Important services that enable Kentuckians to receive needed care at home and in the community, rather than an institutional setting like a nursing home, will be cut back if the American Health Care Act (AHCA) becomes law.
There are currently 39,289 Kentuckians who receive Home and Community Based Services (HCBS) through Medicaid. These individuals include participants in the Supports for Community Living and Michelle P. Waiver programs, for which there is already unmet need. Because the AHCA makes permanent cuts to the traditional Medicaid program over time, the state likely would be forced to roll back these critical services for elderly and disabled Kentuckians, as shown in a new report from the Center on Budget and Policy Priorities.
Long-term care is an issue of increasing concern. The number of Kentuckians over the age of 85 is expected to grow 30 percent between 2025 and 2035. Older adults, as well as disabled children and adults, tend to need more health care, and often require assistance with aspects of daily living including meal preparation, household chores such as laundry and transportation to appointments. HCBS are less expensive than nursing home care, and often people would prefer to remain in their communities rather than move to a nursing home. According to one report, in 2014 Kentucky Medicaid paid an average of $48,000 annually for nursing home care, but only $15,000 for home-based care.
Despite the fact that home and community-based services are often cheaper, Kentucky has been underutilizing them compared to other states. A report shows Kentucky spends 81 percent of all long-term care dollars on nursing home care (compared to a national median of 69 percent). The AHCA would make that imbalance worse.
One reason is that states are not required to provide HCBS through Medicaid, but are required to provide nursing home care. In addition, the AHCA caps federal Medicaid funding to states, squeezing Medicaid dollars over time through a mechanism called a per capita cap. The formula for the cap doesn’t take into account the growing average age of the elderly population, squeezing funding further. State officials likely would be forced to reduce optional benefits, including HCBS. By one estimate, eliminating the Medicaid expansion, which the AHCA effectively does, and instituting a per capita cap would shift $16 billion in cost to Kentucky’s state budget over 10 years.
Dependent seniors and those with disabilities in Kentucky are already subject to long wait lists for HCBS, and further cuts would make those waits even longer, or possibly end those services altogether. We should be making policy decisions that help communities thrive, not force people out of them.
The videos below show the real Kentuckians, and their communities, that benefit now from HCBS programs at risk under the AHCA.