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No Caps on Care

Frequently Asked Questions about ACA and Medicaid

We’ve all heard a lot of talk about repealing the Affordable Care Act lately. But did you know Medicaid is also on the chopping block? Congressional Republicans have long talked about changing Medicaid, and any changes to Medicaid will impact IHSS providers and home care recipients.

Here are some common questions and answers to help make sense of what’s going with our health care and home care.

What is Medicaid?

Medicaid, which is called Medi-Cal in California, is an entitlement program that provides health coverage for millions of low-income Americans – including children, seniors, pregnant women, and people with disabilities.

What is an entitlement program?

An entitlement program is a government program that guarantees benefits to individuals who meet the program’s eligibility requirements. In the case of Medicaid, this also means the state is guaranteed federal funding to pay for the cost of Medicaid programs like health insurance and IHSS.

What does the Affordable Care Act have to do with Medicaid?

The Affordable Care Act (also known as the ACA or Obamacare) went into effect in 2014. The ACA expanded Medicaid eligibility to cover many Californians who did not qualify before – including 47,000 UDW caregivers.

In addition, half the funding the state uses to pay for the IHSS program comes from Medicaid.

How does Medicaid funding work?

Right now, the federal government provides at least $1 for every $1 each state spends on Medicaid. To ensure those in need always have access to health care programs, Medicaid funding increases as need for Medicaid programs increase. In fact, during the most recent recession, more than 10 million additional people were able to enroll in Medicaid.

How have Republicans proposed to change Medicaid?

Republicans want to limit the amount the federal government spends on Medicaid. They plan to do this by putting a cap on the amount of money states receive to pay for the program.

One proposal would be to use block grants to limit states to a preset amount of funding for Medicaid.

Another proposal known as per capita caps would give states a set amount of funding per individual or per group of Medicaid covered individuals, such as children, seniors, and people with disabilities.

What’s wrong with these proposals?

Right now, federal funding for Medicaid increases as the need for Medicaid programs like health care and in-home care increases. However, if the amount of money states receive is capped by block grants or per capita caps, states would not receive additional funding even if they need it.
Individuals and families would either have to go without insurance, or states would have to cut funding to programs like IHSS to afford the additional health care cost. Either way, many Californians could suffer.

How would my family and my IHSS client be impacted if the Republican proposals are passed?

If California receives less federal funds for Medicaid, the state will have to make choices that will hurt the families and clients of IHSS providers.

To reduce the amount of money the state spends on Medicaid, the state would make the eligibility requirements for Medi-Cal and IHSS stricter, which means many people in need of services like seniors and people with disabilities who need IHSS, would no longer have access to them.

Other essential public services UDW caregivers and California communities rely on, such as education and law enforcement, could also be cut to pay the additional cost for Medicaid programs.

Bottom line:

  • Medicaid is a vital program that provides funding for our health insurance and IHSS.
  • Republicans want to save money by capping—and cutting—our care.
  • Medicaid caps would mean less access to health care and services like in-home care.

Justice in Aging – Issue Brief: Medicaid Funding Caps Would Harm Older Americans