By David Cruz
Correspondent
Until 2014 when the federal Medicaid program expanded under the Affordable Care Act, New Jersey was among the states with the smallest amount of growth in the program. But since New Jersey opted into Medicaid, the state has seen almost half a million new enrollees and the heavily-subsidized spending has grown to just over $14 billion. It was a pragmatic decision, Christie said at the time, but nowadays, Gov. Chris Christie has been promoting the new administration’s plans for Medicaid, mainly block grants.
“You know I’ve spoken a lot to the president-elect about this and I think he is fairly quickly going make changes to the Medicaid that gives much greater flexibility to the governors to decide what type of treatment, what type of exceptions, what type of requirements are particularly in need for your state,” the governor said this week.
Buzzwords like innovation and flexibility are frequently part of the discussion about Medicaid block grants. The new administration has been mostly vague on details, though.
“I promise you when Donald Trump becomes president, we’re going to work with newly re-elected majorities in Congress to block grant Medicaid to the states and allow states in America to innovate with consumer-driven, market-driven proposals to meet the health care needs of our most vulnerable people,” said Vice President-Elect Mike Pence on the stump in November.
But it’s in the details where critics say the devil lurks. Ray Castro of the left-leaning New Jersey Policy Perspective, says capping the program’s funding, which is essentially what shifting to block grants will do, could affect tens of thousands of New Jersey’s most vulnerable residents.
“We now receive about $3 billion additional in the Medicaid program,” said Castro. “The Medicaid program itself is around a $15 billion program so even if you get a one or two percent cut that’s hundreds of millions of dollars. That’s a cost that’s shifted to the states. The original proposal for block grants down in Washington cut the program by one trillion dollars nationwide over ten years, so you can see what the disastrous consequence of that could be for our state.”
Medicaid covers half the babies born in the country, say federal administrators; it covers half of the cost for long-term care and 40 percent of the Medicaid budget goes to cover people with disabilities. Federal Medicaid administrators like Andy Slavitt, say a cap is a cut and with Medicaid, you don’t have to cut much to get to the bone.
“They really mean we want to cut the amount of money that the federal government is going to give to New Jersey to take care of Medicaid patients. And the question is what are you going to cut? Medicaid is an incredibly efficient program today,” said Slavitt, “so there’s not a lot of places to cut and then you put on top of it things like the Opioid crisis and other shocks to the system. It’ll be very difficult for a state to manage in a situation where the federal government cut and capped what they were delivering.”
Like a lot of the new proposals hinted at by the new administration, we just don’t know what a Medicaid block grant program will look like, but it’s almost certain that New Jersey — and most states — will probably be seeing less and critics say that could mean two steps back, after the baby step forward represented by the Affordable Care Act.