The latest version of the Senate’s Better Care Reconciliation Act, or BCRA, was released July 20, 2017. According to the CBO analysis, the new version of the BCRA would reduce federal deficits by $420 billion over the 2017-2026 period, the net result of a direct spending decrease of $903 billion partially offset by a $483 billion decrease in revenues. Of special interest to states, the reduction in Medicaid spending is $772 billion, or 85 percent of the reduced spending, directly impacting states’ budgets. The effects of the bill on the number of uninsured is little changed from the earlier version. In 2018, 15 million more people would be uninsured than under current law and would reach 22 million in 2026.

Last week in Washington, D.C. 27 state legislative leaders gathered for the sixth annual CSG Medicaid 101 Policy Academy. Attention was focused on the Medicaid reform plan, called the Better Care Reconciliation Act of 2017, under consideration in the U.S. Senate following the House approval of the American Health Care Act in early May. CSG prepared a brief side-by-side comparison of the...

The president's federal budget was released May 23 and the analysis of winners and losers began practically before the ink was dry, although almost all of Washington seemed to agree the budget was dead on arrival. Cuts to the Medicaid and Children's Health Insurance Program, or CHIP, alone total $616 billion over the next ten years. The budget also envisions saving $250 billion from partly repealing and replacing the 2010 health care law. Taken together, these Medicaid cuts are nearly half the nondefense discretionary funding cuts. To further understand just how important federal Medicaid funds are to states, CSG looked at 2017 federal funding flowing to the states. According to Federal Funds Information for the States, or FFIS, data, the federal Medicaid funding for 2017 is more than 50 percent of all federal grant funds flowing to states in all but four states.

Medicaid Infographic

Medicaid is the second largest source of health care insurance in the United States, serving over 74.5 million people in some of our most vulnerable communities. Coverage is provided to low-income children, adults, seniors, and people with disabilities. Many Medicaid enrollees would be uninsured or underinsured without this coverage. The Medicaid program is funded with a combination of federal and state funds, with more federal participation in states with fewer fiscal resources.

CSG Midwest
Some Medicaid recipients in Wisconsin will have to submit to drug screenings and tests if federal officials give the OK to a demonstration waiver submitted by the state in April. This new requirement would apply to childless adults who are eligible for health insurance through the BadgerCare Plus program. As a condition of eligibility, individuals would have to complete a state-administered questionnaire. If the answers indicate possible abuse of a controlled substance, a drug test would be required. For anyone who tests positive, Medicaid eligibility would be contingent on completing a substance-abuse treatment program.

The American Health Care Act, or AHCA, the proposed legislation to repeal and replace the Affordable Care Act was passed by the U.S. House of Representatives on May 4. The bill contained several major changes to the Medicaid program that, if enacted, would directly impact states’ budgets. CSG estimates the annual state loss of federal Medicaid Funds from the high of $7,210.1 million in California to $16.8 million in Delaware. The median loss is $474.1 million for Connecticut, with half of the expansion states losing less federal funds annually and half of the expansion states losing more federal funds annually.

As plans to repeal and replace the Affordable Care Act, or ACA, are under construction, states face the possibility of losing significant federal funding for their Medicaid programs.

The implementation of the Medicaid expansion through the ACA, established access to healthcare for low-income adults who were not previously eligible. Specifically, nonelderly adults with an income at or below 138 percent of the federal poverty level— about $16,394 for an individual in 2016—gained access to coverage. As a result,...

The Kansas Legislature’s attempt to join the ranks of the 31 states and the District of Columbia that have already expanded their Medicaid programs came to a halt during the first week of April. The Kansas House voted narrowly to uphold Gov. Sam Brownback’s veto of a bill to expand Medicaid. The vote fell three votes short of the necessary super majority required to override the veto.

The Urban Institute released an analysis of the state-by-state impact of the AHCA, 2019 to 2028. The Urban Institute looked at the impact of the proposal on state funding (see Table 5). If states made up for the loss of federal funds with state funds, it would require a 16.1 percent increase in all states' Medicaid spending over the ten year period. 

Yesterday the Congressional Budget Office – or CBO – released its cost estimate for the House Republican plan to repeal and replace the Affordable Care Act. All told, the report says, the federal deficit would be reduced by $337 billion over the 2017-2026 decade. Reducing the federal deficit is welcome news to most federal policymakers.

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