Nothing is more important than our health. Without our physical and mental health, everyday tasks can seem suddenly insurmountable. Our job could be in question, our ability to show up for our families in jeopardy, and our enjoyment of everyday hobbies and activities unlikely. But all of us, at any point, are only one accident or illness away from needing significant medical care. For many, the ability to pay for that necessary care comes through employer-sponsored health insurance. But for more than 92 million Americans, including 817,000 Iowans, their health insurance comes from Medicaid.
As an attorney with Disability Rights Iowa (DRI), I see up close the important role that Medicaid plays in the lives of Iowans with disabilities as I advocate for my clients to receive necessary services paid for by this insurance system. Prior to my work with DRI, I carried a misguided understanding of this vital government-provided program. Over my seven-plus years with the agency and becoming what my friends and colleagues affectionately call a “Medicaid Attorney,” I’ve learned a few things that I wish I had known before.
Here are my insights about the system that are guiding my system-change efforts with Mid-Iowa Health Foundation’s HealthConnect Fellowship:
Medicaid provides coverage for adults and children, people with disabilities, and seniors. While Medicaid was designed as a poverty-reduction program, the reality is that most individuals are unprepared for the massive financial challenges that come with a life-altering accident or illness. When the unthinkable happens, like a serious car accident or stroke, Medicaid can ultimately provide the necessary coverage to ensure that the person moves forward with the health care they need. Even without an unexpected accident or injury, long-term care for later in life is expensive.
50% of all Iowans living in a nursing facility receive their coverage from Medicaid.
Home- and Community-Based Services (HCBS) Waivers allow individuals who otherwise qualify for institutional care, like a nursing facility, to live at home and receive the services they need. People live healthier, happier lives when they remain at home with their families and are actively engaged in schools and communities. HCBS services can make that possible. Children and adults with many different types of diagnoses, such as intellectual disabilities and brain injuries, can qualify to receive extensive services in their own homes.
At any given point, 40-50% of all Iowa children receive their health care coverage from Medicaid.
Whether a child is eligible through their family’s income status or due to a major disability, having access to Medicaid means that any time a child faces one of the many common childhood ailments – like an ear infection – or encounters a more complex challenge – like a physical disability or mental health diagnosis – the family knows that the child has health care coverage. No family should ever question whether they can take their child to a health care provider when needed. Medicaid allows families to make choices that address their children’s health issues in a timely manner and live healthier lives.
Despite Medicaid being a vital tool that allows families to stay healthy and actively engaged in their communities, Iowa lawmakers recently passed a bill that will drastically change the way government benefits are administered, including Medicaid. The bill, which the Governor is expected to sign into law, places new burdens and administrative hurdles on families who receive government assistance.
It is estimated that up to 1% of Iowans will lose their benefits. This equates to 8,000 Medicaid recipients, including 600 children on the Children’s Health Insurance Program (CHIP).
This makes my job as a lawyer advocating for people to receive necessary medical services more difficult. Learning about and educating others on the importance of Medicaid to promote Iowans’ well-being can encourage policies that increase access to this vital support system.
In 2016, Iowa privatized Medicaid, contracting with private health insurance companies, called managed care organizations (MCOs), to administer benefits for nearly all Medicaid members. The transition has, and continues to be, rocky for many Iowans on Medicaid, especially for those with disabilities. As an attorney with DRI, I spend much of my time representing clients in the appeal process. My clients are children and adults with disabilities facing the loss or denial of medically necessary services because of decisions by the MCOs. This ranges from the reduction of in-home care for those who need assistance with daily tasks, like bathing and cooking, to the denial of wheelchairs for children who are unable to walk independently.
Iowa has a history of over relying on institutions to provide care to those with disabilities. DRI was part of a federal lawsuit that found the conditions at a state institution to be abusive and neglectful to the young people living there. In January of this year, DRI and partners filed a federal lawsuit alleging that the state fails to ensure adequate mental health services for Medicaid eligible children and instead over relies on institutional care. These kinds of lawsuits have been necessary to ensure Iowans have access to the care and support they deserve within their communities.
Despite the many, many challenges in the system, Medicaid is a vital safety net for hundreds of thousands of Iowans. I see through my work every day how this health care coverage allows adults to work and children to stay engaged in school. Without Medicaid, the health and well-being of so many of our friends and neighbors would be at risk.
The next time you read an article or catch a news story about Medicaid, I hope you’ll remember that Medicaid is health care. And nothing is more important than our health.
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