Meeting with Center for Budget and Policy Priorities

We know how important Medicaid policies are for you. Here in D.C. we are doing our part to continually insert ourselves into these discussions on behalf of individuals with disabilities, their families and those that provide care and services. Recently, UCP attended a talk with the Center for Budget and Policy Priorities (CBPP) regarding the threat posed to Medicaid in the current political environment.

Here is a summary of the meeting, along with key takeaways. The primary topic of discussion from CBPP that posed the biggest threat was the sectioning of Medicaid funding to states, primarily in the form of Per Capita Caps and Block Grants.  Amongst the various alterations in the budgetary sector of Medicaid, are Block Grants and Per Capita Cap, both of which section off the funding to states. While both have their varying adverse factors, the common ground lies in the fact that the implementation of such monetary action depletes the protection that the disability community receives through Medicaid.

We appreciate the varying level of background and impact of this issue for our network, but we wanted to provide this as a resource to use as you see fit.  If you have additional questions please reach out.

What is the difference between a Block Grant and a Per Capita Cap?

  • Block Grants are given to the state in one lump sum
    • States allocate where the money will go
    • States also have to make up the difference after federally allotted money is used
  • Per Capita Caps are fixed
    • Capped funds from the governments issued to states per beneficiary of Medicaid
    • There is an anticipated larger gap between funding and spending due to the increase of technological advancement

What is the problem at hand?

Block grants are one of the least accountable of measures to “reform” Medicaid.  It has an inability to adjust to varying economic conditions; it can be cut easily and it’s bias towards, or against, certain beneficiary groups puts it at a position of being severely harmful to the disability community.

Per Capita Caps have been a part of the Republican Task Force in regards to Medicaid Reform. Seen as the lesser of two evils, the attention surrounding this initiative has given it undue positive light in attempt to downplay the negative repercussions that the implementation of such will have on those with disabilities who benefit from Medicaid.

If implemented, Per Capita Caps will limit the budgetary liberty per beneficiary. Through its supposed flexible nature, the fluctuation of this cap will cause altercation amongst the beneficiary groups and the state governments. Seen as bipartisan, and a better alternative to Block Grants, Per Capita Caps inevitably moved conversation away from the stride that Medicaid innovation has made.

In terms of Republican Task Force strategy, many Democratic Governors and Senators have signed on for Per Capita Caps, seeing, again, that it may be considered to be the lesser of two evils. This supposed bipartisan act will decrease the amount of funding per state per beneficiary, therefore increasing the cost as time goes through due to a variety of external factors, i.e., disease, pharmaceutical drug innovation, accessible technology, as these costs will not be picked up by Per Capita Cap.

What does this mean for the disability community?

As mentioned, it is evident that the disability population under Medicaid will not be protected in the event that Per Capita Caps are implemented, due to the fact that there have been vast strides in the innovative technology surrounding assistance for those who have disabilities. As per the act, these costs will not be picked up by Per Capita Cap, meaning that any new innovation will be subject to budgetary restrictions and will only be available with additional cost.  

This is all concerning and individuals with disabilities may no longer be entitled to health care or to long term services and supports under a block grant.  Combined with a fixed amount of severely reduced funding, states could be forced to cut eligibility, benefits, and provider payments. People with disabilities stand to lose access to physicians, medications, therapies, medical equipment, and many other crucial products and services. Worse, states could go back to institutionalizing people with disabilities to save money since they would no longer have to meet the quality standards currently imposed by the Medicaid program for nursing homes or community based services.  

A per capita cap would make this problem [of the struggle that patients go through to get the necessary budgets to have accessible care] worse by limiting the federal role in Medicaid and shifting more of the program’s costs onto states, providers, and patients. Cuts to provider payments, elimination of benefits and reductions in access to care are virtually unavoidable under this type of proposal.

It seems that if Medicaid budget cuts do go underway, that many of the services that allow for individuals with disabilities to have liberties, will disintegrate, therefore forcing certain individuals to refer back to institutions to obtain services that were otherwise integrated within the community. In a way, this repercussion contradicts the Olmstead Act from 1999, which worked to remove economic influences from forcing individuals into institutions. By cutting Medicaid budget, and by proxy, its services, individuals that work in the community and live at home face the threat of losing a large portion of their own budget on medical care, forcing them out of their homes and back into institutions.

What can we do next?

We continue to watch and monitor the development of programs around Medicaid Block Grants and Per Capita Caps.  We need to look at both of these as threats to the current Medicaid system and not as one being a solution that is be is imperative that there should be a conversation shift in the way that the media portrays this endeavor. Instead of looking at Per Capita Cap as the lesser of two evils, it is important to take into account what this means specifically for the disability community and what this means for the future of technology and pharmaceutical advancements. State officials should be informed of the true bearing of cost that they will be burdened with, and they should be prepared to hear of the lack of protection that it will provide to beneficiaries.

Keeping everyone who is affected by the funding changes in Medicaid updated is imperative, seeing as it is one of the issues that will affect life on a day to day basis for individuals with disabilities. We wish to drive programs and legislations that will allow for a higher standard of health care. We not only wish to expand upon the knowledge that our affiliates hold on Medicaid and other health care issues, but also wish to understand how each individual is impacted by these issues and work towards significant policy change.

