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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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Key Medicaid Questions Post-Election

This fact sheet provides insight into how a repeal of the Affordable Care Act (ACA) and changes in the financing structure would affect Medicaid, including the Medicaid expansion, and how a Trump administration could change Medicaid through administrative actions.

The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid

This column was published as a Wall Street Journal Think Tank column on November 21, 2016. Early media coverage of the Republican health-care agenda has concentrated on plans to repeal and then replace the Affordable Care Act. The larger story is GOP preparations for a health policy trifecta: to fundamentally change the…

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.

Medicaid Financing: How Does it Work and What are the Implications?

The Medicaid program is jointly funded by states and the federal government. There has been renewed interest in how Medicaid is financed in light of the additional federal financing for the Medicaid expansion under the Affordable Care Act (ACA) as well as ongoing budget discussions at the federal level. This brief reviews how the Medicaid program is financed as well as the implications for budgets, responsiveness to state policy choices and need, the links between Medicaid spending and state economies.

Medicaid Timeline

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

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…

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…

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…

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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.