June marked a somber anniversary for Chase Brown and his mother, Lisa. It’s been 11 years since the partially paralyzed 29-year-old with autism first applied for community-based services through Medicaid. He’s still waiting.
A recent Houston Chronicle article examined Brown’s story and the heartbreak for so many other individuals with disabilities and their families who remain on Medicaid waiting lists for services across the country. As Lisa Brown stated about her son: “I just … feel like I don’t know what to do. You know, what can I do for him? I don’t know how to keep him safe.”
Yet as the Brown family waits to receive care through Medicaid, Democrats in Washington have spent billions of dollars extending “temporary” increases in Obamacare subsidies that pay the insurance premiums of individuals making hundreds of thousands of dollars per year. The contrast appears striking, yet sadly consistent, as Democrats have for the past decade placed the needs of able-bodied adults ahead of individuals with disabilities like Chase Brown.
Waiting Begets Waiting
At 29, Brown’s disabilities stem from autism and the after-effects of a stroke he suffered several years ago. His mother cares for him as best she can, but after Chase’s father died, she became even more desperate for him to move off the waiting list and finally qualify for services from Medicaid. But because community-based services like respite care — as opposed to institutional care in nursing homes — remain optional for state Medicaid programs, states can, and most do, impose waiting lists due to limited resources.
Two factors affect the waiting lists — one practical, one ideological. On the practical side, creating a waiting list can paradoxically lead to more waiting. If people think they may have a need for care in the future, they will often join the waiting list immediately, so that if they need services, they will be closer to the head of the queue.
The Chronicle story discussed this dynamic in detail. For instance, one publicly funded website encourages Texas parents of children with disabilities to put their name on the Medicaid waiting list “even if you hope your child will never need those services,” due to the likely duration of the wait.
Unfortunately, Texas and six other states that currently have waiting lists for care assess eligibility and needs for care only when people on the waiting list reach the top of the queue, rather than when they first apply for services. As such, at least some of the individuals on waiting lists in these states likely do not qualify for services. It also means that individuals could wait years — or, in the case of Chase Brown, more than a decade — thinking they will eventually receive care, only to discover after all that waiting that they do not qualify.
Screening all the patients on the waiting list for eligibility would impose additional up-front costs to Texas and the six other states that do not assess patient needs at the time of application. But in each case, it would give both families and the state a more accurate picture of total needs within the state.
The Role of Obamacare
Another factor looms over the waiting list issue, yet receives nary a mention in the Chronicle’s lengthy story: Obamacare. Because even as Chase Brown and many others like him continue to wait for care, the left has spent much more of its attention in recent years on expanding Medicaid to able-bodied adults than on treating patients like Chase.
All told, the most recent data indicate that more than 665,000 individuals with disabilities, living in 39 separate states, sit on waiting lists to receive care. Most of those people (more than 464,000) have intellectual or developmental disabilities, like Chase Brown. Individuals spend an average of 44 months, or nearly four years, on Medicaid waiting lists before they receive access to care.
While Texas has not expanded Medicaid to the able-bodied under Obamacare, most of the 39 states with waiting lists for care have done so. Those that have receive a greater match (90 percent) to cover their able-bodied adults than to eliminate their waiting lists for patients like Chase (normally 50-75 percent, but increased by 6.2 percent for as long as the Biden administration retains its public health emergency over Covid).
It doesn’t take a rocket scientist or a degree in accounting to figure out that states have a greater financial incentive to expand Medicaid to able-bodied adults than to devote additional resources to reducing their waiting lists for individuals with disabilities. Yet leftist think tanks continue to try and deny that these obvious financial incentives have perpetuated waiting lists for those with disabilities, going so far as to issue junk studies claiming no correlation between expansion under Obamacare and waiting lists.
The Chronicle notes that Texas has taken some steps to reduce its waiting list, increasing resources in its last budget to open new “slots” for patients with disabilities. As welcome as that progress is, many patients in other states could benefit if their Medicaid programs focused resources on these most vulnerable populations, rather than providing coverage to able-bodied adults.
The next time someone asks why Texas hasn’t expanded Medicaid, policymakers in that state should point to Chase Brown and his family. Unless and until each and every Texan with a disability has access to the services they need — not a waiting list, but access to actual care — the left shouldn’t even think about spending taxpayer dollars expanding coverage to able-bodied adults.