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Updates in the Media

Medicaid Changes Ahead: 

Stay Informed, Set Your Strategy, Take Action!

The central principle of APSE's Employment First movement is that work is an important part of a meaningful, healthy, full life. Affordable, appropriate healthcare and employment services make full time jobs a reality for millions of Americans with disabilities. Since 2010, the Affordable Care Act (ACA)-- through its expanded Medicaid coverage--has enabled more people with disabilities to lead productive lives in their communities.


After months of draft proposals, Congressional Republican leaders have made their move on repealing and replacing the Affordable Care Act (ACA). They introduced the American Health Care Act (AHCA), which would radically restructure Medicaid and make major changes to key ACA provisions.


The bill has already cleared key House committees: Energy and Commerce, and Ways and Means. The AHCA has also received a score from the Congressional Budget Office. CBO estimates that the bill will leave 24 million Americans without healthcare coverage by 2026, but save $337B in that same time frame. One thing is certain: if the legislation is enacted as proposed, it will gut federal Medicaid funding and shift major administrative and cost burdens to the states and to individuals. Many cannot not afford to absorb these increases. The drastic funding cuts ($880B over 10 years) would eliminate adequate support for agencies that serve people with disabilities.


APSE members must act now. APSE is very concerned about the proposed massive cuts to Medicaid, the program that enables Americans with disabilities to work and live in their communities through long-term services and supports. Please contact your members of Congress and ask them to vote “NO” on the AHCA.



1. Stay Informed

Major Proposed Reforms

  • REPEAL at least some--if not all--portions of the ACA, including Medicaid expansion. A full 42% of Medicaid funding currently pays for services and supports for individuals with disabilities. Medicaid is also the primary funder of employment services and supports for these individuals. AHCA dramatically cuts funding for programs vital to the people APSE serves.
  • CHANGE the way federal Medicaid funding flows to states. Currently, federal funds are allotted to individual Medicaid programs in each state. Proposed reforms include "block grants" or "opportunity grants" where the federal government would pay out a lump sum to each state. The state would then distribute the funding as it sees fit. A second funding alternative under consideration is "per capita caps." This means that the federal government would set a limit on how much it contributes for each Medicaid enrollee. Advocates worry that per capita caps lack the spending flexibility to meet the needs of many people with disabilities.
  • REDUCE the overall amount of federal Medicaid funding. States contend that they would not be able to make up for this funding gap without significant federal support.

Take Action

2. Set Your Strategy

APSE urges members to monitor how reforms may affect the programs most important to people with disabilities in their area. Here are ACA and Medicaid provisions that have been especially important to the APSE community:  

  • Medicaid expansion - The ACA offers states the option of expanding Medicaid coverage to more low-income citizens. Thirty-one states and the District of Columbia have opted for the expansion.
  • Dependent coverage - The ACA allows young adults to remain under their parents' insurance coverage up to age 26.
  • Long Term Services and Support (LTSS) - Medicaid is the primary payer across the nation for LTSS, including those for children, adults, and seniors with disabling conditions. Medicaid provides coverage in several ways and over a continuum of settings, including community-based LTSS.
  • Community First Choice (CFC) - CFC makes it easier for states to offer home- and community-based services to Medicaid beneficiaries.
  • Home and Community-Based Services (HCBS) - States can provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than in institutions or other isolated settings. HCBS serve people with intellectual or developmental disabilities as well as physical disabilities. Services can include those that support employment goals.
  • Intellectual disabilities/developmental disabilities waiver - This program also provides services to help individuals remain in their homes and communities rather than in intermediate care facilities.

3. As a national organization...

APSE can be a strong voice for federal programs and legislation that support Employment First. The most effective voice of all, however, is a motivated constituent who takes the time to contact his/her legislator and weigh in on an issue. 


APSE provides tools--including APSE Action Alerts--to guide you when you contact members of Congress to discuss issues that matter to people with disabilities. We urge you to take advantage of these tools...and let us know how we can help!

Updates from APSE

The Impact of Medicaid Cuts on People with Disabilities: State-by-State Breakdown (March 24, 2014)

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