Major Medicaid Initiatives to End if Court Reverses ACA

The recent announcement by the Department of Justice that it supports a district court decision this would cancel the entire Affordable Care Act (ACA), which is even more at stake for Medicaid than is generally understood – in the unlikely event that higher courts uphold the decision. In addition to eliminating the extension of Medicaid by ACA to low-income adults, this decision would jeopardize other Medicaid initiatives and create a massive disruption of Medicaid state programs, even in non-expansive states.

Admittedly, the most significant change in ACA with Medicaid is its extension to adults whose incomes are below 138% of the federal poverty line, allowing millions of people to obtain coverage Medicaid for the first time and has significant benefits for them, their families and their communities, shows. If the ACA is invalidated, almost 13 million Low-income adults would lose their health insurance and, with it, access to treatment for chronic illnesses, mental illnesses and substance use disorders. This would also result in greater financial instability for providers of safety nets, such as hospitals, as they would incur greater un-compensated care costs due to the higher number of uninsured adults.

But that's not all. If the position of the administration prevails, it will also have:

• Endanger the ability of states to administer their Medicaid programs. The ACA has asked states to transform the way they determine eligibility for Medicaid for most registrants. In addition to changing the way income is counted to align with the eligibility rules for federal tax credits to help low- and middle-income households cover their markets, the CAA also asked States to determine eligibility according to simplified processes. States should revert to older and more complex methods of treatment and determination of eligibility for Medicaid. This would not only hurt beneficiaries, but could also be a major challenge for states, given the considerable technological changes they have made to their eligibility systems to comply with the ACA law. It is unclear how states could determine eligibility for Medicaid if they were to suddenly revert to pre-ACA rules.
• Reduce coverage for children, including children of former children in foster care. The court's decision would reduce from 133% to 100% of the federal poverty threshold the mandatory eligibility of Medicaid to children ages 6 to 18, which would jeopardize their access to the important benefits of Medicaid that help children with disabilities. 39, flourish and succeed in adulthood. It could affect about 1.5 million children in 21 states. States could continue to cover these children from Medicaid as an optional eligibility group, or move them to the child health insurance program, which offers somewhat narrower coverage and higher costs. Moreover, if the decision is upheld, Medicaid eligibility for former children in foster care would be governed only by persons under the age of 18, as against 26 years of age. now requires.
• Make it more difficult for elderly and disabled people to access home care and their communities. New State options providing long-term community-based care for seniors and persons with disabilities would end, which could lead recipients to return to institutions for care.
• Increase federal and state costs for prescription drugs. The court's decision would eliminate the increases in Percentage of Medicaid drug reimbursement allowed by law. The costs of Medicaid-managed care would increase as Medicaid's health plans would no longer be eligible for discounts.
• Discourage States from promoting prevention services. States would have no more interest in offering preventive and vaccination services at no cost to beneficiaries, including Smoking cessation programs for pregnant women.
• Jeopardize the reform of the delivery system and other initiatives to improve the quality of health care. The court's decision would have effectively ended the Center for Medicare and Medicaid Services (CMS), ending demonstration projects designed to improve the delivery of care to Medicaid and Medicare beneficiaries, while reducing costs for states and the federal government. The court's decision would also prevent States from using health homes – a model of delivery system reform put in place by the ACA to help states improve the health outcomes of beneficiaries with complex diseases.
• End significant improvements in the integrity of the Medicaid program. The ACA has made changes to support state and federal efforts to ensure the integrity of the Medicaid program. If the court's decision is upheld, states would no longer need to screen suppliers, provide enhanced oversight for new suppliers and suppliers, or establish compliance programs consistent with improvements to program integrity. from the ACA.
• Reduce transparency. States would no longer have to solicit public comments requests for Medicaid demonstration projects under Article 1115, or federal "waivers", and CMS would no longer have to solicit public comment before approving them. In addition, nursing homes would no longer have to disclose information regarding property, liability requirements and expenses.

Fortunately, the ACA remains the law of the country for the moment. And the legal reasoning behind the district court's decision is low; even some of ACA's most committed opponents to predict he will be overthrown. But if it were upheld, as the administration demands, the damage done to tens of millions of people enrolled in Medicaid, and not just those enrolled in the extension of ACA, would be serious .