Friends and Supporters, On Monday, May 12, 2025, we got our first real look at Congressional Republicans’ approach to spending cuts in Medicaid. Cuts are estimated at $715 billion over the next 10 years. There’s quite a lot of detail to digest, but here are some of the features of the reductions: - Approximately 14 million Americans will lose health insurance through Medicaid.
- There are community engagement requirements. To maintain eligibility, Medicaid beneficiaries who are “able-bodied” (this is not defined anywhere) must work or be legitimately and demonstrably involved in “not less than 80 hours of community service” per month.*
- Hospital/provider taxes, ordinarily applied by states and then certified by states to generate federal Medicaid match, are frozen (i.e., can’t be increased).
- Eligibility re-determination every six months (currently every year).
- Cost-sharing requirements that mandate beneficiaries pay certain co-pays, deductibles and the like not to exceed “5 percent of the family income of the family involved."
*Language the reconciliation draft includes: ‘‘(V) who is medically frail or otherwise has special medical needs (as defined by the Secretary), including an individual—(dd) with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living.” There’s more action taken with respect to the Affordable Care Act, but our focus is on Medicaid. Absent from the reconciliation language are two of the most egregious changes that would have devastated Americans with intellectual and/or developmental disabilities (IDD), namely block granting of Medicaid and per capita caps. We’re glad these have not (yet) found their way into proposed changes. But make no mistake, these changes and the reductions they create are massive. While they don’t target people with IDD, we and our partners locally and nationally are very concerned. We believe these changes do two things that will indirectly—and significantly—impact people with IDD. First, we are concerned about the impact of these changes on our workforce and their families. As you know, when our workforce is impacted, it inevitably impacts on the continuity of supports Makom and organizations across the country deliver. And second, there is a consequential cost-shift from the federal government to states. The two states in which Makom does its work, Maryland and Virginia, will incur new costs in required monitoring and compliance costs, as well as in a reduction in certain federal matching funds that are proposed in the reconciliation. We are monitoring closely for the scale of those costs, knowing full well that if states incur new costs (and, given the prohibition against increasing or initiating provider taxes used to increase federal match to compensate for these otherwise unfunded federal mandates), people with IDD are likely to be the first to feel the brunt of state rate and funding reductions. We need you. Again. We need your voice. It is a powerful and effective tool in our fight to protect Medicaid on which 5 million Americans with IDD rely. On which Virginians and Marylanders supported by Makom rely. Contact your Congresspeople. They work for YOU, your family, and your loved one who happens to have an IDD. Make it personal (change anything you want in the e-mail text). Phone calls, e-mails, even good ol’ fashioned letters are all great ways of making your voice heard. Whatever you do, do it now. So much is at stake, there is no time to waste. -David
David Ervin, Makom CEO
dervin@makomlife.org |
