Medicaid Change Could Have Impact On States

Big changes could be coming to a health care program that insures millions of senior, disabled or low-income Pennsylvania residents.

The Trump administration is supporting the idea of switching Medicaid to a block grant system, which it says would free states to manage the program as they think best, without federal overhead.

"You really cut out the fraud, waste and abuse, and you really get help directly to them," Trump counselor Kellyanne Conway said Sunday on NBC.

In the existing model, federal government guarantees to match state funds for qualifying Medicaid expenditures. That means federal funding is based on actual costs incurred.

The proposed changes would mean states receive a set amount of Medicaid funds based on historic spending levels.

Critics, citing past research on a block grant proposal from 2012, fear the changes could leave 25 to 35 percent of Medicaid enrollees without coverage. More than 2.7 million Pennsylvania residents are currently in the program.

Gov. Tom Wolf this week issued a statement that the federal government should not pursue "a block grant program that would cut funding for Medicaid coverage for many hard-working Pennsylvanians," warning that it could have "a devastating impact" on the state's most vulnerable residents.

Additionally, the Department of Human Services on Tuesday estimated that if Pennsylvania's federal Medicaid funding were to be capped at the total it received for budget year 2015-16, that would result in a $1.27 billion cut for 2017-18.

In a Facebook post Monday, U.S. Senator Bob Casey called block granting Medicaid "just a cute phrase for $1 trillion in cuts that will result in less nursing home care for seniors and less health care coverage for the struggling and those with disabilities."

He also wrote that it would "cause substantial job loss for middle class families, large numbers of whom work at hospitals."

Comment from Pennsylvania's other U.S. senator, Pat Toomey, was not available Tuesday.

Russ McDaid, president of the Pennsylvania Health Care Association, which represents more than 500 nursing and assisted living homes and other senior providers, said it understands the need to assess spending.

But, he said in an email, caring for a Medicaid patient costs an average of $9,300 per year more than nursing homes here get paid for doing that.

"Medicaid reform may put the safety net at risk if there are no requirements for specific types of care or eligibility," McDaid wrote.

Ron Barth, president and CEO of nonprofit senior services association LeadingAge PA, said he's waiting to see specifics.

"There could be some good things about block grants; there could be some very bad things about block grants," he said.

A good example would be giving Pennsylvania flexibility to use Medicaid funding for assisted living, he said; a bad example would be reducing funding.

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