President Donald Trump and his congressional allies have repeatedly tried and failed to repeal the Affordable Care Act (ACA).1 Various repeal bills have included provisions to slash Medicaid funding by eliminating the ACA’s Medicaid expansion and restructuring the remaining program through block grants or per-capita caps.2 By placing caps on federal Medicaid spending, these programs would either reduce enrollees’ benefits or tighten eligibility requirements. Now, after failing to implement these reforms legislatively, the Trump administration is bypassing Congress to cut federal Medicaid expenditures and dismantle key Medicaid expansion provisions of the ACA.
In January, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma was reported to be considering drastic changes to Medicaid’s rules that would allow states to adopt structures similar to block grants or per-capita caps using the Medicaid waiver authority—a mechanism to make alterations to Medicaid services without legislative approval.3 Since then, she has continued to express support for capping federal Medicaid payments to the states.4
Block grants and per-capita caps threaten health care access for the almost 75 million low-income and disabled people enrolled in the program.5 This issue brief outlines the ways in which the administration is encouraging states to use waivers to adopt these alternative funding approaches, thus undermining Medicaid and ignoring the will of voters, who overwhelmingly oppose such programs.6
View the complete August 7 article by Tarun Ramesh on the Center for American Progress website here.