APA Public Interest Policy Office: April 14, 2005

Before any harmful cuts are made, we believe that Medicaid deserves a more careful review than is possible through the Budget Resolution in the coming weeks. We strongly support the Senate version of this legislation, which rejects proposed Medicaid cuts and instead creates a Bipartisan Commission on Medicaid to devise reforms and report back in one year.

If we are ever to succeed in making mental health services part of the mandatory package of services provided to Medicaid beneficiaries (rather than optional as they are now for all but children in the Early and Periodic Screening, Diagnosis and Treatment Program - EPSDT), we must work to preserve the overall funding for this vital program. Medicaid advocates believe that cuts in Federal Medicaid funds in this Budget Resolution will increase the likelihood that states will choose to cap spending on optional services and populations. APA's Public Policy Office has been advocating for the Medicaid program together with the APA Practice Organization, which developed this legislative alert. Please take a few moments to make your voice heard on this important issue by writing or calling your members of Congress as explained below.

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ACTION
What You Can Do: Urge Your Representative and Senators to Support the Senate Position on Medicaid.

1. To identify your Representative, visit the U.S. House of Representatives Web site - http://www.house.gov. Enter your zip code to get your Representative's name and phone number and/or fax number. Find your 9-digit zip code (you will need this to locate your members of Congress). This will send you to your member's webpage where the phone and fax number should be under the "Contact Us" section.

To identify your Senators, follow this link - http://www.senate.gov/general/contact_information/senators_cfm.cfm - and scroll down to find your Senator's contact information.

2. Please call or fax (a sample letter is below) your Representative and/or Senators. When calling, ask for the staff member who handles health care.

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TARGETS
The Senate Members of the Conference Committee are: Senators Judd Gregg (R-NH), Pete Domenici (R-NM), Charles Grassley (R-IA), Wayne Allard (R-CO), Kent Conrad (D-ND), Paul Sarbanes (D-MD) and Patty Murray (D-WA). The House Conferees are yet to be decided, but are likely to include: Representatives Jim Nussle (R-IA), Jim Ryun (R-KS), Ander Crenshaw (R-FL), Adam Putnam (R-FL), John Spratt (D-SC), Dennis Moore (D-KS) and Richard Neal (D-MA).

House Republican members should also be encouraged to support the Senate position on Medicaid, especially if they are considering signing on to Representative Heather Wilson's April 13 Dear Colleague letter supporting such a commission. (See below)

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BACKGROUND
In February, the Bush administration proposed program efficiencies to reduce Medicaid funds by a net $45 billion over the next ten years. This was part of larger proposed cut in entitlement spending to help the President meet his goal of reducing the annual deficit by 50% in five years.

APA was among the first groups to endorse a bill (S. 338) by Senators Gordon Smith (R-OR) and Jeff Bingaman (D-NM) to create a Medicaid commission of expert stakeholders-governors, state legislators, state Medicaid directors, providers and consumers-to make recommendations on the populations served, financial sustainability and quality of care.

Identical legislation was introduced in the House by Representative Heather Wilson (R-NM) and Delegate Donna Christensen (D-VI) (H.R. 985). Both bills have strong bipartisan support. The bill sponsors are hoping to build on the positive experience of the 1997 Medicare Commission that recommended the most cost-effective ways to improve service delivery and quality.

When the House Budget Committee met to consider a spending plan, Members proposed $20 billion in Medicaid cuts, a position that was adopted by the full House. The Senate Budget Committee voted to include a cut of $14 billion in Medicaid growth over five years. But, on March 17 the full Senate voted 52-48 to accept a Smith/Bingaman amendment striking the proposed $14 billion cut and instead create a Bipartisan Medicaid Commission that would recommend reforms within one year. We need your support to help ensure that the Senate position prevails in the House-Senate negotiation on the Budget Resolution.

Representative Heather Wilson is asking House Republicans to cosign an April 13 letter to House Budget Committee Chairman Nussle calling for no cuts to the Medicaid program, and instead urging funding to create a Medicaid commission. To quote from the letter, "As detailed in H.R. 985, a Commission would serve as a credible forum for an honest, open discussion and the development of comprehensive recommendations on how we can reform the Medicaid program. The Commission would be the right setting at the right time to carefully deliberate and recommend solutions to improve the health of low-income Americans and put the program - one of the most complicated federal programs we oversee - on a stronger financial and management footing."

MATERIALS
* The fact sheet by Senators Smith and Bingaman is attached.
* Additional advocacy information is also available at: http://www.medicaidmatters2005.org.

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SAMPLE LETTER
The Honorable (full name) or The Honorable (full name)
United States House of Representatives United States Senate
Washington, DC 20515 Washington, DC 20510

Dear Representative (last name): Dear Senator (last name):

I am writing as a psychologist and constituent to urge you to help the Senate position on Medicaid prevail in the conference on the 2006 Budget Resolution.

Medicaid deserves a more careful review than is possible through the Budget Resolution this spring. Medicaid is the largest funder of mental health services in the nation, and because it is included only as an optional service for states to provide, I am extremely concerned about the potential impact that cuts may have. A dramatic reduction in the Federal share of Medicaid funds may encourage states to cap spending on optional services and populations.

While the House seeks a $20 billion cut in Medicaid growth, the Senate rejected proposed Medicaid cuts and instead proposes a Bipartisan Commission on Medicaid to devise reforms and report back in one year. This panel would be composed of expert stakeholders-governors, state legislators, state Medicaid directors, providers and consumers-to make recommendations on the populations served, financial sustainability and quality of care.

As Representative Heather Wilson and colleagues explain in a letter to House Budget Chairman Nussle,
"...a Commission would serve as a credible forum for an honest, open discussion and the development of comprehensive recommendations on how we can reform the Medicaid program. The Commission would be the right setting at the right time to carefully deliberate and recommend solutions to improve the health of low-income Americans and put the program - one of the most complicated federal programs we oversee - on a stronger financial and management footing."

I hope that you will oppose Medicaid cuts and support the creation of a Bipartisan Medicaid Commission. Thank you for considering my views.

Sincerely,

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