Medicaid block grants…again?

Medicaid Block Grant Proposal

medicaidMedicaid block grants  . . . again?  Regardless of your political persuasion it is quite evident that benefits for the older and disabled and likely to change when Donald Trump becomes president. Obviously things said during the campaign process do not always materialize. However, the appointments being made to high level positions in the administration speak loud and clear as to the direction things are likely to go.

Congressman Tom Price has been proposed as the director of HHS, the agency that oversees Medicare and Medicaid. Mr. Price has been a strong opponent of the Affordable Care Act and it appears that the law is likely to be repealed in the first 100 days of Trump’s presidency. While the Affordable Care Act is less about older and disabled individuals, there are parts of the Act that will affect the older and disabled population.

For the older and disabled, Mr. Price is likely to try to do several things that Mr. Trump did not really touch on much during the campaign. The first, which Paul Ryan has been pushing for years, is to try to make Medicare a voucher program and give older and disabled adults a voucher to purchase private insurance.

How Medicaid Block Grants Work

Not only is Medicare in the spotlight for revamp, so too is Medicaid. One major change endorsed by both Trump and House Speaker Paul Ryan would transform Medicaid from an entitlement program into a block grant program. In an entitlement program, coverage is guaranteed for everyone who is eligible. The federal government’s commitment to help states cover costs is open-ended. The states’ obligation is to cover certain groups of people and to provide specific benefits. Children and pregnant women who meet specific income criteria must be covered, for example.

Currently Medicaid is a state and federal joint program. The Federal Government guarantees to split the cost with the states as long as the states do not make Medicaid harder to obtain that broad federal rules allow. The states can be more generous with the eligibility rules but not tougher or federal matching funds will be denied. With a block grant the federal government writes a check to the state for a set amount each year and the states can then make any eligibility rules they like. So if a state is having financial difficulties it can simply make it harder to access Medicaid services to balance its budget. For a small or young state, this may be the right choice. For a state like Pennsylvania, with the third largest number of older adults in the nation and a large disabled population, this could be a disaster. A bad recession or a surge of needy people could push the budget (which is not in good shape currently) into serious disrepair because all of the financial risk is on the individual states.

We do not know how the calculation of the block grant funds would be made or if all Republicans would support such a plan. Plus if the block grant amount is calculated in a manner that the states find is unacceptable than there are always the courts to decide. Just be aware, as advocates for the older and disabled members of our society, and as older and disabled adults, you appear to be a target of the upcoming administration. Be alert, be aware and be advised so that you can properly handle the changes if and when they arrive.

About The Author

Named One of the Main Line’s Top Elder Law Attorneys by Main Line Today

Robert M. SlutskyRobert M. Slutsky has practiced Elder Law since 1992 and was one of the area’s first elder law attorney. Mr. Slutsky advises clients on Medicaid and Asset Protection Planning, Guardianships, Wills, Trusts, Powers of Attorney, Estate Administration, Special Needs Planning and General Estate Planning. He has represented for profit and non-profit elder care providers and the Pennsylvania Department of Aging. Mr. Slutsky has been the solicitor for the Montgomery County Office of Aging and Adult Services, the Area Agency on Aging for Montgomery County, for over 15 years.