Who Are the 7 Million Nonelderly Adults with Disabilities in Medicaid and What Would the House GOP Bill to Restructure Medicaid Financing and Repeal the Affordable Care Act Mean for Them?

A new brief from the Kaiser Family Foundation explains the role that Medicaid plays for nearly 7 million nonelderly adults with disabilities in the U.S. and explores what the American Health Care Act could mean for their health care and coverage.

Medicaid covers more than three in 10 nonelderly adults with disabilities, including people with physical disabilities, such as cerebral palsy, multiple sclerosis, and traumatic brain or spinal cord injuries; intellectual or developmental disabilities such as Down syndrome and autism; and mental illness. Over half who are enrolled in Medicaid live below the federal poverty level. They are four times as likely to receive nursing or other health care at home, and more than 1.5 times as likely to have 10 or more health care visits in a year compared to those with private insurance.

Through Medicaid, nonelderly adults with disabilities have access to regular preventive care as well as medical care for illnesses and chronic conditions.  States must provide certain minimum services for adults, such as inpatient and outpatient hospital, physician, lab and x-ray, and nursing home services.  States also can choose to provide a broad range of optional services such as prescription drugs, physical therapy, private duty nursing, personal care, rehabilitative services, and case management.

The changes to Medicaid in the House GOP bill – notably the end of enhanced funding for the ACA Medicaid expansion and the fundamental change in program financing to a per capita cap – carry significant implications for this population. For those who have gained Medicaid eligibility through the expansion, loss of the enhanced match could curtail their prospects for keeping that coverage. And while per capita cap financing could come with increased flexibility for states in subsequent legislation, the associated federal funding reductions over time may lead states to consider cuts in Medicaid eligibility, benefits, and provider reimbursement. Nonelderly adults with disabilities could be particularly affected by such cuts, as many rely on Medicaid coverage pathways and services that are offered at state option and have higher spending, due to their greater need for acute and long-term care services.