the advocacy monitor

Independent Living News & Policy from the National Council on Independent Living

Fact Sheet: The Affordable Care Act and The Disability Community

January 6, 2017

There are a lot of questions about the upcoming healthcare threats our community will be facing. We know that Congress wants to repeal the Affordable Care Act, and recent reports say that House Republicans are aiming to get a repeal bill on President-Elect Trump’s desk by February 20. We also know that there have been proposals to turn Medicaid into block grants or per capita caps. In this alert you can read more about what this all means, as well as NCIL’s strategy to fight against cuts to our coverage.

Read NCIL’s Call to Action: Saving the Affordable Care Act and Fighting Medicaid Block Grants!

The Affordable Care Act

How does the Affordable Care Act (ACA) benefit people with disabilities?

  • Young adults can now remain on their parents’ insurance plan until age 26.
  • Insurers cannot discriminate against people with pre-existing conditions by denying coverage, charging higher premiums, or refusing to cover care related to those conditions.
  • Insurers are not allowed to impose lifetime or annual dollar limits.
  • People with incomes of up to 400% of the federal poverty level (FPL) are eligible for subsidies to purchase health coverage.
  • All plans are required to cover certain minimum benefits.
  • Medicaid was expanded in 31 states plus DC.
  • The Money Follows the Person (MFP) demonstration program that helps people with disabilities transition from institutions to the community was reauthorized and expanded.
  • The Community First Choice option (CFCO) was established, which increased the Federal Matching Assistance Percentage (FMAP) for states who provide new or expanded home and community based services (HCBS).
  • The Balancing Incentive Program (BIP) was created to provide financial incentives to states to increase access to HCBS.
  • The U.S. Access Board was authorized to develop accessibility standards for medical diagnostic equipment (MDE).

What has the ACA achieved?

  • 20 million people have gained health insurance, including people with disabilities and other pre-existing coverage who became newly eligible.
  • CMS was able to award MFP grants to 16 additional states for a total of 47.
  • Five states have selected the CFCO.
  • Eighteen states have participated in BIP.
  • Medicaid has been expanded in 31 states plus the District of Columbia, and nearly 11 million people have gained Medicaid coverage. In those states, eligibility was broadened to include all adults under 65 with annual incomes below at least 138% of the federal poverty level (FPL).

How will repealing ACA impact people with disabilities?

  • People with disabilities may lose coverage due to pre-existing conditions. Prior to the ACA, 13% of applicants were denied coverage and 34% were offered a policy at a higher cost or without coverage for their pre-existing condition. Over 400 conditions that up to 1 in 2 Americans have could be used to justify denying coverage.
  • People with disabilities may lose coverage due to plans being unaffordable. Currently, people with incomes of up to 400% of FPL are eligible for subsidies. If these subsidies are repealed, many people will no longer be able to afford coverage.
  • People with disabilities may lose their ability to live in their homes and communities. MFP has now been adopted by 47 states, and five states have elected CFCO. Without extending MFP and preserving CFCO, it will be much harder for people with disabilities to get out of institutions, and to pay for community-based services and supports.
  • People with disabilities may lose Medicaid coverage. People with disabilities who don’t meet the Medicaid disability requirements and people who are currently waiting on determinations can now obtain Medicaid coverage if they fall under state FPL eligibility levels. If Medicaid expansion is repealed, the 11 million people who have gained Medicaid coverage are at risk of losing their health care coverage.
  • Unemployment of people with disabilities may increase. A recent study found that people with disabilities were significantly more likely to be employed in states that expanded Medicaid (38%) than in states that did not (31.9%). If Medicaid expansion is repealed, it is realistic to expect that employment in those states may decrease.

Block Granting Medicaid

What are Medicaid block grants and per capita caps?

Currently the federal government covers a percentage of states’ Medicaid costs. Under Medicaid block grants, the federal government would pay the state a specific lump sum (likely based on historical spending), rather than a percentage of the state’s costs. Under per capita caps, the federal government would pay the state a fixed amount for each beneficiary instead. Both options drastically reduce federal funding for state Medicaid programs, with gaps increasing over time relative to current spending. To counter the significant costs that are shifted to states, they are given ‘flexibility’ to make changes to their program.

How would block granting Medicaid impact people with disabilities?

  • Deep cuts to federal funding, requiring states to either find new funds to cover expenses or institute changes to the state Medicaid program.
  • Changes to compensate for federal funding cuts could include changes to eligibility, enrollment caps, waiting lists, benefit cuts, and lower provider payments.
  • Benefits for ALL of the 74 million people who rely on Medicaid, including the ten million beneficiaries with disabilities, would be threatened.
  • An example: under Speaker Ryan’s previous proposal, between 14 and 21 million people would eventually lose their Medicaid coverage, on top of the 11 million who will already lose coverage if Medicaid expansion is repealed. Moreover, it called for cuts in federal spending on Medicaid of about $1 trillion over the next 10 years.