See below message from AHCA President & CEO Mark Parkinson:

The future of our Medicaid funding faces its greatest threat in my six-plus years at AHCA/NCAL. Congress is considering reforms that would further challenge our ability to provide care to our poorest residents. These proposals could dramatically reduce funding to the states, and some even eliminate provider assessments and other important funding mechanisms. The good news is that we are on top of it, and I am convinced that if we work together and respond in a huge way, we will win.

We need you to be part of our response. This memo will explain the challenge we are facing, outline our response, and discuss several steps you can take to help ensure our success.

Why Medicaid is at Risk

Republicans have wanted to reform the Medicaid program for the last 10 years. This is not a criticism; they are responding to a financial reality. Republican leadership, led by Speaker Ryan, believes that spending for Medicaid has increased dramatically and that its growth is not sustainable. The Speaker and others have argued that even though the short-term pain of reforming Medicaid could be considerable, it is necessary to ensure the long-term survival of the program.

Despite the Speaker’s focus on Medicaid, his efforts have stalled in the past. That is primarily true because Democrats have held either the Senate and/or the Presidency for the last eight years, and the Democrats are against any major reforms that they believe will harm the Medicaid population.

Two dynamics have come together that make Medicaid reform a real possibility now. The first is that Republicans now control both Congress and the Executive Branch. President Trump has made clear that he is supportive of Medicaid reform efforts, and you may have seen some of his spokespeople discuss his support for block grants in national interviews.

The second dynamic is just as important. Republican leadership has decided that it will make Medicaid reform part of the “replace” in the “repeal and replace” of Obamacare. This is important because virtually all Republicans will feel like they have to vote for “repeal and replace.” By placing Medicaid reform in the Obamacare repeal bill, leadership has substantially improved its chance to pass.

The Reform Under Consideration

Medicaid reform is not inherently bad or threatening. Done in a thoughtful way, it could even be helpful. It’s our job to make sure that if it happens, it is done in a reasonable way that protects our centers and, more importantly, our residents. Fortunately, leadership has not settled on an approach at this time. Multiple ideas are under discussion, and that is why our action right now is so important.

Most reform proposals in the past have been block grants. This eliminates the open-ended nature of the Medicaid program and instead provides states with a set amount of money each year to spend as they desire. These proposals have generally been bad for providers because they provide states less money than they currently receive and provide less certainty about what populations states will cover.

More recently, the discussion has included per capita caps. Under these proposals, states would receive a dollar amount for each resident that falls into one of four categories. Generally, the categories are older adults, persons with disabilities, children, and adults in the expansion group. These proposals are also not inherently bad. It all depends on the details. If the federal government does not adequately fund the program, it will fail. In addition, if states can siphon money away from older adults and persons with disabilities, and as a result, our net revenue declines, this proposal is not acceptable. Most of the proposals have failed us for those reasons.

Some of the proposals being discussed would be devastating. One proposal that passed the House in 2012, but stalled in the Senate, would have eventually provided 30 percent less funding to states. We all know that we cannot take any cut, let alone one approaching that magnitude.

Our Position

Our position is that long term care is shamefully underfunded as it is, and it is not reasonable to consider or pass any proposal that would make it worse. We have prepared a five-page briefing document that explains this in detail. We’ve had a great response to the document, and we encourage you to use it in any way that is helpful to you.

Our Strategy

Democrats in Congress are almost uniformly opposed to Medicaid reform. The key Republicans working on the details for the “repeal and replace” legislation are:

  • Majority Leader of the Senate Mitch McConnell
  • Chairman of the Senate Finance Committee Orrin Hatch
  • Speaker of the House Paul Ryan
  • Majority Leader of the House Kevin McCarthy
  • Chairman of the House Energy and Commerce Committee Greg Walden
  • Chairman of the House Energy and Commerce Subcommittee on Health Michael Burgess

We have met with these leaders and their staff on multiple occasions and continue to do so. All are outstanding leaders who have shown a willingness to work with us, but that alone is not enough. It is great to have a seat at the table, but it doesn’t mean anything if we do not win. Winning could happen in three ways. The first would be if leadership simply decides not to take up Medicaid reform in repeal and replace. If enough people make noise about the negative impact it could have, this is a real possibility. The second would be if leadership decides to preserve Medicaid coverage for the frailest and most vulnerable people in the program, who have an ongoing need for medically necessary long term services and supports, and focus the per capita cap reform effort on people with acute care needs added in the Obamacare expansion. The final way would be if our residents are protected in the per capita cap. If funding for long term services and supports is guaranteed at adequate levels, and our services required, we can soften the impact. The board has made clear that options one and two are our top priorities.

What You Can Do

In addition to meeting with the leaders who are putting repeal and replace together, we now want other members of Congress to contact these leaders and express their support for nursing facilities and assisted living. We believe that if other members of Congress approach the leaders listed above, it will make a difference. You can help us do this in three ways.

  1. We have activated our Capwiz program this week, an internet-based grassroots program. If you are already signed up for Capwiz, you will get an email today asking your permission for an message to be sent on your behalf to your member of Congress and two Senators expressing you support for nursing facilities and assisted living and asking them to contact leadership. If you are not signed up for the Capwiz program, click here to register. We also want you to circulate this memo and the Capwiz link to others in your organization so that we can generate thousands of emails. To do that, you will need to circulate this memo to your staff at the building level. Sending emails to Congress from CNAs, residents, and family members is a great way to help our effort.
  2. If you have a personal relationship with a member of Congress, please contact them.  Send them the five-page document. Let them know how important our care is and that they need to contact Congressional leadership and make sure Medicaid for the frailest and most vulnerable citizens is protected.
  3. Go see your member of Congress. Almost all will be in their home districts the week of February 18. Take the document and spread our message. If you want to come to Washington, D.C. in March, that would be great as well. We already have hundreds coming to town, and we would love to help arrange a Hill visit with your member of Congress.

We Can Win This

Congressional leadership consistently tells us that it is not going after the people our members care for in the Medicaid debate. That’s reassuring, but it is not enough. We need to work together, work hard, get our message across, and hold the policymakers to the commitment we have made to care for the neediest and frailest citizens of this great country.

Thank you for your help.


Mark Parkinson
President & CEO
American Health Care Association