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In 2017, President Donald Trump and Republicans in Congress unsuccessfully sought to repeal and replace the Affordable Care Act and switch Medicaid to a system of per capita cap financing. They may pursue such policy goals again this year. At the same time, the Trump administration has signaled a willingness to allow states to use Section 1115 waiver authority to reshape Medicaid, with several states seeking waiver provisions not previously approved by any administration, including work requirements, drug screening and testing, eligibility time limits, and premiums with disenrollment for non-payment for traditional Medicaid populations. And continuing efforts to combat the opioid epidemic are likely to focus attention on Medicaid’s role in the fight.
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Financing Health Coverage:  The State Children’s Health Insurance Program Experience

  Financing Health Coverage: The State Children’s Health Insurance Program Experience Enactment of SCHIP sought a balance between increasing funds available for coverage and limiting total federal outlays. While SCHIP has had widespread support and success in helping to provide coverage for uninsured children, its capped financing system has also…

Implications Of A Federal Block Grant Program For Medicaid

This issue brief examines the broad implications of converting Medicaid to block grant financing, one of several ideas that have been put forth to help reduce the federal deficit. The paper, which does not analyze any specific proposal, notes that switching to block grant financing would fundamentally alter the Medicaid…

State Variations In Medicaid: Implications For Block Grants And Expenditure Growth Caps

  Medicaid, jointly financed by state and federal governments, is made up of over 50 separate programs with disparate populations covered and services offered. In an effort to better understand the implications of federal policy changes for the financing structure of Medicaid, the Kaiser Commission on the Future of Medicaid…

The Impact of the “Medigrant” Plan on the Federal Payments to States

  The Impact of the “Medigrant” Plan on the Federal Payments to States The analysis examines the conference agreement plan for the redistribution of federal funds under a block grant for the Medicaid program. It also discusses the implications of the reductions in federal spending for beneficiary coverage. Report: The…

Medicaid and Block Grant Financing Compared

  – Issue Brief State and federal budget pressures, rising health care costs, and new waiver initiatives have promoted debate over restructuring Medicaid at the federal and state level. Questions about how Medicaid is financed are central to this debate. This paper compares the current Medicaid financing system to a…

Medicaid Timeline

This timeline of key developments tracks the evolution of Medicaid and its role in America’s health care system.

Proposed Changes to Medicaid Expansion in Kentucky

On June 22, 2016, Governor Bevin released his proposed Section 1115 demonstration waiver application called Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) as an alternative to the current Medicaid expansion which is being implemented through a state plan amendment according to the terms in the ACA. On July 3, 2017, Kentucky submitted an amendment, proposing several changes, to its pending waiver application to the new Administration. This fact sheet summarizes the proposed changes to the current Medicaid expansion in Kentucky.

Overview of Medicaid Per Capita Cap Proposals

The House Republican Plan (“A Better Way”) released on June 22, 2016, includes a proposal to convert federal Medicaid financing from an open-ended entitlement to a per capita allotment or a block grant (based on a state choice). This proposal is part of a larger package designed to replace the Affordable Care Act (ACA) and reduce federal spending for health care. Often tied to deficit reduction, proposals to convert Medicaid’s financing structure to a per capita cap or block grant have been proposed before. Such changes represent a fundamental change in the financing structure of the program with major implications for beneficiaries, providers, states and localities. Key things to understand about a per capita cap include the following: how a per capita cap works, key design challenges, and implications of a per capita cap.

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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.