Groups Mobilizing To Protect Medicaid

By Ori Nir

Published July 11, 2003, issue of July 11, 2003.
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WASHINGTON — The nation’s major Jewish organizations are launching a program aimed at shielding federal social programs that cater to the poor, with its first priority to be maintaining Medicaid’s present funding and strict federal supervision over the way states deliver Medicaid services.

“This will be our main focus in the next few months,” said Reva Price, Washington representative of the Jewish Council for Public Affairs, a policy coordinating body representing 13 national Jewish organizations and 123 local community relations councils. The nation’s main public health insurance program for the poor, Medicaid “is one of our most important safety nets. If there’s a hole in the net, a lot of people will fall through,” Price said.

Earlier this month, the JCPA board decided to launch an emergency mobilization campaign to protect human-service programs that the organization thinks will be hurt by proposed administration budget cuts. The umbrella organization agreed to give this campaign priority over pro-Israel lobbying efforts and to focus on educating Jews about the potential impact the budget crisis has on poverty in the United States in general and in the Jewish community in particular. Next week, a special committee assigned by the JCPA board will meet to devise a public-education and lobbying strategy on Medicaid.

The projected Medicaid cuts, the organization’s top priority, would result from a proposed shift in the way the federal government participates in the federal-state partnership. Under the current system, the federal government matches state contributions on a shifting scale keyed to poverty levels. The administration is proposing to shift its funding to block grants, a move critics say would encourage states to cut their own contributions as a way to balance budgets.

Cuts in Medicaid would affect millions of Americans. In 2002, more than 47 million people received health coverage and long-term care services funded by Medicaid. Its most devastating impact, experts said, would be on low-income seniors, for whom alternative government-subsidized programs do not exist. Seniors receive a large portion of the Medicaid pie: 27% of all Medicaid funds, even though they comprise only 10% of Medicaid enrollees. Because of the high cost of long-term care and prescription drugs for the elderly, on average, a senior Medicaid enrollee cost the program $12,318 in 2002, much above the $2,334 average for nonelderly adult enrollees.

In the Jewish community, officials say, tens of thousands of elderly people stand to be hurt by a cut in Medicaid. Hardest hit would be those in Jewish nursing homes, which receive a large portion of their funding directly from Medicaid.

Medicaid is the single largest source of funding for nursing home care in America, according to the Center on Budget and Policy Priorities, a Washington think tank.

Harvey Tillipman, executive director of the Association of Jewish Aging Services, said that Jewish nursing homes across the nation are sending him “messages that there are going to be cuts in budgets, that funding is going to be reduced, that they are being told: ‘Expect to lose money that is not going to be forthcoming.’”

“I am hearing it not from a handful of states, but all over the place,” Tillipman said.

His organization, based in Washington, represents homes and residential facilities for Jewish elderly in North America, mostly run by Jewish federations, which run more than 160 nursing homes across the country. Typically, between 60% and 90% of seniors in these nursing homes are on Medicaid, he said.

In all, there are 396 Jewish federation-affiliated senior housing, assisted-living or skilled nursing apartments in North America (including Canada), according to AJAS. Jewish community federation provide housing for more than 12,000 low-income elderly people; most of them rely heavily on Medicaid. Federations and 145 affiliated Jewish family agencies serve 198,000 senior citizens — 96,100 in their homes, according to United Jewish Communities, the federations’ national body.

“All these people are going to be impacted to varying degrees” by a cut in Medicaid, said Bert Goldberg, president and CEO of the Association of Jewish Family and Children’s Agencies. He said, however, that it is impossible to predict the effect on various categories of Medicaid recipients because the program varies from state to state. President Bush’s proposal to reform Medicaid will further increase this diversity, Goldberg said.

Unlike its better-known relative, Medicare, Medicaid is jointly funded by the federal government and the states. The federal government pays anywhere from 50 % to 77% of the total cost of Medicaid. The exact percentage in each state comes from a formula that gives a higher “Medicaid matching rate” to poorer states based on per capita income. The matching system gives an incentive to states to spend more on Medicaid. For every state dollar spent on Medicaid, the federal government will give the state between $1 and $3, depending on how affluent the state is.

But the Bush administration is now proposing to change the way the federal government contributes to Medicaid and instead base it on block grants to states. The administration argues that if states receive a fixed amount of money from the federal government as its share in Medicaid, it will give them a freer hand in delivering health services to the needy and thus encourage them to devise more efficient ways of doing that.

Opponents contend that dispensing Medicaid money through block grants, particularly at a time when states are suffering severe budget constraints and massive deficits, would open the way for states to cut their contributions in order to balance budgets.

As they run out of their emergency budgets, states are considering a multitude of ways to decrease Medicaid costs, from reducing benefits to increasing copayments. According to a survey conducted by the Henry J. Kaiser Family Foundation, 27 states limited Medicaid eligibility in 2002, and 17 states either have taken steps or are considering taking action to reduce spending on long-term care, both in nursing homes and in community-based settings.

Opposing the administration’s block-grant plan will be the main emphasis of Jewish organizations as they lobby Congress on Medicaid, said Goldberg. “We will also call for an increase in the amount that is available for the program, but in this economic climate, I don’t think we’ll see an increase. The most we’re hoping for is that we can stay even.”

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