Overview
Medicaid is the nation’s primary health insurance program for people with disabilities, but it is so much more than health care. For individuals with disabilities and their families, Medicaid also funds vital supports to keep them in their communities.
For many people with intellectual and developmental disabilities (I/DD), Medicaid generally is the only source of funds for them to live and work in the community with friends and families and avoid more costly and segregated nursing homes or institutions. Nationwide, state and federal Medicaid together provide over 75 percent of the funding for services for people with I/DD. However, many states have lengthy waiting lists for these vital services or are only able to provide limited supports to eligible people with I/DD.
Medicaid is critical for many people with disabilities who may not have access to employer-based or other private coverage, have greater medical needs, and often require assistance with activities of daily living throughout their lifetimes. The program currently covers over 10 million non-elderly people with disabilities.
You can learn more about The Arc’s position on Medicaid by reading our position statements on health care and long term supports and services.
Why It Matters
Medicaid makes life in the community possible and is the primary source of health care and community-based supports for many people with I/DD.
The federal/state Medicaid program is the major – and usually the only – source of funding for long term supports and services (LTSS) that many people with I/DD rely on to live in the community. This effective and cost-efficient program allows people with I/DD to live and work among their neighbors.
While Medicaid is a federally administered program, states retain authority and flexibility in providing services. Medicaid funds both mandatory services, which states are required to provide under federal law, and optional services. Mandatory benefits include services like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services like prescription drugs, case management, physical therapy, and occupational therapy.
Home and community-based services (HCBS) are optional services or subject to federally-approved waivers. The fact that HCBS are optional or waivered services is why there are often long waiting lists in states for participation in Medicaid-funded community-based supports and services. Steps must be taken to remove the institutional bias of federal programs, waiting lists must be addressed, and Congress should strengthen the right to a full life in the community.
What The Arc Is Doing
Medicaid is critical for people with I/DD and their families — providing benefits, supports, and civil rights protections that help make community living possible — and it is a top priority for The Arc.
Our Policy Goals
The Arc’s Public Policy Goals include many recommendations on how to protect, strengthen, and expand Medicaid to better meet the needs of people with I/DD. We believe in maintaining individual entitlement to a full range of Medicaid health and long term supports and services (LTSS) for all eligible children and adults with disabilities regardless of employment status, time limits, or other caps. We oppose Medicaid deconstruction or any moves to provide states with flexibility that eliminates basic protections for eligible individuals. We also oppose the imposition of entitlement caps, Medicaid block grants, per capita caps, allocations, allotments, limiting provider taxes, and other proposals that shift costs to states or other mechanisms that cause reductions in eligibility, services, or protections.
Our Coalition Work
The CCD LTSS Task Force, which The Arc co-chairs, works with Congress and the Department of Health and Human Services to support expansion of LTSS and oppose efforts to repeal, weaken, or block implementation of relevant LTSS provisions.
How Medicaid Works
Medicaid is a jointly funded program with matching state and federal funds. The federal government pays for nearly 60 percent of the cost, though the match rate varies from state to state. Under the current structure, the federal government has a commitment to help states cover costs, and in turn, states are required to provide specific benefits to certain groups of people, including individuals with disabilities. If a state increases its Medicaid spending, the federal funding will also increase. Within the basic requirements of the program, states have substantial flexibility to administer the program and to add services and additional beneficiary categories.
How You Can Help
There are many ways to advocate with and support The Arc’s grassroots movement.
The Arc promotes and protects the human rights of people with intellectual and developmental disabilities and actively supports their full inclusion and participation in the community throughout their lifetimes.