MEDICAID 2005 AND BEYOND

MEDICAID 2005 AND BEYOND

National Health Law Program's Capital Communique

December 17, 2004

It is thought that the President's budget and/or Congress' budget resolution may include proposals to block grant Medicaid directly or mandate severe cuts that could only be accomplished by restructuring Medicaid.

When the President releases his budget in early February; it may include a Medicaid block grant proposal, as it has the past two years.

Then Congress will begin negotiating a budget resolution, which sets out funding levels for discretionary spending and targets for revenue and entitlement program cuts. Medicaid and Medicare are examples of entitlement programs. The budget resolution may also include "reconciliation" instructions, which would require authorizing committees to make specific cuts in programs under their purview.

Reconciliation instructions, which are binding, specify which committees must cut specific amounts (likely over a 5 year time period) and provide a deadline to report legislation containing the cuts. In the Senate, legislation making the reconciliation cuts may not be filibustered, needs only a majority vote to proceed, and is extremely difficult to amend during debate on the Senate floor.

If significant cuts are mandated by the reconciliation instructions, committees such as the Senate Finance and the House Energy and Commerce Committees which oversee Medicaid and SCHIP may have little choice but to make dramatic structural changes to meet the target amounts. This could, for example, cause the committee to consider a Medicaid block grant as a way to achieve mandated savings. Thus, reconciliation may offer a back door alternative for restructuring Medicaid in a way that could not be achieved with stand-alone legislation (which would require at least 60 supporting votes in the Senate to overcome a filibuster).

POSSIBLE ACTION: Those wishing to do so could send letters to the White House and Members of Congress expressing opposition to: 1. block granting the Medicaid program; or 2. including reconciliation instructions that would require large scale Medicaid cuts or restructuring.

NYAPRS Note: see tomorrow's NMHA alert for sample letters you can send!

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Last Updated on 12/21/04 webmaster@namiscc.org

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