GOP Would Give States Less Money, More Flexibility for Medicaid

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By Alex Ruoff

States are likely to see less federal funding for their Medicaid programs but greater flexibility to experiment with those programs under a Republican ACA replacement plan, according to a House lawmaker.

State Medicaid programs, including those that were expanded under the Affordable Care Act, would move to a “shared partnership” with the federal government, where states will pay a larger share than they do now, Rep. Pat Tiberi (R-Ohio) told reporters Jan. 5. However, the federal government will more freely grant waivers to states to allow them to experiment with new coverage models designed to reduce their Medicaid budgets, he said.

“With a partnership, there might be less federal funding but there’s more flexibility for states to be innovative to deal with their own Medicaid population,” Tiberi, who chairs the House Ways and Means health subcommittee, said. His is one of two committees in the House charged with designing an ACA repeal.

Senate Republicans kicked off their ACA repeal plan recently by starting debate of a budget plan. Under congressional rules, the House and Senate can pass ACA repeal provisions using this vehicle with a simple majority.

Republicans have yet to coalesce under a single plan for replacing the ACA’s key provisions, including billions of dollars to states that expanded their Medicaid programs and subsidies for Americans with low incomes to purchase health insurance on the individual marketplace. Aides to Senate Republican leaders have said lawmakers want to end some insurance industry regulations and taxes quickly but expect to maintain other provisions for as long as four years.

Tiberi said House members are still debating key parts of their plan. He said their plan would mitigate the number of people who lose their health insurance, including those on Medicaid.

Seeking Flexibility

Many states, including Ohio, asked the Obama administration for waivers to federal requirements for their Medicaid programs that would allow them to charge enrollees premiums or require participants to pay into a health savings account. These requirements are designed to reduce state spending on Medicaid and promote personal responsibility.

The Centers for Medicare & Medicaid Services denied Ohio’s waiver request in September. The state claimed the waiver would have saved Ohio around $1 billion over five years ( 177 HCDR, 9/13/16 ).

President-elect Donald Trump has similarly pushed for state flexibility on Medicaid, with many analysts saying the program might be converted to block grants or per capita payment caps. These would limit the amount of federal money going to state Medicaid programs and also allow states to impose their own requirements. Critics suggest these changes would have a net effect of cutting benefits and, together with measures such as work requirements, moving the program back to temporary, safety-net coverage.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

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