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The Trump administration has signaled a willingness to allow states to use Section 1115 waiver authority to reshape Medicaid, with two dozen states seeking waiver provisions such as work requirements, drug screening and testing, eligibility time limits, and premiums with disenrollment for non-payment for traditional Medicaid populations. The administration has placed a special emphasis on work requirements. In another area, continuing efforts to combat the opioid epidemic have focused policymakers’ attention on Medicaid’s role in the fight. And although President Donald Trump and Republicans in Congress in 2017 unsuccessfully sought to repeal and replace the Affordable Care Act and switch Medicaid to a system of per capita cap financing, there remains the possibility that they could rekindle their efforts to achieve these goals.
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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.

Compare Proposals to Replace The Affordable Care Act

President Donald Trump and Republicans in Congress have committed to repealing and replacing the Affordable Care Act (ACA). How do their replacement proposals compare to the ACA? How do they compare to each other? Includes the Graham-Cassidy-Heller-Johnson amendment (introduced 9/13/2017) as well as other proposals from key members of Congress.

The Republican Health-care Plan the Country Isn’t Debating

In this Washington Post op-ed, Drew Altman discusses how Republicans’ ideas to change Medicaid and Medicare and repeal the Affordable Care Act would fundamentally change the federal role in health, calling it: the biggest change in health we are NOT debating.

Data Note: Data Do Not Support Relationship Between Medicaid Expansion Status and Home and Community-Based Services Waiver Waiting Lists

Some have said that state choices about whether to adopt the ACA’s Medicaid expansion come at the expense of providing Medicaid home and community-based services (HCBS). Since 2002, the Kaiser Family Foundation has surveyed states about their HCBS waiver waiting lists. All states offer at least one HCBS waiver for seniors and people with disabilities today. States choose how many people to serve under these waivers, and their ability to limit enrollment can result in waiting lists when the number of people seeking services exceeds the number of waiver slots. This analysis examines the most recent data available, including HCBS waiver waiting list data for 2015 and 2016. The data do not support a relationship between a state’s Medicaid expansion status, which is primarily financed with federal funds, and changes in its HCBS waiver waiting list.

Medicaid’s Role for Medicare Beneficiaries

This brief outlines Medicaid’s role for Medicare beneficiaries. It describes the role that Medicaid plays for 10 million Medicare beneficiaries to help inform upcoming debates about proposals to restructure Medicaid financing in ways that could reduce federal funding.

Data Note: Estimated Medicaid Savings in the House Budget Resolution from March 2016

While the current Budget Resolution under consideration will set the framework for a repeal of the ACA, the Budget Resolution that passed in March 2016 provides insight into other Medicaid cuts that could be considered by Congress later this year. This Data Note examines proposed reductions in federal Medicaid funding under the March 2016 House Budget Resolution.

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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.