Advocacy Alert – Senate “Better Care Reconciliation Act of 2017” June 26, 2017


On June 22, the Senate Republican leadership released legislative text on their alternative to a bill (H.R. 1628) narrowly approved by the House of Representatives to repeal and begin replacing signification parts of the Affordable Care Act (ACA). Similar to the House-passed bill, the Senate’s so-called “Better Care Reconciliation Act of 2017” would convert federal Medicaid financing to a per capita cap beginning in FY 2020. This would be detrimental to individuals with Down syndrome and their families because states will face even larger funding deficits in the Medicaid programs, leading to potentially significant cuts in home and community-based services that are critical to facilitating economic independence for people with disabilities.




A vote in the Senate could occur as early as this week. Please contact your Senators and urge them to oppose Medicaid reimbursement caps for people with disabilities. Let them know that their commitment to protect the most vulnerable in our society (i.e., the disabled) will not be met if the Medicaid reimbursement caps in the “Better Care Reconciliation Act of 2017” are enacted.




Enactment of the Medicaid per capita reimbursement caps in the Senate bill would be harmful to people with Down syndrome in a number of ways. Most notably:


Mandatory Medical Assistance


The Senate bill exempts from the reimbursement caps medical assistance expenditures made on behalf of children entitled to Medicaid on the basis of disability or blindness. This only applies to childhood disability, and would end once children reach age 18. People with Down syndrome have co-occurring conditions that contribute to the medical complexity of Trisomy 21. Many such individuals and their families depend on state-based Medicaid programs to access interdisciplinary treatments throughout their lifespan, yet this access to medical assistance and treatments will be cut when many people with Down syndrome need it the most. In addition, with reimbursement caps, states would have fewer resources to incentivize health care providers to transform their practices to provide more integrated services and better care coordination, which would help to lower long term health care costs.


Optional Home and Community-Based Services








Like the House-passed bill, the Senate version will halt the progress that has been made nationally in promoting home and community-based services, improving the coordination of care and services resulting from medical complexities, and facilitating economic independence for people with Down syndrome and other disabilities. That’s because the Medicaid reimbursement caps are intended to slow the rate of federal health care spending, and programs critically important to people with Down syndrome – such as employment supports through Long-Term Services and Supports (LTSS), and Section 1915(c) Home and Community- Based Services (HCBS) – are optional services that states are not mandated to provide.


People with Down syndrome receive employment supports from Medicaid that enable them to both attain and maintain gainful


employment. They also receive Home and Community-Based Services (HCBS) that allow them to be active and valued members of their communities. Employment supports and HCBS are optional services, and would likely be the first services to be cut by reimbursement caps.




In opposing the Medicaid reimbursement caps in the “Better Care Reconciliation Act of 2017,” help your Senators to understand why the Medicaid program is personally important to you and your family, and how reimbursement caps will harm the most vulnerable in our society. We need their support to ensure that cost-effective health insurance and supportive services will continue to be available to individuals with Down syndrome and other disabilities.


For additional information, please see the Kaiser Family Foundation summary of the Senate bill, along with a side-by-side comparison with both the House-passed bill and the Affordable Care Act.


Please share feedback from your advocacy outreach with our team by sending us an email at: policy@ndss.org.