By skyforbes 
New York Times | March 7, 2017
Under the Republican plan released on Monday, March 6, 2017, federal funding for every Medicaid beneficiary would essentially freeze, rising only with the medical component of the Consumer Price Index, or the price of medical care. That change would allow funding to grow if more people sign up for Medicaid, but not if the cost of care for Medicaid patients spikes, or states want to offer new benefits or increase payments to doctors.
Some health experts worry that over time, states would be unable to respond to changes in the health care needs of their population unless they use their own money, potentially risking the survival of a program that has been a critical source of health coverage for the poor.
“I think of it as essentially putting states behind bars,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “Whatever you were doing circa 2016 is what you’re going to do forever.”
The Republican plan would set different spending targets for different types of Medicaid beneficiaries, like older Americans, blind and disabled people, children and adults.
This is partly because spending for older Americans, along with disabled people, make up a larger proportion of Medicaid spending, even though they are a smaller share of enrollment. Spending for that population is less likely than others to track the medical consumer price index, because much of the money tends to go to nursing home care, not traditional medical services.
Putting an end to the open-ended commitment from the federal government could create an incentive for states to drop its costliest populations, like older Americans, out of concern that their costs will grow faster than inflation, Ms. Rosenbaum said.
Under Obamacare, 31 states and the District of Columbia expanded Medicaid to cover adults whose income was at or below 138 percent of the poverty line, covering millions of low-income Americans who previously found it difficult to afford insurance.
The federal government currently covers nearly all the costs of Medicaid enrollees who became eligible under the expansion.
But in 2020, enrollment under the expansion would freeze, and if a state decided to continue enrolling new beneficiaries under the expansion criteria, it would have to pay more to do so.
Enrollment could inevitably decline because Medicaid is a program where people go in and out over time, say, if they lose a job, for example.
It is not yet clear how much savings the new plan would produce, but Republican leaders have long argued that fixing federal funding for Medicaid would ultimately produce significant savings in the federal budget while providing states more flexibility in managing the program.
The changes would not begin until 2020. But the long-term impact on states would be unequal, with some faring better than others, depending on how much they spent on the program, their demographics and whether they participated in President Barack Obama’s expansion of Medicaid eligibility.
url: https://www.nytimes.com/interactive/2017/03/07/us/politics/medicaid-reform-impact-on-states.html