Over one-quarter, nearly one million, American Indians and Alaska Natives (AI/AN) live with a disability. More than a million of all AI/ANs are enrolled in Medicaid and the Childrens’ Health Insurance Program (CHIP). And, many more are eligible for health coverage through these programs. Without Medicaid and CHIP dollars, the Indian Health Service (IHS) system will not survive. AI/ANs with disabilities living both on the reservation and in urban areas stand to lose not only “essential health services”, but also the programs and services that keep us out of institutions and in our own homes with our families. In addition to direct health care, the program pays for critical supports like wheelchairs, hearing aids, prosthetics, bathroom and house aids. Most importantly, Medicaid pays for in-home care.
Both the House and Senate versions of the effort to repeal the Affordable Care Act institute a per capita cap for Medicaid. This means that the federal government would offer a fixed amount of money for each beneficiary, including AI/ANs with disabilities. The Medicaid shift would also have implications for the 90 percent of AI/AN children attending public schools. Currently, Medicaid reimburses schools for everything from speech and occupational therapy to wheelchairs. Disability advocacy groups assert that under this proposal, states would no longer have to consider schools as eligible Medicaid providers, which would mean that districts would have no Medicaid dollars to provide medically-necessary services.
The Consortium of Citizens with Disabilities declares that betraying the Medicaid guarantee for people with disabilities while slashing federal support will force states to cut services and eligibility that put the lives, health, and independence of people with disabilities at significant risk.