States with rapidly aging populations, like Missouri, are seeing increased costs to Medicaid programs that cover low-income residents.
But the Republicans' health care proposal to replace the Affordable Care Act would create per-capita caps for federal Medicaid funding, potentially shifting increased costs to states. Advocacy groups for seniors warn that the proposal working its way through Congress may not adequately fund their care.
“There’s no way to build in any greater efficiency,” said Harvey Tettlebaum, an attorney for the Missouri Health Care Association, which represents nursing homes. “These are people that are sick and they’re getting sicker, which means the sicker they get the more intensive care they require and the more it costs.”
The issue comes to a head when older adults need long-term care in a nursing home, which isn’t covered by Medicare. Often, they’re forced to spend down their assets to qualify for Medicaid coverage.
“Families that contact our 24 hour helpline will say, ‘But we have Medicare coverage!’ But it's not going to cover skilled care for the long haul,” said Stephanie Rohlfs-Young, vice president of programs at the Alzheimer’s Association’s St. Louis chapter.
"Families with Alzheimer’s are often in a skilled care situation for two, three, maybe four years,” she said.
Paid out of pocket, skilled nursing costs an average of $64,000 a year, according to the Missouri Department of Health and Senior Services.
The Republican proposal, called the American Health Care Act, also would quickly phase out federal match funds for states that expanded the program through the Affordable Care Act, often referred to as Obamacare.
Missouri’s Medicaid program, which did not take federal funds to expand eligibility, covers about 982,000 residents who are low-income, disabled, or pregnant. Two-thirds of enrollees are children.
But care for older and disabled enrollees tends to cost more, particularly when it comes to long-term care. One in five Missouri residents is projected to be over the age of 65 by 2030, according to projections by the state’s Office of Administration.
Members of Missouri’s Republican delegation did not respond to respond to requests for comment on Thursday, but several have posted public statements in support of the legislation.
“Washington’s outsized role in health care has limited choice, driven up costs, and diminished the quality of care Americans receive,” Republican U.S. Rep. Wagner wrote in a post on Facebook. “Our unified Republican government is working to repeal #Obamacare and give you a patient-centered health care system.”
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