United Cerebral Palsy Celebrates Enactment of Comprehensive Health Care Reform


Lauren Cozzi
(202) 973-7114 (direct)
(203) 858-5292 (cell)

Washington, D.C. (April 2, 2010) – United Cerebral Palsy (UCP) applauds President Obama’s March 30 signing of the Health Care and Education Reconciliation Act of 2010 (H.R. 4872) into law, which contains “fixes” to the health care reform bill (H.R. 3590). This historic legislation is certain to rank among the top domestic legislative achievements of this generation. It will bring about comprehensive health care reform that will benefit nearly all Americans while reducing the federal deficit.

The Disability Policy Collaboration, and UCP’s grasstops and grassroots work were instrumental in securing enactment of this landmark legislation.

“We are extremely pleased that the new law marks the attainment of several of United Cerebral Palsy’s priority public policy goals, because people with intellectual and developmental disabilities will benefit greatly from a number of important provisions of the law,” said Stephen Bennett, former President & CEO, United Cerebral Palsy. “However we know that no bill is perfect, and we have a significant amount of work ahead to ensure the law is implemented properly. This includes the impact some of the provisions have on the budgets of the developmental disability provider network without the critical funding supports from the federal and state governments.”

“This law, coupled with the Patient Protection and Affordable Care Act  (H.R. 3590), which President Obama signed last week, will dramatically improve disability related health care and long term services and supports,” explained Liz Savage, Director of Health Policy for the Disability Policy Collaboration, who attended the historic ceremony. “These laws represent a sea change in access to quality, affordable health care for people with disabilities.”

Law provisions include the following:


  • Prohibiting private health insurance exclusions for pre-existing conditions.
  • Eliminating annual and lifetime caps in private insurance policies.
  • Restricting the consideration of health status in setting premiums.
  • Expanding Medicaid to cover individuals with incomes up to 133 percent of the federal poverty line (approximately $29,000 per year for a family of four).


  • Ensuring that minimum covered benefits include products and services that enable people with disabilities to maintain and improve function, such as rehabilitation and habilitation services and devices.

Access to Quality Care

  • Improving training of physicians, dentists, and allied health professionals on how to treat persons with disabilities.
  • Requiring the Centers for Medicare and Medicaid Services to collect data on beneficiaries with disabilities access to primary care services and the level to which primary care service providers have been trained on disability issues. Ensuring prevention programs include a focus on individuals with disabilities.

Long Term Services and Supports
Strengthening long-term services and supports through a two pronged approach:

  1. Taking pressure off of the Medicaid program
    • The Community Living Assistance Services and Supports (CLASS) Act would create a national long term services insurance program which assists eligible individuals and their families to meet long term needs with a cash benefit and without forcing them into poverty to receive Medicaid benefits.
  2. Improving the Medicaid program
    • The Community First Choice Option would help to eliminate the institutional bias by encouraging states to cover personal attendant services under the state’s optional service plan instead of through the waiver system by offering a 6% increase in the federal share of Medicaid for these services.
    • Increasing the federal share of Medicaid, known as the Federal Medical Assistance Percentage (or FMAP), for home and community based services (HCBS) and during periods of economic downturn.
    • Allowing states to offer additional services under the 1915(i) Medicaid HCBS Waivers State Plan Option.
    • Providing spousal impoverishment protections for HCBS Beneficiaries.

This bill signing came after a week filled with events, including:

  • On March 21, the U.S. House of Representatives (House) voted 219 to 212 to pass the Senate health care reform bill, the Patient Protection and Affordable Health Care Act (H.R. 3590). Thirty four Democrats and all Republicans opposed the bill. The non-partisan Congressional Budget Office estimated that the legislation would cost $940 billion over ten years and reduce the federal deficit by $130 billion over the first ten years and $1.2 trillion in the second ten years. The House then took up a budget reconciliation bill [the Reconciliation Act of 2010 H.R. (4872)] to make amendments to the health care reform bill to address issues which were problematic to many Members of Congress. The reconciliation bill was passed by a vote of 220 to 211.
  • On March 23, President Obama signed the Patient Protection and Affordable Care Act (H.R.3590)into law, which includes the CLASS Act and the Community First Choice (CFC) Option.
  • On March 25, the U.S. Senate voted to pass the Health Care and Education Reconciliation Act of 2010 (H.R. 4872) which contains “fixes” to the health care reform bill (HR 3590) by a vote of 56 to 43. The House then passed the reconciliation bill for a second time, because the Senate had made some technical changes to it by a vote of 220 to 207.

About United Cerebral Palsy
United Cerebral Palsy (UCP) was founded over 60 years ago by parents of children with cerebral palsy, and today UCP is a leading service provider and advocate for adults and children with disabilities. The UCP mission is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network. This includes approximately 100 local service providers reaching over 176,000 adults and children daily in the U.S., Canada, Scotland and Australia. The UCP national office in Washington DC supports affiliates through programmatic assistance; an annual conference; events to raise awareness and support; marketing and communication services; advocacy; advancement of federal disability public policy through the Disability Policy Collaboration (DPC); and development of forward-thinking programs like Life Without Limits, a national movement to empower people with disabilities to envision and build a better future, and MyChildWithoutLimits, an online resource and community for parents, families and caregivers of children ages zero to five, newly diagnosed with a disability or developmental delay. For more information, please visit