House ACA Repeal Bill Puts Children with Disabilities and Special Health Care Needs at Severe Risk

The Senate is currently considering the American Health Care Act (AHCA) — the House-passed bill that would not only effectively end the Medicaid expansion, but radically restructure federal financing for virtually the entire Medicaid program, threatening coverage for tens of millions of Americans.  THESE CHANGES TO MEDICAID WOULD MAKE IT ESPECIALLY HARD FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, INCLUDING THOSE WITH DISABILITIES. These changes to Medicaid would make it especially hard for children with special health care needs, including those with disabilities, to get the care they need to stay healthy, remain in their communities, and succeed in life.

Medicaid provides affordable and comprehensive health coverage to over 30 million children, improving their health and their families’ financial well-being.[1]  In addition to the immediate health and financial benefits that Medicaid provides, children covered by Medicaid experience long-term health and economic gains as adults such as better health status, higher educational attainment, and greater earnings.[2]  Medicaid plays an especially important role for children with special health care needs — including many children with private insurance who receive Medicaid “wrap-around” coverage to address gaps in their private coverage — by providing the services and supports they need on a daily basis.

The House-passed bill includes several changes that would harm children with special health care needs who rely on Medicaid.  The House bill would:

    • Roll back Medicaid coverage for children ages 6 to 18.  The Affordable Care Act (ACA) raised Medicaid’s minimum income eligibility limit for children from 100 to 133 percent of the poverty line, the level already in place for children under 6.[3]  This change enables all children with family incomes below 133 percent of the poverty line — regardless of age — to be covered by Medicaid, a better coverage option for children with special health care needs than the Children’s Health Insurance Program (CHIP), which doesn’t cover some benefits these children need, such as special medical equipment and nursing care in their homes, and has out-of-pocket costs.  The House plan would lower the eligibility level back to 100 percent of poverty, potentially affecting about 1.5 million children in 21 states.[4]

    • Radically restructure Medicaid’s federal financing.  The AHCA would fundamentally change Medicaid’s financing, ending the current federal-state financing partnership and converting virtually the entire Medicaid program to a per capita or block grant starting in 2020, putting coverage at risk for nearly 70 million people.[5]  Converting Medicaid to a per capita cap or block grant would likely force states to increasingly cut eligibility and benefits, including long-term services and supports provided in beneficiaries’ homes and health services provided at school.  These benefits are critically important to children with special health care needs.

- Center on Budget and Policy Priorities

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