'Drastic and Draconian'

Trump's Medicaid Cuts Would Decimate Jewish Social Services, Putting the Most Vulnerable at Risk

American Jewish nursing homes and residences serving the disabled receive $6 billion a year in U.S. funding. Without it care will be slashed, say experts

Healthcare activists protest to stop the Republican health care bill at Hart Senate Office Building on Capitol Hill in Washington, U.S., July 17, 2017.

NEW YORK — Gail Levinson doesn’t know what her mother would have done if a Jewish group home wasn’t available for her developmentally disabled brother, Evan. Having him live in a Jewish setting was important to their mother, Bea Sabin, who died recently at 93. So for many years, before moving to a residence better able to meet his advancing medical needs, Evan, who is now 61, lived in a home run by New Jersey’s Jewish Association for Developmental Disabilities.

Now the government funding that pays for his care is at risk due to legislation that would slash Medicaid funding, the government insurance program for poor and disabled Americans. Though a health care bill under consideration by Congress died on Monday for lack of Republican support, experts say it is sure to be re-introduced. When that happens, it will likely contain a similar Medicaid-reducing provision.

“This is an issue that we believe will be revived,” said Scot Marken, CEO of the Jewish Foundation for Group Homes, which runs 25 group homes for the developmentally disabled in the Washington, D.C. area.

The most recent bill would have slashed Medicaid by $1 billion a year within five years. While there is major conservative, Republican-driven passion for replacing the law known as Obamacare, if the new legislation passes experts say it will decimate the Jewish social services field.

Jewish nursing homes, Jewish senior centers, Jewish group homes and agencies serving disabled children receive $6 billion a year through Medicaid, according to William Daroff, senior vice president for public policy at Jewish Federations of North America.

“It is the underpinning of the social safety net and the social safety net underpinning for the Jewish community,” he said in a video conference call through the Jewish Council for Public Affairs on Monday.

In a subsequent interview, Daroff told Haaretz, “this is the most drastic and draconian proposed cut since Medicaid was established in 1965.”

“This is earth shaking,” agreed Paul Castro, president and CEO of Jewish Family Service of Los Angeles, which provides support services to 100,000 elderly and disabled people a year. About $7 million of his NGO's $33 million annual budget comes from Medicaid, he said. If the proposals are enacted into law, “in some areas it won’t only be catastrophic – there will be such minimal resources left that many, many people will become far more at risk than they are today.”

Ron Halber, executive director of the Jewish Community Relations Council of Greater Washington, told Haaretz that cutting Medicaid will create a serious problem for Jewish nursing homes across the country, since in many, more than 70 percent of the residents depend on the government funding. 

'Sicker population'

Scot Marken, CEO of the Jewish Foundation for Group Homes, lobbying against health care cuts on Capitol Hill. His foundation runs 25 group homes for the developmentally disabled in the Washington, D.C. area.
Courtesy Jewish Foundation for Group Homes

Castro noted that in many cases, services funded by Medicaid, like home health-care aides, allow the elderly and disabled to live independently far longer than they would be able to otherwise. Without that help, they will likely need more expensive residential care sooner.

“We will have a quicker and sicker population that will find people more quickly looking for care in nursing homes,” Castro explained. “A lot of folks won’t be able to have what they need to have quality of life going forward.

The proposed cuts to Medicaid will mean that “people with disabilities will be forced to live in large, isolated institutional settings or with aging parents who are no longer able to care for them,” said Levinson, who recently retired as director of the Supportive Housing Association of New Jersey, which advocates on behalf of 100 group homes like those in which her brother lives.

People like Evan, in need of around-the-clock care, “will have nowhere to go,” she said, adding, “Supportive housing – small group homes and independent apartments with support – have become the norm in many states, allowing people with disabilities the opportunity to live with dignity and more independence in communities, often near their families.”

Levinson's mother Bea visited Evan weekly until the end of her life; his sisters, who live nearby, continue to do so. “Continued care in the supportive housing system keeps Evan alive and well,” Levinson told Haaretz. “We must prevent Congress and the president from making any cuts to this vital program.”

Medicaid is the largest source of funding for health-related services for poor and disabled Americans, providing coverage for 74 million this year – nearly one-quarter of the country's population. Administered by states, Medicaid is jointly funded by federal and state governments.

Going back a century when discrimination meant that Jewish doctors weren’t given admitting privileges at other hospitals, the American Jewish community established its own extensive network of health and social services agencies.

Today in the country, according to JFNA’s Daroff, there are 15 Jewish academic medical centers, 100 Jewish long-term care communities that include nursing homes and assisted-living facilities, 125 Jewish family and children’s services agencies, and Jewish group home systems for the disabled in another 13 communities.

Any agency taking government funding must accept patients regardless of faith, and current populations served by historically Jewish institutions range widely. Today 99 percent of patients at Chicago’s Sinai Hospital, for instance, are black or Latino, Daroff told Haaretz. Just one percent of its current patients are Jewish, he said.

But in other Jewish health and support-related organizations, say experts, as many as 80 or 90 percent of clients may be Jewish, depending on location and services provided.

If the proposed Medicaid cuts become law, medical facilities “would have to close wings or wards or reevaluate their existence altogether,” said Jonathan Westin, senior director of health initiatives for JFNA, an umbrella group for 148 Jewish federations. Most of these federations fund health and social service agencies in their communities.

Medicaid pays for the care of 65 percent of nursing-home patients in America, many of them middle class, and for the care of 30 percent of all disabled adults. It also underwrites the care of 60 percent of all disabled children, and 76 percent of poor children, according to a recent report.

Pushing people to poverty

The Jewish Foundation for Group Homes in the Washington, D.C. area is one Jewish social service agency. It runs 25 residences, each of which houses three to six adults with developmental or intellectual disabilities, said CEO Scot Marken. The foundation also provides in-home services to clients in 55 private settings. About 70 percent of the 200 people it serves are Jewish, he noted.

The threatened chop to Medicaid will hit his clients hard, Marken warned. Nearly three-quarters of his foundation’s $14.3 million budget comes from the government, half of that from federal Medicaid, he said. If those cuts become anchored in law, “it’s definitely possible that we would need to shut down homes. If there were a 25-percent reduction in federal dollars that would be about $1.2 million we couldn’t make up. We’d have to reduce or eliminate services,” he told Haaretz.

The cutbacks resulting from a slashing of Medicaid support will also mean lots of jobs lost, said JFNA's Daroff, who noted that this would push more people into poverty and into needing what remains of Medicaid-funded services.

People working in the field say that philanthropists would be unable to plug the holes left if Medicaid is significantly reduced.

“During the economic downturn we had a great deal of stress on the agency and clients, but the donor community stepped forward,” said Castro, who has worked at family services in L.A. since 1980.

“But this is the most across-the-board undermining and reduction, and the philosophical sense is that the government no longer has a significant responsibility in maintaining a safety net for the most vulnerable,” he continued. “The donor community can’t make up the billions of dollars in social safety-net services provided by the government. In my entire tenure this is the worst threat we have seen to the wide range of people who come to us for help.”

Medicaid cuts would mean, for instance, that seriously developmentally disabled adults, unable to live on their own, would be without the group housing where staff helps them bathe, cook, eat, shop, get dressed and make it to medical appointments, day treatment programs and jobs.

“These are the kinds of things that begin to spiral” downward, Castro said, without the support they receive today. Preparing for the anticipated cuts is challenging the entire field of American Jewish social services, he said. “You want to prepare for the storm and have no idea if it will be a tsunami or just a hurricane.”