Why Block Granting and other changes to Medicaid will cut out people in need

written by Jayme Day

The Trump Administration, along with a majority Republican House and Senate, is already working to change the Affordable Care Act (ACA). One potential change we’ve heard lots about is shifting Medicaid from an entitlement program to a block grant. While block granting is touted as a way to give states more power to innovate, changing the Medicaid program from an entitlement to a block grant will shrink the program and cut out many people in need.

Block granting Medicaid will result in large cuts to the program, removing the ability of states to have any of that flexibility to innovate. States already have the ability to tailor the Medicaid program to meet their needs. The federal Medicaid program sets out the basic care and who is eligible; states can then apply for waivers and amendments to add or modify care from the federal baseline.

How else could loss of the ACA hurt people experiencing homelessness?

  1. Loss of the ACA = loss of Medicaid Expansion.
    Through the ACA, 32 states have expanded Medicaid coverage to 12.3 million people who would not otherwise be eligible.. Medicaid expansion is particularly important for people experiencing homelessness. Eligibility requirements and restrictions often exclude people who are homeless because they cannot document a disabling condition.
  2. Loss the ACA = loss of health care protections.
    If Congress repeals the ACA entirely, insurance companies can change their coverage to be less accessible. For instance, insurance companies could deny people based on a preexisting condition, or they could make it difficult for people to keep their coverage, for instance they could not renew insurance to people whose costs become too high. Many people experiencing homelessness have complex and costly health conditions as a result or even as a cause of their homelessness. Making insurance out of reach to homeless persons exacerbates their health and their ability to maintain stable housing.
  3. Loss of the ACA without replacement = millions without health insurance.
    If Congress repeals the ACA without an immediate replacement, even if the replacement is set one to three years out to provide time for replacement this can undermine health insurance for people as soon as it is repealed. As soon as it is repealed, individuals will no longer be incentivized to enroll in health insurance and insurance companies are more likely to pull out of exchanges. An additional 20 million people have gained health insurance under the ACA. Broadening the insurance pool has allowed more people experiencing homelessness to get covered and get the services they need.

Learn more about block granting

Here are some organizations putting out information on how changes to the ACA impact the work we do.

Take Action

Call your members of Congress and tell them that people experiencing homelessness need access to coverage and care.