Medicaid cuts could harm the disabled

By JEFF MORRIS

With March being Developmental Disabilities Awareness Month, it is perhaps ironic that many families who care for those with disabilities are worried that potential cuts to Medicaid will have a devastating impact.

Whether they actually have anything to worry about seems to depend on who you choose to believe.

Medicaid has become a key element of the growing budget battle taking place in Washington, D.C. — and, because it is a program whose funding is shared by the federal government and the states, is likely to become part of a budget battle in New York.

On March 10, The New York Times’ Margot Sanger-Katz reported that Republican leaders in Congress had directed the committee that oversees Medicaid to cut $880 billion from the next budget. 

“They say these cuts aren’t necessarily aimed at Medicaid, the insurance program for 72 million poor and disabled Americans,” wrote Sanger-Katz. “The cuts could come from Medicare, for instance. But Trump has vowed not to touch that very popular program. And a sum this large can’t come from anywhere else.”

That point is amplified by Kevin McAvey of Bedford, managing director at a health care consultancy who works with Medicaid agencies across the country. (see McAvey’s op-ed on Page 6.) He notes that it would simply be impossible for the House Committee on Energy and Commerce to save $880 billion from the programs under its purview without making cuts to Medicaid.

Lawler’s position

In a telephone town hall on Wednesday, Congressman Mike Lawler, the Republican who represents CD-17, responded to a question about Medicaid. 

“I’ve been very clear — I am not cutting benefits from the people who need and rely on these vital programs,” he said. “When it comes to the budget resolution, there was not one single cut identified in the budget resolution, and anyone suggesting that people’s health care was ripped away from them, that 200,000 people lost their health care overnight, is lying, because that did not happen.”

McAvey contends that Lawler, who has made such statements before, is being disingenuous when he claims he is not going to cut benefits. 

“There’s a key word missing there: enrollment,” said McAvey. “I have never heard any GOP member of Congress pledge to not impact who is eligible for Medicaid right now; that’s where they’re going to go.” 

He said one of the proposals they have on the table is to reduce the federal matching rates, which would result in states having to reduce their Medicaid eligibility. In New York, said McAvey, most estimates say CD-17 has about 150,000 enrollees. He cited a recent think tank report saying if Congress pursues a reduction in the matching rate for those who receive Medicaid through the Affordable Care Act, it could impact 42,000 of those individuals.

A Feb. 27 letter to Senate leaders from the Coalition of State Medical Associations urged the Senate “to protect Medicaid from the devastating $880 billion in spending cut targets in the House Budget Resolution.” The letter went on to say, “Our states have enacted innovations and efficiencies in our state Medicaid programs that have reduced costs and improved health outcomes. Yet these proposed cuts will jeopardize those advancements, our patient’s health and the viability of the healthcare system.”

The Arc Westchester

Locally, the fate of Medicaid is inextricably linked to the future of The Arc Westchester, the largest agency in the county supporting children, teens and adults with developmental disabilities, including individuals on the autism spectrum, and their families. 

Founded in 1949, The Arc Westchester has over 700 employees who provide nearly 2,000 people throughout the county with a broad range of programs and services designed to foster independence, productivity and participation in community life. 

Tibisay Guzmán, The Arc’s executive director, told The Recorder that over 80 percent of their funding comes from Medicaid, with another 10 percent coming from the state.

Guzmán noted that The Arc’s services begin with babies who are born with developmental disabilities. 

“Right from the start, there’s a team that goes in there to ensure the baby receives services as early as possible. Studies have shown that the earlier you provide intervention — speech, language, OT, physical therapy, as well as other Medicaid services — the better the likelihood that this person will be more independent as they grow up.”

Later on, she said, The Arc, with Medicaid funding, serves many children with disabilities in New York state, providing support systems after school and continuing their therapies. It then supports adults, with 44 homes in Westchester that are supported by Medicaid. The Arc has over a dozen residences in the northern part of the county, including several in the Bedford, Pound Ridge, and Lewisboro areas. They also have a number of preschool inclusion classrooms in that area, where their teachers provide special preschool education at a mainstream preschool. And there is a large hub of day services in Mount Kisco at the Ann Manzi Center.

