"Many of us cannot imagine ourselves in such a situation, but disability and disease can happen to anyone. For many people, including most middle-class and working-class Americans, it's Medicaid, not Medicare, that provides them with care in these situations."
National Academy of Elder Law Attorneys (NAELA) President Hy Darling, CELA, CAP, released the following statement on the Better Care Reconciliation Act, the Senate's version of the American Health Care Act, today:
I appreciate that the Senate heard NAELA's concerns regarding the provision in the House passed American Health Care Act that would have imposed new restrictions on how much home equity states could exclude when an individual applied for Medicaid. This provision would have been particularly harmful to individuals with disabilities in high-cost areas who wished to remain at home.
Unfortunately, the Senate version of the American Health Care Act makes even worse the House's radical changes to Medicaid by capping the federal government's commitment to individuals with disabilities and low-income seniors, putting their health and well-being at risk. Then, starting in 2024, it limits federal payments to the states based on the growth of the Medicaid inflation, which, over time, could be insufficient to keep up with the cost of care. This could not come at a worse time, as the population of Americans over the age of 85 grows rapidly.
As members of the National Academy of Elder Law Attorneys (NAELA), we represent individuals faced with significant long-term care needs. These are some of our nation's most vulnerable people. Many require assistance to perform the most basic life functions. Their families are emotionally, physically, and financially exhausted from the process. They have had their dignity stripped and lost their life savings as a result of illness and disability.
Many of us cannot imagine ourselves in such a situation, but disability and disease can happen to anyone. For many people, including most middle-class and working-class Americans, it's Medicaid, not Medicare, that provides them with care in these situations.
Changing Medicaid's financial structure for the worse without addressing many of the underlying issues in the program only exacerbates these problems. Take just one example: Providing services at home is optional while more costly institutional care is mandatory. States under new budget constraints from the per-capita cap may keep the mandatory and jettison the optional. So the change in financial incentives puts Americans, such as those with dementia, a spinal cord injury, or children with developmental disabilities, at risk of being institutionalized when they could otherwise receive care in a less restrictive, less costly, more comforting setting.
The Senate also continues with the House's repeal of Medicaid's three-month retroactive coverage. Without retroactive coverage, the families of seniors discharged to a nursing home after a traumatic accident could be liable for tens of thousands of dollars of nursing home costs, which facilities may then deny them entry because they lack sufficient funds.
Medicaid can be improved upon so that individuals with disabilities and older Americans can receive the long-term care they need, without having to become destitute to do so, without having to put unneeded stress on their families. The Better Care Reconciliation Act, as proposed by the Senate, does not do that. It simply makes an already bad situation worse.
Members of the National Academy of Elder Law Attorneys (NAELA) are attorneys who are experienced and trained in working with the legal problems of aging Americans and individuals of all ages with disabilities. Established in 1987, NAELA is a non-profit association that assists lawyers, bar organizations, and others. The mission of NAELA is to establish NAELA members as the premier providers of legal advocacy, guidance, and services to enhance the lives of people with special needs and people as they age. NAELA currently has members across the United States, Canada, Australia, and the United Kingdom. For more information, visit NAELA.org
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