Audrey Winkler, executive director of JESPY House in South Orange, is worried about what will happen if the American Health Care Act (AHCA) receives congressional approval. One-hundred twenty of their 230 clients with a variety of physical and developmental disabilities who have been integrated into the community rely on Medicaid (in addition to limited revenue from their jobs) to pay for everyday costs such as rent, utilities, food, and clothing.
If AHCA passes in the Senate, these benefits, said Winkler, will no longer be available and they will have to depend on only Social Security to supplement their basic needs.
“This could be a real emotional blow with upsetting consequences,” said Winkler.
Fifty clients will likely have to move away from the community they have been a part of, “after having worked for years to build lives of their own.”
As the Senate scrambles to pass its version of the health-care bill before the July 4 holiday recess, a reduction in Medicaid eligibility is a cause for Jewish communal concern. The AHCA passed in the House of Representatives on May 4. While no Jewish agency expects to close its doors, cutting expenses, staff, and programs will be on the table.
NJJN spoke with six local social service agency heads, from Jewish Family Services to JESPY to Daughters of Israel, who described a mood of uncertainty and anxiety as they consider the impact of the legislation.
“There are a lot of unknowns. That’s probably the biggest part of it,” said Susan Grosser, executive director of Daughters of Israel, a nursing facility in West Orange. “We don’t know when or how or even if there are going to be any changes that will affect us.”
The AHCA will roll back Medicaid enrollment eligibility to what it was before the expansion provided by the Affordable Care Act in 2010. In New Jersey, that expansion increased Medicaid eligibility by 36 percent.
The AHCA would also cap reimbursement, offering a block grant to states, with the state deciding how the money will be allocated.
In a May 5 email to colleagues, William Daroff, senior vice president for public policy for Jewish Federations of North America, called the change “devastating,” a “gutting of Medicaid” that “would negatively impact Jewish social service agencies that provide health, long-term care, and home- and community-based care.” He pointed out that Jewish social service agencies receive approximately $6 billion annually from Medicaid.
Tom Beck, executive director of Jewish Family Service of Central New Jersey (JFSCNJ), said the AHCA could result in “significant cuts to mental health and other health and social services that would have a significant impact on our community.”
He added, “As we are an outpatient mental health facility that does fundraising, we will apply for grants and engage in other fund-raising activities to help cover the costs of care for those clients who might be impacted in the future.” To make up for potential gaps in affordability of mental health counseling, he said, the agency has discretionary funds from private donors and grants available through the Union County Division on Aging.
Avi Lewinson, interim director of Jewish Family Service of Metro-
West (JFS), worries that critical programs won’t be able to help as many people or may even be cut altogether. New Jersey benefited greatly from Medicaid expansion and now some 20 percent of JFS clients rely on Medicaid, and close to 12 percent of the JFS counseling budget comes from it.
Cuts in Medicaid “would make it that much more difficult for us,” said Lewinson. “We’ll have to find another source of assistance, or we might have to say we cannot provide certain services.” These cuts could include programs such as Meals on Wheels provided in the Jersey City and Hoboken areas, and programs in synagogues which serve senior populations. Also, fewer people could have access to support coordinators who work with the state’s Division of Developmental Disabilities to connect clients with funding and resources.
Even worse, there may be a reduction in what services are permitted even for those eligible for Medicaid, according to Lewinson. Among these is transportation. “Medicaid might cover a particular service, but not the means to get there,” he said.
“It’s very scary. It’s like going to the grocery store and getting one ounce less for the same money.”
Susan Grosser of Daughters of Israel said the decrease in funding from the proposed law is dramatic because of how it would affect a federal government matching system. “This is oversimplified, but if the state spends $100 per day, the federal government would match that, so we would get $200 for that day.” She added that with a block grant, “The state of New Jersey would decide how to split it up, and what a particular nursing home would get.” The new system of block grants, she said, “could be very detrimental to this industry.”
The new system of block grants could force service agencies to compete for limited funds. “Let’s not pit one group against the other,” said Winkler of JESPY. “That’s horrible. We ought to work together to block the block grant funding.”
Seventy percent of the populations of nursing homes are reliant on Medicaid funding, according to Grosser. When the Medicaid dollar amount decreases, she said, health-care workers will feel the squeeze. “Nursing homes will have to figure out how to decrease expenses,” she said. “The biggest expense is staffing. That will affect quality of outcomes; quality of care will be affected.”
Finally, if eligibility for Medicaid changes, it will limit services and reimbursement rates. “The implication for seniors who rely on Medicaid for their care is just insurmountable,” she said.
Bruce Birnberg, executive director of Stein Hospice, part of the Wilf Campus for Senior Living in Somerset, was the only one of the six agency heads who was unconcerned by the new health-care bill.
“The primary payer for hospice is Medicare, not Medicaid,” he said. “So no one in the industry is in fear. We are relatively insulated.”
At JESPY House, Winkler said, the proposed changes associated with AHCA “will erode the types of services we provide; change the economic, ethnic, and gender diversity of our clients; and undermine the vibrancy of our community.”
Winkler said that, despite the possible changes, JESPY is trying to ensure it can continue to provide the same level of services as before. She offered a list of efficiencies the agency has already implemented that included everything from changing the organization’s business plan, to thinning the staff, and hiring a development director to focus on grants.
And yet, she said, “We foresee an annual gap of approximately $1 million over a phased-in period through 2019.”