Could the Ryan Plan leave millions of seniors without nursing home or long term care?
Congressional Quarterly recently covered an important issue omitted from most of the discussion of Paul Ryan's budget plan passed by the U.S. House of Representatives.
Yet with as many as 70 percent of nursing home residents now relying on Medicaid payments, a Republican proposal to transform the third-largest federal entitlement program could alter the day-to-day living and health care arrangements of millions of elderly or disabled Americans.
We have heard how the Ryan plan would impact retired Americans with dramatic changes to Medicare but has anyone heard much about the effect on elderly recipients of Medicaid?
One explanation, health policy analysts say, is that people don’t like to think about being old and unable to care for themselves. Another is that many American voters think of Medicare as a social insurance program for the middle class, but regard Medicaid as a welfare program for the poor. When it comes to long-term care, however, that’s not the case. While Medicare pays for short-term skilled nursing care after a specific illness or surgery, it doesn’t cover longer-term care, like the years in a nursing home a patient with Alzheimer’s might need.
That’s up to its sister program, Medicaid, the federal-state partnership enacted with far less fanfare on the same date in 1965. Medicaid bears the burden for families and individuals who can’t pay annual nursing home bills of $72,000, and for those elderly or disabled who started out paying, but exhaust their assets. Many states also cover some long-term care arrangements that allow people to continue living at home.
Just how many of our aging population are relying on some form of Medicaid?
According to the Kaiser Commission on Medicaid and the Uninsured, 1.4 million Medicaid beneficiaries were in nursing homes in 2010, and 2.8 million more were getting other forms of long-term care support from Medicaid, often in home- and community-based alternatives to nursing homes. That translates into about 70 percent of the nursing-home population relying on Medicaid. About one in three Medicaid dollars went to long-term care in 2007, although it varied sharply from state to state, according to a study by the Urban Institute and the Kaiser Commission on Medicaid and the Uninsured.
How does the Ryan Plan propose to "reform" Medicaid?
The House’s budget proposal, adopted April 15 and based on a plan by Budget Chairman Paul D. Ryan of Wisconsin, would change Medicaid dramatically. No longer would Medicaid be an entitlement, that is, a guarantee of care. Ryan would change it into a block grant, giving governors great latitude over whom they cover and what services they provide. The Congressional Budget Office estimates that block grants based on the Ryan formula would trim federal Medicaid spending by about a third in the first decade, and in half by about 2030.
For further reading, see The American Association of Retired Persons (AARP)fact sheet titled The High Cost of Capping Federal Medicaid Funding."