The expansion of Medicaid under Obamacare that began in 2014 has siphoned state resources away from caring for the severely disabled, hundreds of thousands of whom have been languishing for years on Medicaid waiting lists, a new study found.
In the 30 states that have opted to expand health care coverage to able-bodied adults through Medicaid, 250,000 disabled individuals continue to wait for openings to receive home and community-based care, according to a study by the Foundation for Government Accountability (FGA).
The study also reported that nearly 22,000 people on the waiting lists in Medicaid expansion states have died since Obamacare began providing health care insurance to qualifying adults. Those deaths include 5,534 in Louisiana, 1,970 in Michigan, 823 in Illinois, 304 in Nevada, and 154 in Pennsylvania, according to the study.
“While Obamacare did not create these waiting lists, it is increasing the likelihood that the truly needy individuals will never get the help they need by diverting billions of dollars to able-bodied adults,” the FGA report says.
Other research, including a 2017 study by the Kaiser Family Foundation, challenges the notion that providing health coverage to more able-bodied adults has drawn state resources away from the disabled. In fact, they say the opposite is true.
“There does not appear to be a relationship between a state’s Medicaid expansion status and changes in its HCBS (home and community-based services) waiver list,” the Kaiser study says. “Most expansion states (20 of 30) either had no HCBS waiver waiting list or had a decrease in their waiting list from 2014 to 2015.”
FGA research director Nicholas Horton, who authored the FGA study, counters that expansion states are using some of their own funds to provide coverage under Obamacare – funds that could have been used to help the severely disabled who are on waiting lists for the home care program.
“The Medicaid system is already bloated and has lost its focus …” Horton told Watchdog.org. “The Medicaid program was never intended to be an open-ended catch-all welfare system.”
The move to cover adults who are not disabled through Obamacare lacks taxpayer protections, he said, adding that FGA favors protecting the states’ safety nets for the truly disabled.
The FGA report recommends stopping Medicaid expansion through the Affordable Care Act (ACA), or Obamacare, instituting work requirements on able-bodied Medicaid enrollees, and rooting out fraud in the welfare system.
The report itemized the waiting list numbers in Medicaid expansion states, but it did not investigate the HCBS waiting lists in states that have not taken part in Obamacare, according to Horton. Nor did it look at whether the lists of disabled who are waiting for care had increased since Obamacare took effect – or whether the death rate for those on the lists has increased since Medicaid expansion began four years ago.
The FGA has also not taken a position on whether the federal HCBS waiver program through Medicaid should be expanded to help more disabled individuals, he said. Such an expansion would be more difficult because Medicaid is devoting more and more resources to able-bodied adults, according to Horton.
“We are hopeful that we can just have a conversation on what the Medicaid system was designed to do,” he said.
Elizabeth Edwards, senior attorney with the National Health Law Program in North Carolina, authored a paper in February of last year which rejected the idea that Medicaid expansion in recent years has squeezed programs for the disabled.
“The biggest threat to the goal of decreasing wait lists and increasing access to Medicaid HCBS programs are cuts and caps to Medicaid,” Edwards told Watchdog.org in an email. “In fact, the ACA and Medicaid expansion have helped people on HCBS waiting lists, increased HCBS programs and generally provided increased access to necessary services.”
The number of people added to HCBS waiting lists in expansion states in 2013 to 2015 was one-quarter of the number added by states that have not opted for Medicaid expansion, Edwards’ study found. In addition, many people on waiting lists who previously did not qualify for Medicaid services now have access to necessary medical care in the expansion states, the study says.
Edwards also challenged the contention that deaths of disabled individuals on the waiting lists – those with severe disabilities, chronic issues or other health concerns -- can be blamed on the rollout of Obamacare.
“Many people who pass away while waiting for access to HCBS are likely passing away due to their health conditions, and their deaths are likely not related to access to the HCBS program for which they were waiting,” she said. “The ACA and Medicaid expansion provide increased access to health care, and data shows that … access to HCBS has increased since the ACA.”
The states with the longest HCBS waiting lists are Texas and Florida, neither of which has opted for Medicaid expansion under Obamacare, according to the Kaiser study. Between 2014 and 2015, Texas’ waiting list went from 163,146 to 204,550, while Florida’s list stood at 83,365 in 2015, up from 76,750 in the previous year, the study says.
Elizabeth Stelle, director of policy analysis for the Commonwealth Foundation in Pennsylvania, however, does see a connection between more funds going for health care for the able-bodied and efforts to provide care for the truly needy. About 13,500 people are on the list for home and community-based services for the disabled in Pennsylvania, according to Stelle.
“Since Medicaid expansion, you’re not seeing big gains in getting people off the lists …” she told Watchdog.org. “We really haven’t seen much progress.”
Those on the list are entitled to institutional care through Medicaid, but it’s the home and community-based care that they are lacking, Stelle said.
The Commonwealth Foundation has endorsed the concept of work requirements for able-bodied adults on Medicaid as a way to provide them with a path out of poverty.
“The big picture here is too many times we judge the success of the Medicaid program by how many people are enrolled,” she said, rather than seeing the program as a stepping stone to improve people’s lives.