Medicaid Advocacy

Medicaid is a joint federal-state program and leading health insurance program in the U.S. It covers primary and acute care services, as well as long-term care services and supports for low-income populations, seniors, disabled persons including children and adults with intellectual and/or developmental disabilities (I/DD).

The federal government sets the basic framework for covering certain mandatory populations and benefits and regulates the delivery of health care services and reimbursement. The federal government also pays a share of states’ Medicaid expenses based on the state’s federal medical assistance percentage (FMAP), which varies depending on a state’s average per capita income.

Medicaid is jointly funded by the state and federal governments: the federal government matches the funds that states are willing to spend in Medicaid programs. States must pay for mandatory populations and services.

Federal Medicaid budgets are created through spending resolutions in the House and Senate. Once these resolutions are set. funds are allocated to specific programs and services, like Medicaid, through appropriations bills. Medicaid-related appropriations bills are generally handled by the House Energy and Commerce Committee (ECC) and the Senate Finance Committee. Any differences between the House and Senate versions of these resolutions and bills are resolved before a final budget can be passed.

State funding for Medicaid (i.e., 1915(i), Intermediate Care Facilities, Innovations Waiver, etc.) is controlled by the North Carolina General Assembly. The North Carolina Appropriations Committee from each chamber work together to create a Medicaid spending budget.

By the numbers

• Medicaid provides healthcare coverage to one in five Americans — more than 70 million people. (U.S. Centers for Disease Control)

• In North Carolina, Medicaid covers 3.1 million people, including at least 285,000 with disabilities (ncdhhs.gov).

• North Carolina currently receives approximately 65% of its Medicaid funding from the federal government. (Kaiser Family Foundation.org)

• Currently, the U.S. House Budget Committee has instructed the ECC to cut at least $880 billion from the Medicaid budget over 10 years (see House Budget Committee Resolution excerpt).

Medicaid provides vital healthcare and community-based supports and services. It is often the only funding source for long-term support services that make it possible for individuals with autism to live and work in their community rather than in more costly institutions.

In North Carolina, Medicaid pays for:

• Home- and community-based services through waivers like the Innovations Waiver and others.

• Services provided in intermediate care facilities, group homes, and other residential settings.

• Health care (routine and emergency care), rehabilitation services like physical therapy, occupational therapy, speech therapy, dental care, eyecare, and medications.

• Clinical treatment such as Applied Behavior Analysis (ABA) and outpatient/in-patient therapy.

• In-school service for some Medicaid-eligible students.
  (medicaid.ncdhhs.gov)

North Carolina’s Medicaid 1915i services help individuals with autism live more independently in their home and community and give caregivers the support they need. Services like:

• Respite Care: providing breaks for caregivers, including overnight and weekend care.

• Job Help and Supported Employment: helping individuals find and keep a right-fit job.

• Individual and Transitional Support: helping individuals find housing, manage finances and more.

• Community Living and Support: helping individuals learn to perform daily activities, like bathing and dressing.

• Community Transition: helping individuals move from an institutional setting back to their community.

Funding cuts or caps imposed on Medicaid would have life-altering consequences for North Carolinians with Autism Spectrum Disorder (ASD).

• Many could lose their independence, facing institutionalization in nursing homes or state facilities at an added cost to families and taxpayers.

• Currently existing facilities in North Carolina could not support all the individuals receiving community-based services in the state.

• North Carolina would grapple with drastically reduced Medicaid funding and eligibility restrictions, potentially leaving autistic individuals and families without vital services.

• Without the supports provided by Medicaid, many individuals would be reliant on already strained family and community supports.
• Waiting time for Innovations Waivers, now at more than 10 years, would increase. (Innovations Waitlist, NCDHHS)
• Crucial services like behavioral therapy, personal care, and mental health treatment could become more limited or become altogether unavailable.

• Schools could lose Medicaid reimbursements and face increased financial burdens.

• Access to healthcare providers accepting Medicaid could become more limited or unavailable in some areas.

You can play a vital role in protecting Medicaid. Contact your U.S. Senators (Senator Thom Tillis, 202-224-6342 and Senator Ted Budd, 202-224-3154) and your House Representative (U.S. House Representative list) and tell them:

• I am a constituent from [your NC city, zip code]. I oppose Medicaid cuts and caps.

• I am a person with autism/a family member/a professional in the autism field.

• Medicaid is a lifeline for people on the autism spectrum. [If applicable] My family depends on Medicaid for services/supports. (Share a brief personal story.)

• Do not cut or cap Medicaid funding. North Carolina already has a 10+ year waiting list for waiver services. Cuts to Medicaid will harm people who rely on Medicaid and make it harder for North Carolina to provide care.

You can also help raise awareness about the importance of Medicaid for individuals with autism, and the devastating impact of potential cuts by sharing your own experiences and encouraging others to use their voices to advocate for this critical program.

The Autism Society of North Carolina (ASNC) is a nonprofit organization dedicated to a mission to improve the lives of individuals with autism, support their families, and educate communities. Established in 1970, ASNC has been a trusted partner for all people with autism in North Carolina.

ASNC focuses resources on high-quality programming with 86 cents of every dollar raised going directly to funding services. More at autismsociety-nc.org.