< public policy < Public Policy Position Statments

Medicare and Medicaid Reforms

The American Therapeutic Recreation Association (ATRA) is the largest national association of recreational therapists, health care providers who use recreational therapy interventions to improve function of individuals with illnesses or disabling conditions. Recreational therapy is a health care and human service discipline that delivers treatment services designed to restore, remediate and/or rehabilitation functional capabilities for persons with injuries, chronic illnesses and all disabilities.
March 2003.

ATRA POSITION: MEDICARE

ATRA supports Medicare reform to ensure that the program continues to serve the needs of all beneficiaries, including beneficiaries with disabling conditions and chronic illnesses. However, Congress must protect beneficiaries with disabilities and those with chronic conditions by ensuring that they can have access to prescription drugs without requiring them to leave traditional Medicare and join a managed care plan. Managed care health plans do not adequately serve the needs of people with disabilities or chronic conditions. It is essential that beneficiaries have prescription drug coverage under “traditional” Medicare that is comparable to other Medicare alternatives so that beneficiaries are not forced to join a managed care health plan that may not meet their needs.

· Medicare must have a defined benefit package available to the entire beneficiary population that encompasses comprehensive rehabilitation benefits for people with disabilities, including recreation therapy.

· Medicare reform should include comprehensive access to affordable and appropriate prescription drug coverage, which is essential to Medicare beneficiaries and beneficiaries with disabilities under the age of 65. Regardless of the coverage options available, Medicare beneficiaries should have access to comprehensive prescription-drug coverage without being forced into a managed care health plan.

· Medicare reform should not include competitive bidding for durable medical equipment, orthotics and prosthetics, and supplies as this proposal degrades quality of care and access.

ATRA POSITION: MEDICAID

ATRA supports continued Medicaid reform to strengthen eligibility, coverage, and reimbursement. However, the current proposals released by the President in his FY 2004 budget and similar reforms being debated in Congress are troubling for beneficiaries who have disabilities or chronic conditions. The current proposals would result in long term funding shortfalls and require states to make significant cuts in eligibility, coverage, and reimbursement.

· States need meaningful fiscal relief by increasing the Federal Medical Assistance Percentage (FMAP), which is a payment make by the federal government to states to assist in payment of all Medicaid services. Medicaid reform should not be tied to a capped, “block-grant” that would require states to assume all risk for Medicaid services and be forced to cut optional benefits for beneficiaries.

· The Medicaid waiver program should be strengthened and have more accountability in the Medicaid waiver approval process. While waivers can be effective in responding to specific patient need, the waiver process is not currently accountable and has the potential to negatively impact care for vulnerable populations.

· ATRA opposes restructuring the SCHIP program, as this program has been beneficial in providing important health care services to lower-income children. Federal funding should be increased to ensure that States are not forced to cut benefits or lower eligibility requirements.