This brief describes Medicaid's role for nearly 7 million nonelderly adults with disabilities living in the community to help inform the debate about the American Health Care Act's proposals to end enhanced federal funding under the ACA and reduce federal Medicaid funding under a per capita cap. Medicaid covers more than three in 10 nonelderly adults with disabilities, providing a broad range of medical and long-term care services that enable people with disabilities to live and work in the community. (1) Over half of nonelderly Medicaid adults with disabilities live below the federal poverty level, and nearly 85% have incomes below 200% of poverty ($24,120/year for an individual in 2017). (2) Nonelderly Medicaid adults with disabilities are four times as likely to receive nursing or other health care at home, more than 2.5 times as likely to have three or more functional limitations, and more than 1.5 times as likely to have 10 or more health care visits in a year compared to people with disabilities who are privately insured. People with disabilities account for 15% of total Medicaid enrollment but 42% of program spending due to their greater health needs and more intensive service use. Medicaid spending per enrollee for people with disabilities is substantially higher than for those without disabilities, due to their greater health needs and reliance on Medicaid for expensive but necessary services, especially long-term care in the community and nursing homes, that are generally unavailable through private insurance and too costly to afford out-of-pocket. Medicaid spending per enrollee for people with disabilities also varies substantially by state (from $10,142 in AL to $33,808 in NY in 2011). Nonelderly adults with disabilities may be particularly affected by Medicaid changes in the American Health Care Act (AHCA), including the fundamental shift to per capita capped financing. (1) Most Medicaid disability-related coverage pathways and community-based long-term care services are provided at state option, making them subject to cuts as states adjust to substantial federal funding reductions under a per capita cap. The CBO estimates that the AHCA will reduce Medicaid spending by $880 billion from 2017 to 2026. (2) The AHCA also would end enhanced federal funding for the ACA's Medicaid expansion, which covers some nonelderly adults with disabilities, and Community First Choice attendant care services for people with disabilities, which could jeopardize states' ability to continue to finance these options.
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