There is good reason why people with disabilities have been protesting Senators’ offices and holding sit-ins across the country all the way from Washington, DC to Missoula, MT. For folks like myself who receive care and services at home and in our communities under the Community First Choice (CFC) program and Home- and Community-Based Services (HCBS) waiver, not only is healthcare on the line, so is life and liberty, literally.
Since 1999, I have lived with a spinal cord injury (SCI) that I sustained in a motor vehicle accident. Prior to attaining my SCI, I was a member of the U.S. Army Reserves and worked on a ranch. Since then, I graduated from the University of Montana with a Bachelor’s degree in social work, am employed full-time, and am able to live independently. All of this has made me less dependent on other government services, but none of it would be possible without Medicaid.
The Senate health care plan, the Better Care Reconciliation Act (BCRA), would create additional barriers for people with disabilities and seniors to access affordable, or even adequate, health care.
Under current law, Medicaid is a federal-state financed partnership. Our state is able to respond to health care needs as they change over time, as well as react swiftly with increased funding for health services in the event of a natural disaster or epidemic.
Alternatively, the current Senate health care bill restructures Medicaid financing to a per capita cap system, which imposes an arbitrary, fixed amount of federal spending per beneficiary. Beginning in 2020, that change would cut federal Medicaid funding immensely, with the cuts growing each year. The cuts would continue to deepen in coming decades, rising to a 35 percent cut by 2036, according to the CBO.
Per capita caps shift the financial burden to individual states. Montana would likely have to make cuts that seriously harm beneficiaries, such as restricting eligibility, reducing services, cutting payments to providers (something that is already happening), or a combination of all three approaches to rationing care.
Let’s be clear: “Rationing care” is simply a polite way of saying “limiting health care goods and services to only those who can afford to pay.”
Services such as CFC, HCBS Waiver, and other community-based supports, are considered “optional” Medicaid services, making them a likely target for even more cuts.
Medicaid services are a lifeline for Montanans with serious health problems (including children with disabilities and special health care needs) to remain in their homes with family and in their established communities instead of a nursing home or institutionalized facility. CFC and HCBS services assist people who need them with their most basic daily living activities, such as bathing and dressing.
People with disabilities who have no choice but to rely on Medicaid services — such as personal-attendant care, skilled nursing, and specialized therapies — could lose access to the services they need to live independently, work, participate in the American dream, or even remain in their homes. People will either die or be forced into institutions.
In FY2017 there were approximately 561 home health, 3245 CFC, 853 PAS, and 2,729 HCBS waiver members receiving services in one or more of these programs in Montana. Another 253 Montana Medicaid members received hospice services in FY 2017.
Some people are born with a life-long disability, while some of us may experience it suddenly through a life-changing accident, and still others may develop unexpected disabilities as we age. Truly all of us are affected by these cuts to health care services, which allow us to live as independently as possible and provide our loved ones with the resources to live and work in our home communities. No one wants to be separated from family and friends or sent to isolating and expensive institutions.
As the Senate prepares a new version of their health care plan, I call on Senator Daines and Senator Tester to reject any bills that restructure Medicaid funding as a per capita cap or block grant system; that would threaten people’s abilities to stay in their homes and get care; or would eliminate Montana’s bi-partisan Medicaid expansion. Life and Liberty are guaranteed under the United States Constitution. There isn’t an asterisk in the Constitution that excludes Disabled Americans.
Travis Hoffman is the advocacy coordinator at Summit Independent Living in Missoula.