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No Easy Choices: 5 Options to Respond to Per Capita Caps

Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other cuts, reduce benefits, limit coverage of high cost enrollees, reduce rates or implement delivery system reforms, and promote personal responsibility. Each option has challenges that are identified in the brief.

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Strategies to Reduce Medicaid Spending: Findings from a Literature Review

This issue brief considers the feasibility of realizing substantial Medicaid cost savings through strategies aimed at improving delivery system and administrative efficiency. We review the literature about the potential for Medicaid cost savings from four strategies related to acute care services: (1) premiums, cost-sharing, and enrollee wellness incentives, (2) complex care management, (3) patient-centered medical homes, and (4) alternative payment models, and another four strategies related to long-term services and supports: (5) tightening financial eligibility rules for long-term care services, (6) promoting private long-term care insurance, (7) expanding home and community-based services (HCBS), and (8) increasing use of managed long-term services and supports.

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The Henry J. Kaiser Family Foundation

State Data: What Has Happened to Health Coverage and Financing Under the Affordable Care Act?

As Congress presses forward with efforts to repeal and replace the Affordable Care Act, a new interactive map from the Kaiser Family Foundation provides a window into the changes in health insurance coverage and financing in each state under the 7-year-old law. The ACA increased enrollment in health insurance by…

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Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?

This issue brief examines the factors that could affect states’ ability to cope with reductions in federal Medicaid funding of the sort proposed in the House-passed American Health Care Act (AHCA), which would eliminate enhanced federal matching funds for the Affordable Care Act’s Medicaid expansion and convert Medicaid to a per capita cap or block grant system of financing.

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The Henry J. Kaiser Family Foundation

Data Note: Variation in Per Enrollee Medicaid Spending

This data note looks at Medicaid spending per full-benefit enrollee, examining variation by state and by eligibility group, as well as variation within a given state and eligibility group.

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The Henry J. Kaiser Family Foundation

What’s Really At Stake In the Medicaid Spending Debate

In this Axios column, Drew Altman highlights that the federal debate about the American Health Care Act’s Medicaid spending reductions will ultimately be a debate about every state’s general budget spending priorities, as states discuss whether to offset reductions in federal revenues with some combination of cuts to their Medicaid programs, increased taxes, and cuts to spending in other areas.

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The Henry J. Kaiser Family Foundation

No, Medicaid Isn’t Broken

With Medicaid about to be a focal point of debate in the Senate, Drew Altman’s Axios column looks at why the idea that the program is broken is more urban legend than fact.

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Governors’ Proposed Budgets for FY 2018: Focus on Medicaid and Other Health Priorities

This report provides Medicaid highlights from governors’ proposed budgets for state fiscal year (FY) 2018, which runs from July 1, 2017 through June 30, 2018 in most states. Proposed budgets reflect the priorities of the governor and are often blueprints for the legislature to consider.

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The Henry J. Kaiser Family Foundation

Most States Would Have Seen Declines in Federal Medicaid Funds from 2001 to 2011 Under a Per Enrollee Spending Cap Limiting Growth to Medical Inflation

A new analysis from the Kaiser Family Foundation finds that the majority of states would have gotten less in federal Medicaid funding from 2001 to 2011 if Medicaid financing had been based on a per capita cap. The analysis looked at what would have happened if spending growth per Medicaid…

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Data Note: What if Per Enrollee Medicaid Spending Growth Had Been Limited to CPI-M from 2001-2011?

Congress is currently debating the American Health Care Act (AHCA), which would repeal and replace the Affordable Care Act (ACA) and also make substantial changes to the structure and financing of Medicaid. Among other provisions, the AHCA would use a per capita cap policy to cap federal funds to states for Medicaid. This data note examines what the implications of tying per enrollee growth to CPI-M would have been for the 2001-2011 period for federal spending nationally and state-by-state by major enrollment group. This analysis is meant to illustrate how actual spending compares to spending limits that would have been in place if growth rates had been limited to CPI-M, similar to the limits proposed by the AHCA.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.