Senior Policy Analyst
With Idaho, Nebraska, and Utah voters deciding in November whether to expand their Medicaid programs under the Affordable Care Act (ACA), opponents are recycling a false claim that expansion hurts vulnerable groups like seniors and people with disabilities by making it less likely that they get the services they need to help them remain in their homes. (Opponents are also making exaggerated or false claims about the impact of expansion on state budgets, as we detailed this week.)
In an op-ed, for instance, the conservative Idaho Freedom Foundation’s vice president wrote that “by expanding Medicaid, resources going to the truly needy and elderly will be re-directed” to the people gaining Medicaid coverage under the expansion, supposedly creating a waiting list for home- and community-based services (HCBS). This argument is false, as we’ve repeatedly shown, such as here and here.
Medicaid gives states multiple ways to provide HCBS to seniors and people with disabilities, usually as an alternative to nursing home care. All states take one or more of these options, and they decide which HCBS to provide and how many people to serve. States can have waiting lists for HCBS, but not for Medicaid coverage; states must enroll all eligible beneficiaries, including children, seniors, people with disabilities, and other adults — without exception.
Most states have had waiting lists for HCBS since before the ACA, and there’s no connection between waiting lists and state expansion decisions. While Idaho doesn’t have a waiting list, 10 of the 13 states without a waiting list in 2016 are expansion states, according to a Kaiser Family Foundation analysis. In fact, the state with the longest waiting list is the non-expansion state of Texas. And of the 650,000 or so people nationwide who are on a waiting list, 60 percent live in the 19 states that have not implemented the Medicaid expansion.
State officials from both parties and fact checkers have consistently shown that there’s no connection between Medicaid expansion and waiting lists. For example, Ohio’s Republican governor, John Kasich, blasted Vice President Mike Pence last year for suggesting that 60,000 disabled Ohioans are on a waiting list for services due to his state’s Medicaid expansion. The accusation was “false, and it is just the opposite of what actually happened,” the governor’s spokesman said.
The argument that expansion will force Idaho to divert state resources from other critical services to pay for Medicaid expansion coverage has also been proven false. A 2017 study in Health Affairs found no evidence that expansion forced states to reduce funding in areas like education and transportation.
Voters in Idaho, as well as Nebraska and Utah, should disregard the disproven arguments from critics this November when they decide whether to join the states that have expanded Medicaid and thereby increase health coverage and improve the physical and financial health of low-income state residents.