In a letter dated June 17, 2014, the National Council on Disability (NCD) asks CMS Deputy Administrator/Director Cindy Mann to meet with NCD representatives to discuss solutions to certain unintended consequences it is concerned may stem from the mandate within the Affordable Care Act (ACA) that nonprofit providers of Medicaid services to persons with disabilities and seniors provide health coverage to full-time employees. As the letter explains, many of these providers receive more than seventy-five percent of their revenue from Medicaid. In many states, Medicaid rates have not increased since before the recession. The NCD is concerned that an imposition of the employer mandate, without an increase of Medicaid rates, will cause many providers to be unable to continue providing the same level of service, potentially going out of business and leaving people with disabilities at risk of institutionalization.
The letter lays out three possible solutions, specifically a premium adjustment for community providers whose Medicaid revenue exceeds seventy percent of their total revenue, an automatic inclusion of direct care workers into state Medicaid expansion, and a further extension on the enforcement of the employer mandate for these providers while permanent solutions are developed.