In the News

Members of Congress Matt Cartwright and Susan Wild have joined seven of their colleagues to voice concern over Medicaid changes they say could put beneficiaries at risk.

On Feb. 6, Cartwright and Wild, along with members of the Pennsylvania Democratic Congressional delegation, sent out a loud-and-clear message in opposition of the Healthy Adult Opportunity, a demonstration that the Centers for Medicare and Medicaid Services at the Department of Health and Human Services claims will “increase flexibility” for states to expand health care options.

The Healthy Adult Opportunity, which was introduced on Jan. 30 by the CMS, would allow for states to extend Medicaid coverage to adults under the age of 65 who do not otherwise qualify on the basis of disability, with the possibility to include other groups as well.

However, in order to participate in the opportunity, states have to opt for a cap on federal financing.

States that meet set performance standards and opt for the cap could access between 25% and 50& of the federal savings if their actual spending falls under the cap.

Currently, Medicaid, which is administered at a state level, is jointly funded by states and the federal government. The federal government provides matching payments without a pre-set limit.

According to the Kaiser Family Foundation, capping federal financing might result in challenges for health care programs. The organization cited the fact that “U.S. territories operate Medicaid under a federal cap, which has been set too low to meet enrollees’ needs,” and that such programs are “inflexible when responses to emerging health issues and natural disasters” occur.

Cartwright, Wild and the other members of the PDC made it clear in a letter to Seema Verma, MPH, administrator of the Centers for Medicare and Medicare Services, that distributing Medicaid funding as lump sum annual payments could lead to “tough choices that would put beneficiaries at risk.”

“Let’s be clear about what the Medicaid block grant plan would do: it would put health care for the most vulnerable among us on the chopping block,” Cartwright said. “Across our state, nearly three million people are covered by Medicaid, including 800,000 who gained coverage as a result of the expansion.”

Cartwright and the group were particularly concerned that the Healthy Adult Opportunity would make room for states to limit access to prescription drugs and impose eligibility criteria that could limit health care access to those in need, among other issues.

“Medicaid is also a lifeline for rural hospitals,” Cartwright said. “Before the expansion, we lost two hospitals in Northeastern Pennsylvania alone, both from financial distress. When your local hospital closes, your health care suffers, even if you still have your own insurance. Now is not the time to turn back the clock on this successful program that has helped millions of Americans get the care they need.”

On Feb. 6, Wild announced via a Facebook post that she would vote in favor of a House resolution to block the HAO proposal.

“Bottom line: the administration’s Medicaid block grants would hurt the very people Medicaid is intended to help,” Wild said in the post. “This is an outrageous attack on hard-working families struggling to make ends meet.”

The CMS has stated that the HAO will “enhance the Medicaid program’s integrity through its focus on accountability for results and quality improvement, making the Medicaid program stronger for states and beneficiaries.”

The letter from the Democratic Congress members, however, called out the HAO as “a cynical ploy to cut benefits and raise costs for the millions of individuals who benefited from Medicaid expansion over the last several years,” and applauded Gov. Tom Wolf for rejecting the proposal.

“The ‘Health Adult Opportunity’ proposal is yet another attempt to undermine what is working with our healthcare system and to cut access to affordable healthcare for seniors, children, people with disabilities, and low-income adults,” the letter reads. “We oppose this proposal and urge the Administration to reconsider, and instead work with the Congress to expand – not restrict – access to affordable, quality healthcare for all Americans.”