National Health Care Reform

March 17, 2017

It did not take long for the new Congress to produce sweeping changes to the existing Affordable Care Act (ACA). MOAA is closely following these proposed legislative changes to the health care system. 

One of the key aspects of the newly proposed American Health Care Act of 2017 (AHCA) is its termination of the expansion of Medicaid funds to the states. This was a signature feature of the original ACA. The Congressional Budget Office recently issued findings that detail the legislation's impact on both people and the budget. The good news for the majority of TRICARE beneficiaries is this new legislation appears to have minimal impact on the TRICARE program.

However, what effect it will have will not be perceived as minimal to a critical group of beneficiaries. Those are the military and veteran families who are enrolled in, or have utilized, TRICARE's Extended Care Health Option (ECHO) benefit.  The ECHO program provides financial assistance to beneficiaries with special needs for an integrated set of services and supplies. This includes primarily those beneficiaries who are diagnosed with moderate or severe mental retardation, a serious physical disability, or an extraordinary physical or psychological condition. 

These special needs families frequently also apply for Medicaid to supplement their ECHO benefit. MOAA therefore is concerned about the impact of Medicaid cuts on military and veteran families who access Medicaid for a variety of reasons, including:

  • Complex Conditions: For approximately 200,000 military children, Medicaid is required as a stable source of coverage for some of the most comprehensive and complex care that commercial and TRICARE plans do not offer.

  • Secondary Insurer: Medicaid is also required to serve as a second payer to cover benefits that TRICARE, tied directly to Medicare fashioned for adults age 65 and above, does not comprehensively provide.

  • Waiver Services: Medicaid waivers provide crucial services, not covered by TRICARE, for those with special needs. Because the demand for these services far outstrips the supply, most states have lengthy waitlists to receive assistance. These services are often out of reach for mobile military families, who must start over at the bottom of the state waitlist each time they move to a new state.

MOAA has communicated these concerns to Congress, underlining that with less federal money flowing into Medicaid, states will have to either spend more of their own money to fund the program at current-law levels or cut pay to providers and eliminate optional services or restrict eligibility. Proposed cuts to the Medicaid program will result in longer waitlists for all eligible children, but with a disproportionate effect on military families, who have a difficult time holding their place in line with moves every two to four years.

Whether the impact of changes to health care are minimal or extensive, we remain vigilant when it comes to any changes in order to engage in an instant on behalf of all our TRICARE beneficiaries.

 

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