Grace Feazelle is always busy.

She’s a constant advocate for Hope House, the nonprofit that helped her find a place of her own in Norfolk. She’s led trainings with General Assembly legislative aides and serves on the executive committee of Our Voices, an advocacy group led by adults with intellectual and developmental disabilities in Virginia.

“We go to talk to (legislators) about keeping Medicaid, about making higher wages — a lot of my caregivers have to have more than one job because they don’t make enough money at this one,” she said.

Feazelle, who has cerebral palsy, worries what might happen to the full life she’s built if there are cuts to Medicaid at the federal level. As someone with a disability, her income is limited to preserve her benefits. Medicaid pays for a staff of caregivers who help her with tasks such as getting out of bed, hygiene and making meals.

“If they take Medicaid away, I have no way of getting the medical care that I need,” the 35-year-old said. “I can’t get out of bed myself. My caregivers have to get me up. And they get paid by Medicaid, so if they take that away, I’ll be stuck.”

How would cuts work?

Congress passed a budget resolution directing the U.S. House Energy and Commerce Committee to cut $880 billion in federal spending over the next decade. The resolution does not specifically name Medicaid, but the nonpartisan Congressional Budget Office found there is no other way to achieve that target without the bulk of cuts coming from Medicaid, given the programs over which the committee has budget jurisdiction.

The budget resolution passed the House largely along party lines, with two Republicans voting against. The legislation instructs Congress to cut spending enough to continue to fund President Donald Trump’s 2017 tax cuts.

“The budget resolution was a procedural vote, which didn’t make any policy changes,” said U.S. Rep. Rob Wittman, a Republican who represents Virginia’s 1st District. “Nothing in the federal budget has been cut as a result of this vote.

“This resolution simply unlocked the process for Congress to address important issues — including tax cuts for working class families, lowering energy costs, and stopping the flow of deadly drugs into our country — through a larger legislative package.”

Amid pressure from constituents, particularly in areas with high rates of Medicaid use, some Republicans are advocating for some preservation of the program. Wittman and U.S. Rep. Jen Kiggans, who represents the 2nd District, joined fellow Republicans in voting in favor of the budget resolution. But both have since signed onto a letter urging House leadership to preserve Medicaid for vulnerable populations, noting their districts’ high rates of constituents who depend on it.

“We support targeted reforms to improve program integrity, reduce improper payments, and modernize delivery systems to fix flaws in the program that divert resources away from children, seniors, individuals with disabilities, and pregnant women — those who the program was intended to help,” the letter reads. “However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.”

There are a couple ways elected officials say they could cut Medicaid spending without reducing coverage, including by reducing fraud and waste. The Wall Street Journal recently reported that between 2019 and ’21, insurers were double paid hundreds of thousands of times for people enrolled in multiple states, often after they moved.

“That’s a clear misuse of taxpayer dollars,” Wittman said. “We can reduce the topline budget by rooting out this kind of fraud, abuse, and administrative waste — without touching coverage for vulnerable populations.”

Republicans also reportedly are considering federal reductions to Medicaid expansion programs. Currently, for states that have expanded Medicaid to low-income adults, the federal government funds 90% of the program and states contribute 10%. Virginia has what’s known as a trigger law, which says that if the federal contribution drops at all, Medicaid expansion will cease. That would mean the disenrollment of some 600,000 Virginians who use Medicaid.

Republicans are also floating the idea of Medicaid work requirements. Analysis from KFF, a nonprofit health research organization, found that most adults under 65 who use Medicaid already work — many in low-wage jobs that offer low employer insurance offer rates.

People with disabilities

If Medicaid is cut, the effects on Virginians who use it would be far-reaching.

In Virginia, about 2 million adults and children are insured through Medicaid or FAMIS, the commonwealth’s counterpart health care coverage for children. Feazelle is one of about 130,000 Virginians with a disability or blindness who use Medicaid. She also has a developmental disability (DD) waiver administered through Virginia Medicaid that pays for medical equipment and furnishings that make her apartment more accessible and keep her safe in case of an emergency.

“Another part of my independence is a door opener,” she said. “I used to have people have to bust down my door so the ambulance can get in here. But now I have a door opener in case that happens.”

Bernita Richardson, a Virginia Beach resident, is the primary caregiver for her parents and her 8-year-old son, who has cerebral palsy. Ahead of the vote on the budget resolution, Richardson and other constituents traveled to Washington to urge Kiggans to preserve Medicaid.

Medicaid pays for her son’s speech and physical therapies, which he’s used off and on since he was 4 months, as well as for leg braces, which he gets fitted for multiple times a year as he grows and would otherwise cost thousands of dollars out of pocket.

“(Without Medicaid) he wouldn’t be the child that he is now,” Richardson said. “I would be still trying — I still struggle — to find ways to help him improve, but we’d be nowhere near where we are now.”

Veterans

According to the progressive advocacy group The Commonwealth Institute, about 56,000 people in Virginia, including military members on active duty, some veterans and their families are dual enrolled in TRICARE, the military’s health care system, and Medicaid. Nationally, about 850,000 people are dual enrolled in both coverage systems, according to a report from Georgetown University.

“TRICARE has some limitations,” said Freddy Mejia, policy director at TCI, at a Medicaid round table in Newport News. “When we’re thinking about particularly children who need extra supports, things like waivers, home and community-based services, those are really critical supports that Medicaid is able to offer.”

Rural communities

Joan Lingen is chief medical officer at Eastern Shore Rural Health, a federally qualified health clinic that provides primary medical, dental, behavioral health and pharmacy services to over 70% of Eastern Shore residents. On a call with other health professionals, Lingen said 74% of children and 36% of adults receiving dental services through the clinic were on Medicaid.

“Medicaid is crucial to the survival of community dental care on the Eastern Shore of Virginia,” she said. “Medicaid is critical to the health of community health centers, including those in Virginia.”

Nationally, reductions in federal Medicaid are more likely to cause greater harm to health care in rural communities than in metro areas.

Meanwhile, Feazelle, worries about being unable to keep her apartment if Medicaid is cut.

“My parents are getting older,” she said. “They cannot take care of me. And I don’t want to be in a group home. I’m too independent for that.”

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