If any of the cuts to Medicaid are realized, said Guzmán, “Everyone will be affected, because New York state is a large provider of Medicaid, the state is going to try to compensate somewhat, and that will mean higher taxes. We’re probably going to lose services, and the sad part is this is the most vulnerable population in the country.” 

She said the first thing that’s going to go are the soft services that The Arc provides out in the community — and the only alternative she can see would be a return to the days of institutionalization.

Guzmán notes they also provide job coaching so people can continue to work in the community, growing and becoming more self-sufficient, and paying taxes. 

“Businesses appreciate that support,” she said. “Even relabeling what Medicaid is, talking about increasing the eligibility; how can a person with developmental disabilities meet the higher criteria to be eligible for Medicaid? There might be changes coming through that seem to be OK, but will always affect a person with developmental disabilities.”

The county perspective

County Legislator Erika Pierce, a Democrat, told The Recorder, “There are lots of people who think they understand the scope of these Medicaid cuts, but don’t even have disability services on their radar.” 

She said it’s not an issue of cuts to Medicaid taking away “nice-to-haves,” but it’s going to take away “need-to-haves.”

“I don’t think a lot of families understand that,” she said. “When folks who have a child in the school system who has these kinds of disabilities and the kid is aging out of the school district, which for some isn’t until 21, the very first thing you have to do to even get that kid into a wait list for next steps programming is to get them into Medicaid. Not only do actual cuts to the dollar value have huge impacts for what happens next, but even a slowdown in the ability to process applications can have catastrophic impacts on the family, because you can’t even begin to start the conversation of trying to figure out where your kid can be until that Medicaid process is done.”

Pierce said it would affect seniors as well; the percentage of seniors in the district who depend on Medicaid is “pretty high.”

“I don’t know anybody who doesn’t at least have a neighbor or a friend who has someone in their family receiving these kinds of services,” said Pierce. “We already have issues with having sufficient mental health coverage; it will impact there too.” But, she said, the county Legislature cannot directly impact any of this, though it will be left to try to deal with the aftermath. Pierce said people need to let those who represent them in Washington know that these are “not the cuts they want.”

State Assemblymember Chris Burdick, also a Democrat, told The Recorder that Lawler is the person to ask about this. 

“Frankly, when we’re asked what are you doing with respect to the state budget and potential cuts to areas of the budget that are affected by federal funding, our response is, we’re not doing anything,” said Burdick, “because those cuts have not occurred yet, and probably the best thing to do is talk to the Republican members in New York state that have a voice in this and can decide whether or not they’re going to cut Medicaid, whether or not they’re going to cut education, whether or not they’re going to cut transportation.”

Identifying waste

Guzmán said she understood that the focus is to reduce waste and fraud. 

“It’s unclear to us what percentage is identified as fraud. Is it the entire $880 billion? We don’t understand, if that’s the case, why such a large sum is targeted. We haven’t seen anything that clearly indicates what is the amount of fraud that’s been identified. We’re all for cutting fraud, waste and abuse in Medicaid, but what is that number? If that was a lot clearer, we wouldn’t be as concerned.” 

Guzman noted that the state office of the Medicaid Inspector General already investigates such abuse, and she has never been advised of any problems.

In his Wednesday town hall, Lawler stated that New York pays out significantly more in Medicaid benefits than the rest of the country. 

“You have, in states like New York, non-citizens getting Medicaid benefits,” he said. “You have able-bodied adults, not working, getting benefits.”

Lawler said the program needs to be protected for those who need it, including the intellectually disabled, and to ensure “that it is not being abused by people who are ineligible, including non-citizens.” He said there is no reason to be spending money on people who are not eligible for Medicaid.

According to its most recent report, the NYS Office of the Medicaid Inspector General saved and recovered more than $4 billion in 2023, with more than $3.2 billion in inappropriate costs avoided and nearly $872 million in Medicaid overpayments recovered.