AAP opposes new Medicaid guidance on block grants, per capita caps

Sweeping new federal guidance on Medicaid issued by the Centers for Medicare & Medicaid Services (CMS) would be detrimental to children and families, according to the AAP, five other major medical organizations and several health groups.

The guidance announced by CMS Thursday allows caps on federal funding and offers states the option to use block grants and per capita caps for low-income adult populations, including parents with young children.

“The American Academy of Pediatrics urges CMS to immediately rescind this guidance and instead pursue policies that strengthen Medicaid. CMS must instead work to reverse the troubling trend of rising child uninsurance rates due to children losing Medicaid and CHIP (Children’s Health Insurance Program) coverage,” AAP President Sara “Sally” H. Goza, M.D., FAAP, said in a statement (http://bit.ly/2uLYM4u).

Medicaid enrolls 37 million children nationwide. When parents lose coverage, their children are more likely to lose coverage as well. However, the full impact of the guidance on children remains unknown. The AAP and health groups issued a joint statement “united in opposition to any threat to Medicaid that would dismantle a pillar program millions of families rely on” (http://bit.ly/37Gp8nh).

The block grant or per capita cap financing mechanism for Medicaid also violates joint principles on Medicaid waivers supported by the six major medical organizations that represent more than a half-million U.S. physicians (http://bit.ly/2Ogdg3E).

Children, including those with special health care needs and those from low-income families, make up the single largest group of people who rely on Medicaid.

Following the release last September of U.S. Census Bureau data showing 425,000 fewer children had health insurance coverage in 2018, the groups called for immediate action by Congress and the Trump administration to protect and improve health coverage for all children (http://bit.ly/38RBBV9).

“It is … baffling and alarming that such drastic, harmful changes are being proposed to a program that works so well for such vulnerable groups. It is even more concerning that it was done in a way that does not allow those who would be impacted most to weigh in,” Dr. Goza said.

The Medicaid program guarantees specific benefits designed for children, known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT). As a result, children on Medicaid are more likely to get checkups, miss less school, graduate and enter the workforce than their uninsured peers. But under the new guidance, states also will be allowed to opt out of providing EPSDT to some populations.

“We urge CMS to immediately rescind the guidance and keep Medicaid strong," Dr. Goza said. “Simply put: Medicaid works.”