Thread by @povertyscholar

CMS released details today on their latest attempt to undermine #Medicaid. It's called the Health Adult Opportunity (HAO) Program. The euphemism filled "fact sheet" they posted is designed to obscure the purpose & consequences of HAO. Let me break it down. shar.es/a3O5J7

Notice that the "opportunity" here is for states. The emphasis is on giving states "flexibility"--something they already have an immense amount of when it comes to #Medicaid. Beneficiaries are not explicitly mentioned until the end of the intro paragraph, barely an afterthought.

Flexibility is mentioned 8 times in this short fact sheet. It sounds harmless enough, so what is the big deal? Well, look at what the flexibility will be used for. Most of these things represent additional burdens on Medicaid beneficiaries or reductions to the Medicaid program.

"cost sharing" = #Medicaid beneficiaries pay
"aligning benefits"= they get fewer things covered "programmatic adjustment" = administrative burdens that make benefits harder to get
"applying conditions"= fewer people are eligible
"wavering retroactive coverage"= less coverage

Nearly every aspect of the "flexibility" that CMS so giddily touts is about states having the power to take away benefits, exclude beneficiaries and make the whole system/process harder for the people it is meant to help.

Here is the glaring indicator that CMS knows full well that this "flexibility" is not in the best interest of Medicaid beneficiaries: they limit the program to the least sympathetic populations. They only want to do this to the folks they think don't "deserve" health care.

If CMS truly believed that this program was in the best interest of beneficiaries, why not apply it to everyone? Thank goodness they do not, of course. But the choice reflects a narrative that Verma's CMS has consistently pushed: only the most sympathetic are "deserving" of care

In addition to a false narrative of deservingness this program pushes another agenda as well, one with a long history: removing Medicaid's status as an entitlement, capping its funding & undermining its ability to help everyone who is eligible (i.e. block granting it).

The narrative of deservingness & attempt to block grant #Medicaid tap into the same underlying agenda. This is abt eroding #Medicaid, controlling who has access, excluding as many economically & racially marginalized people as possible & insisting that healthcare is NOT a right.

Don't be fooled by the pretense of "performance indicators" as a mechanism for accountability. What are the baseline expectations for these indicators? What will happen if indicators show people are being harmed? What about the voice and perspectives of actual beneficiaries?

Despite the anodyne & euphemistic language CMS uses to describe the "Healthy Adult Opportunity" program this is about making healthcare harder to get for folks on the margins & asserting healthcare as a privilege, not a right. If you're against that, then you're against HAO. /END