With the Congress and the President aligned to repeal the Affordable Care Act, there are now renewed efforts to make further changes designed to close perceived loopholes in eligibility for long term care. On February 1, 2017 the House Subcommittee on Health held a hearing entitled “Strengthening Medicaid and Prioritizing the Most Vulnerable” to begin assessment of three bills which would significantly impact chronic care budgeting under Medicaid. These are titled:

• Verify Eligibility Coverage Act
• Close Annuity Loopholes in Medicaid Act
• The Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017

The Subcommittee materials on these bills may be found at: https://energycommerce.house.gov/hearings-and-votes/hearings/strengthening-medicaid-and-prioritizing-most-vulnerable.

These legislative measures are designed to close off eligibility for spousal transfers and the use of annuities, reduce coverage where windfall amounts are received by recipients and restrict coverage for undocumented aliens. Savings from these measures would be directed to eliminating waiting lists for waivered programs such as the Home and Community Based Services program. The Subcommittee’s background memo states:

“At this hearing, the Subcommittee will discuss draft legislation which would modify provisions in current law that effectively force States to spend money on individuals who may not be the most vulnerable compared to other populations served or potentially served by Medicaid. The goal of the legislation is to strengthen the Medicaid program and protect the most vulnerable Medicaid beneficiaries by better targeting Medicaid dollars to help patients. As envisioned, the legislation would reduce federal and state outlays, decrease the deficit, and set aside a portion of the savings to help States reduce the size of their HCBS waiting lists, thus protecting and prioritizing patients in need. With these goals in mind, some considerations for the Committee as it evaluates the goals of the legislation include:

• What are other areas of Medicaid statute or regulation which may be modernized or improved to reduce outlays and free up resources for prioritizing patients on waiting lists?
• What is the best approach to target resources and reduce waiting lists without creating perverse incentives for States to grow their waiting lists to attract more Federal support?
• Since waiting lists can demonstrate unmet needs, what is the appropriate role for private sector (for-profit and non-profit) resources and entities to play in preventing crowd-out and cost-shifting, and yet helping address unmet needs?”