Proposals to fundamentally restructure Medicaid financing and substantially reduce federal funds under a per capita cap, such as the House GOP's American Health Care Act, have important implications for the over 6 million seniors and 10 million nonelderly adults and children with disabilities who rely on the program for necessary medical and long-term care. Medicaid's current financing structure guarantees federal matching funds as state spending increases. As a result of the options available under current law, there is substantial variation among state Medicaid programs in the eligibility pathways and covered services for seniors and people with disabilities. This in turn contributes to differences among states in spending per enrollee for these populations. A per capita cap would limit the amount of federal Medicaid funding that states could receive per enrollee. Such a change could lock in historic variation in spending among states and limit states' ability to respond to circumstances that increase health care spending, such as public health emergencies like the opioid epidemic, Flint water crisis, or HIV, natural disasters like Hurricane Katrina, or new medical advances like Hepatitis C drugs. This issue brief explains the variation in Medicaid spending per enrollee for seniors, nonelderly adults with disabilities, and children with disabilities compared to other populations as well as variation in per enrollee spending for these populations among states. It also provides a snapshot of state choices about optional eligibility pathways and covered services important to many seniors and people with disabilities.
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)