June 26, 2017
By Florida Legal Services

Background
On June 22nd, Senate leaders released the Better Care Reconciliation Act of 2017 (BCRA). Leadership have stated an intent to vote on or before June 30, 2017. While there are some variations between the bills, the overall impact is the same​:

● Both plans will reduce federal health care spending and cap Medicaid;
● Both plans will increase the number of people for whom healthcare is unaffordable; and
● Both plans shift greater risk, costs, and responsibility to the states.

What are the risks to Florida's federal Medicaid funding? ​
The Senate’s proposal contains essentially the same per capita cap on Medicaid spending as the House bill, the American Health Care Act. This ​fundamental and permanent change eliminates the guarantee that the federal government will pay 61% of health care costs for Floridians on Medicaid. Under both the House and Senate proposals, federal dollars will be capped based on Florida’s prior average expenditures. While the Senate bill contains a provision allowing for some equalization between states that spend significantly more or less than average, Florida would still be disadvantaged as it ranks 48th in average per-enrollee spending. Moreover, because the specified growth rate under a cap could 1 be “dialed” down at any time by the current or any future Congress; the potential long term impact on state budgets, Medicaid beneficiaries, and providers should be considered ​before a vote.

What are the risks to Florida's children?
2.4 million children rely on Medicaid, including 45% of children with disabilities. Currently, children are eligible for coverage of all medically necessary services and the 2 federal government pays 61% of the costs. Under the Medicaid per capita caps, there will be insufficient funding to cover the costs of their care over time--particularly for children with disabilities.

What are the risks to disabled Floridians?
Changing Medicaid to a capped funding program particularly threatens approximately 100,000 Floridians with severe disabilities who rely on home and community based services (HCBS) in order to avoid institutionalization and remain in their own homes. Unlike most Medicaid services required by law, HCBS services are optional. Thus, when capped funding becomes insufficient to 3 cover costs, optional services like HCBS are especially vulnerable to being reduced or even eliminated. 4

What are the risks to elderly Floridians?
Florida’s low per capita rate for the elderly is concerning because the state’s growth rate for this group is among the fastest in the country. This rapid growth rate, coupled with the composition of our “aging” elderly, puts Florida at risk as the costs of care increase with age. 5

What are the risks for Floridians in the Marketplace?​
Approximately a million residents are at risk. These low and moderate income individuals currently receive tax credits to purchase insurance; and because most also receive cost-sharing reduction assistance to pay for the cost of their care, the elimination of cost-sharing subsidies would make their health care unaffordable. In addition, many older Floridians would end up paying more than under current law.

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1 ​http://www.statenetwork.org/wp-content/uploads/2017/04/FL-Fact-Sheet-revised-4.4.17-1.pdf
2 ​http://ccf.georgetown.edu/wp-content/uploads/2017/02/Florida-Medicaid-CHIP-new-v2.pdf
3 ​http://www.cbpp.org/research/health/senate-bill-still-cuts-tax-credits-increases-premiums-and-deductibles-for
4 ​http://www.cbpp.org/research/health/medicaid-cuts-in-house-aca-repeal-bill-would-limit-availability-of-home-and
5 ​“​Data Points to Consider When Assessing Proposals to Cap Federal Medicaid Funding: A Toolkit for States,” RWJF (Feb. 13, 2017).

For questions, contact Miriam Harmatz (​[email protected]​).