I began my career as a mental health therapist working with children and families seeking help from the public community services board in Front Royal, and I can still recall those I counseled through times of crisis. Over the last 45 years, I have worked at the community and state levels in both the public and the private sectors, and I have seen Medicaid save lives and help people move from experiencing crises to thriving.
As a result, I am alarmed by the current efforts in Congress to cut Medicaid, which will mean taking away health care from Virginians who most need it.
Medicaid pays for health care for children, low-income working adults, seniors and those with developmental disabilities. Studies from the National Bureau of Economic Research and the American Medical Association show that in its 60-year history, it has increased access to quality care, elevated economic security, improved overall health and reduced medical debt. Despite its longstanding track record of effectiveness, in recent weeks, Congress initiated its potential unwinding.
Virginia’s federal legislators must protect Medicaid from the largest set of cuts in its history. According to the Virginia Department of Medical Assistance Services (DMAS), 22% of the state population, over 1.8 million Virginians, is covered by Medicaid. This includes 125,000 children in low-income families who rely on Medicaid-funded health care to make it possible for them to grow and thrive. While Medicaid covers community-based care for many of our neighbors with developmental disabilities, more than 15,000 Virginians are on a waitlist to receive services.
I now lead enCircle, a nonprofit human service organization that supports more than 300 adults with intellectual and developmental disabilities and educates more than 200 students with special education needs in communities throughout the commonwealth. Without Medicaid-funded Home and Community Based Services providing daily life skills, nursing and medication management, basic hygiene support and community engagement activities, adults with developmental disabilities would have few options. Moreover, 93% of the students we serve in our Minnick Schools qualify for both free and reduced lunch and Medicaid.
I have experienced the critical role Medicaid plays in transforming Virginia’s system of care for people with intellectual and developmental disabilities from an institution-based model to a more empowering community-based approach. Undercutting Medicaid funding now would force a reduction in care and usher in a potential return to institutionalization, spurring a regressive move backward by decades. Not only would it be devastating for those directly affected but would run afoul of the recently approved legal agreement, achieved through twelve years of hard-won system improvements, between the Department of Justice and the commonwealth.
The House budget mandates that the House Energy and Commerce and the Senate Health, Education, and Labor committees identify $880 billion in cuts over the next 10 years. Though the President and Congressional leaders have claimed Medicaid will not be significantly affected, the sheer scope of the proposed cuts leaves no other options. Medicaid is a federal and state government partnership; in Virginia, the federal and state shares are each roughly 50% for most people who are covered. Congress seems poised to make sweeping cuts but leave difficult implementation decisions on loss of coverage and budget shortfalls to the states.
If Congress approves significant Medicaid cuts, our state legislators will be forced to make difficult and unpopular choices about raising taxes to fill the gap in federal Medicaid funds or cutting the program. Their options will mostly be actions that directly affect the ability of children, low-income working adults, seniors and people with developmental disabilities to access care. These include reducing reimbursement rates for services, eliminating types of services eligible for coverage or limiting who is covered. In any of these scenarios, the people who most need health care provided through Medicaid will lose out.
Now is the time for our Virginia Congressional delegation to speak up for — and vote on behalf of — the Virginians they represent who rely on Medicaid.
Ray Ratke is CEO of enCircle, a nonprofit organization founded in 1888 in Salem, which served more than 1,500 Virginia children, adults and families last year. He’s the former Chief Deputy Commissioner of Virginia Department of Behavioral Health and Developmental Services. He can be reached at rratke@enCircleAll.org