupational health and safety, including the Occupational
Safety and Health Administration.
Discretionary spending in this function includes funding for
Project Bioshield, NIH, the Food Safety and Inspection Service, and
the Food and Drug Administration.
Summary of Committee-Reported Resolution
The resolution calls for $363.3 billion in budget authority and
$365.5 billion in outlays in fiscal year 2013. Discretionary spending
for the year is $56.6 billion in budget authority and $58.2 billion
in outlays; mandatory spending is $306.7 billion in budget authority
and $307.3 billion in outlays. The 10-year totals for budget authority
and outlays are $4.05 trillion and $4.04 trillion, respectively.
While the Committee recommendation is a disciplined budget
that will require committees of jurisdiction and agencies to set priorities
and achieve efficiencies, it does not take the arbitrary approach
that will result from the Budget Control Act’s sequester.
The House Republican budget replaces the sequester. If not replaced,
based on staff estimates, discretionary spending in this
function would be reduced by another $6.5 billion below the committee
recommendation in fiscal year 2013.
Illustrative Policy Options
The exact contours of a Medicaid reform—as well as other policies
flowing from the fiscal assumptions in this budget resolution—
will be determined by the committees of jurisdiction. Nevertheless,
the need for fundamental Medicaid reform and other measures to
slow the growth of Federal spending are unquestioned, and one set
of potential approaches is described below.
MANDATORY SPENDING
Transform and Strengthen the Medicaid Safety Net. One way to
secure the Medicaid benefit is by converting the Federal share of
Medicaid spending into an allotment tailored to meet each State’s
needs, indexed for inflation and population growth. Such a reform
would end the misguided one-size-fits-all approach that has tied
the hands of State governments. States would no longer be shackled
by federally determined program requirements and enrollment
criteria. Instead, each State would have the freedom and flexibility
and to tailor a Medicaid Program that fit the needs of its unique
population.
The Chairman’s mark proposes to turn Medicaid from an openended
entitlement into a block-granted program like SCHIP. These
programs would be unified under the proposal and grown together
for population growth and inflation.
This reform also would improve the health care safety net for
low-income Americans by giving States the ability to offer their
Medicaid populations more options and better access to care.

continued....

page 93

Medicaid recipients, like all other Americans, deserve to choose their
own doctors and make their own health care decisions, instead of
having Washington make those decisions for them.
Based on this kind of reform, this budget assumes $810 billion
in savings over 10 years, easing the fiscal burdens imposed on
State budgets and contributing to the long-term stabilization of the
Federal Government’s fiscal path.
Repeal the Medicaid Expansions in the New Health Care Law.
The recently enacted health care law calls for major expansions in
the Medicaid program beginning in 2014. These expansions will
have a significant impact on the Federal share of the Medicaid Program,
and will dramatically increase outlays.
In the face of enormous stress on Federal and State budgets and
declining quality of care for Medicaid, the new health care law
would increase the eligible population for the program by one-third.
For fiscal years 2014 through 2023, CBO projects the new law will
increase Federal spending by $932 billion.
This future fiscal burden will have serious budgetary consequences
for both Federal and State governments. While the
health law requires the Federal Government to finance 100 percent
of the Medicaid costs associated with covering new enrollees, this
provision begins to phase out in fiscal year 2016. At that time,
State governments will be required to assume a share of this cost.
This share increases from fiscal year 2016 through 2020, when
States will be required to finance 10 percent of the health law’s expansion
of Medicaid.
Not only does this expansion magnify the challenges to both
State and Federal budgets, it also binds the hands of local governments
in developing solutions that meet the unique needs of their
citizens. The health care law would exacerbate the already crippling
one-size-fits-all enrollment mandates that have resulted in
below-market reimbursements, poor health care outcomes, and restrictive
services. The budget calls for repealing the Medicaid expansions
contained in the health care law and removing the law’s
burdensome programmatic mandates on State governments. Adopting
this option would save $932 billion over 10 years.
Repeal the Exchange Subsidies Created by the New Health Care
Law. According to CBO estimates, the health law proposes to spend
$800 billion over the next 10 years providing eligible individuals
with subsidies to purchase government-approved health insurance.
These subsidies can only be used to purchase plans that meet
standards determined by the new health care law. In addition to
this enormous market distortion, the law also stipulates a complex
maze of eligibility and income tests to determine how much of a
subsidy qualifying individuals may receive.
The new law couples these subsidies with a mandate for individuals
to purchase health insurance and bureaucratic controls on the
types of insurance that may legally be offered. Taken together,
these provisions will undermine the private insurance market,
which serves as the backbone of the current U.S. health care system.
Exchange subsidies will undermine the competitive forces of
the marketplace. Government mandates will drive out all but the
largest insurance companies. Punitive tax penalties will force individuals
to purchase coverage whether they choose to or not.

continued...