How funding cuts would impact adults with disabilities and Medicaid in our community

Here in Wisconsin, one out of every six individuals is on Medicaid. Medicaid assistance is pervasive in our communities. Elderly citizens use Medicaid for in-home healthcare or nursing home care. Working families who cannot afford insurance premiums through the Affordable Care Act often get their healthcare coverage through BadgerCare, Wisconsin’s Medicaid program. Three out of five infants and children in Wisconsin receive complete health coverage through Medicaid.

Beyond the populations listed above, individuals with disabilities also receive benefits through Medicaid. Mount Horeb is unique to surrounding communities because our village is home to one of five Madison Area Rehabilitation Center (“MARC”) locations in Dane County. MARC’s mission is to enhance the lives of adults with disabilities by providing individualized employment, vocational, educational, recreational, and personal care services.

Here in the Mount Horeb area, MARC assists around 50 individuals with things like Individual Supported Employment Support services, educational services and day services. Mount Horeb area businesses also benefit from MARC’s support of disabled adults because they gain needed employees. In total, MARC partners with over 200 businesses, volunteer agencies, and recreational organizations.

MARC Job Developers assist with resumes, finding job leads, submitting applications, setting up and attending interviews, and other assistance in gaining employment. After finding the job, MARC provides ongoing job coaching and training.

Emmett Sauchuck, Director of Development at MARC says, “MARC relies on Medicaid for 93% of funding. Medicaid supports almost all of our services...”

The $880 billion in spending cuts now going through the U.S. Senate legislative process are extremely concerning to individuals who are disabled, and their families. Fears for Medicaid cuts have a solid foundation. The nonpartisan Congressional Budget Office (“CBO”) determined that cutting Medicaid is necessary for Republicans to meet their budget goals. Disability advocates and the CBO state that $880 billion in spending cuts cannot happen without drastically cutting Medicaid.

According to Emmett Sauchuck, “Individuals we serve have permanent, lifelong disabilities. The new reporting requirements are designed to save money by limiting the number of people who receive Medicaid benefits. The existing requirements are already an immense burden on individuals with disabilities and their families, and the more convoluted and intense they become, the more chance there is for people to lose their benefits due to an administrative error.

“The addition of work requirements is more like ‘prove you are already working requirements’ because the vast majority of Medicaid recipients who can work are working. All people would have to prove their eligibility and work exemptions over and over again, leading to even more strenuous reporting for our participants and their families.”

The impact on Mount Horeb MARC participants and their families would be very real and felt on a daily basis. Mary Anne and Bill Oemichen from New Glarus have a 32-year-old daughter who participates in Mount Horeb MARC services. Amy Oemichen is autistic, and her disability requires multiple layers of care. MARC helps with vocational assistance and quality of life assistance. Lisa Swenson, from MARC, is Amy’s job coach. Over the years she has worked to help Amy turn a life-long interest in growing things into a career. Amy is self-employed and owns a business called “Wanna Do Herbs.” Amy turns lavender into herbal bath and body products. Amy’s products can be found right here in Mount Horeb at Jangle Natural Living on Main Street.

According to Mary Anne, MARC worked with Amy to develop her business. And MARC continues to assist Amy so that she can maintain and grow a small business she can be proud of. In addition, MARC helps Amy with life skills. Because of MARC services, Amy learns cooking skills, receives help with fine-motor skills through arts and crafts projects, and also has a regular exercise regimen. She takes advantage of recreational opportunities out in the community. All these services ensure that Amy is part of the larger community. And all these services are possible because of Medicaid funding.

Medicaid impacts Amy’s life in other ways as well. Amy’s health insurance coverage is through Medicaid. And, because Amy needs 24/7 assistance, her ability to live independently, in her own apartment, is directly linked to in-home care. Amy’s care team includes a case manager as well as full-time and part-time in-home care workers. Mary Anne points out that not only will Amy be impacted if she loses funding for in-home assistance, but there will also be a cascading impact on the people who assist and care for her. They also stand a chance of losing their jobs.

Amy excels in an independent living environment. She regularly visits her parents’ home but always expresses a desire to return to her own apartment. When considering how Medicaid funding impacts her daughter’s life and the lives of so many other disabled adults she knows through MARC, Mary Anne says that all the parents she knows have had stress levels that are “off the charts” since it became clear that Medicaid cuts are on the table.

According to Mary Anne, the options are very limited for adults with disabilities if they lose Medicaid services. Moving back home with parents is not a long-term solution because parents do not live forever. The other long-term care option is institutional care, at a much higher cost. Mary Anne considers all the work done over the last 50 years to help folks with disabilities integrate into and live productive lives within their communities, and wonders whether cutting Medicaid will force the disability community to go back half a century - to a time when people could not make choices about where and how they want to live.

Mary Anne also has concerns about increased reporting requirements. Many of her concerns reflect what Emmett Sauchuck pointed out: “existing requirements are already an immense burden.”

Mary Anne manages a yearly Medicaid reapplication process, now proposed to increase to twice yearly. This includes having Amy’s doctor document that “yes, she still has autism; yes, she still needs these services,” and “no, she cannot hold a traditional job.”

From the standpoint of someone who is intimately involved with the system, Mary Anne wonders about the increased administrative time and cost that will be required to prove that a lifelong diagnosis, such as autism, indeed continues to exist, and that work exemptions apply.

But most importantly, doubling reporting requirements will mean folks lose coverage. Mary Anne states that while she has the capacity to make sure all reports are correct and filed on time, not every disabled person or their family has the time or ability to do so. This one fact alone almost ensures that people will lose coverage because they don’t file required paperwork on time or fill it out exactly as directed.

There is a determination in Washington, DC, to cut Medicaid spending to provide tax cuts which overwhelmingly benefit billionaires and millionaires. But in the end, the real cost will be borne by over 72 million people in this country who depend on Medicaid, including some of our most vulnerable citizens and family members.