WASHINGTON -- Vital health care services for more than 17 million of the nation's most vulnerable citizens could be on the chopping block if the Republican health care bill becomes law.
If Medicaid home and community-based services are cut for children with special needs and adults and seniors with disabilities, many would end up in costly nursing homes, require more assistance from struggling family members or simply do without the care that allows them to live independently.
Many of these low-income patients are functionally and cognitively impaired. They require home health aides, personal care attendants and day care programs to help with basic activities like eating, dressing, bathing and mobility.
Medicaid, the state-national health care plan for poor people and those with disabilities, is the largest public provider of these nonmedical services, covering 30 percent of working-age adults with disabilities like cerebral palsy, mental illness, and traumatic brain and spinal cord injuries.
Unlike coverage for nursing home care, which is mandatory under Medicaid, home care services for the elderly and people with disabilities are optional.
Patient advocates fear that states will trim those optional Medicaid services if the program faces the 10-year, $880 billion cut in federal funding that the GOP health care bill proposes.
If the legislation becomes law, and states roll back their home and community-based services, many Medicaid patients with special needs and disabilities will end up in nursing homes, said David Certner, legislative policy director at AARP.
"This really threatens the ability of people to live independently in their homes," Certner said. "We can take care of three people at home for the cost of one person in a nursing home, so it's bad policy and it's bad in terms of what people prefer."
People with disabilities make up 15 percent of Medicaid enrollees but account for 42 percent of program spending because of their costly care, according to the Kaiser Family Foundation.
Faced with a loss of services, other home care patients would require more support from family members, who "are already carrying a huge load for their loved ones," said Alice Dembner, senior policy analyst at Community Catalyst, a national advocacy group for vulnerable patients.