On June 22, Speaker of the House Paul Ryan (R-WI) released a plan titled, "A Better Way," which lays out a proposal to replace the Affordable Care Act (ACA). The proposal would make significant structural changes to entitlement programs, including Medicare and Medicaid. Specifically, it would give states the option of being funded through either block grants or per capita caps. A block grant is a fixed amount of funding that would not change based on state expenditures or beneficiary enrollment. A per capita cap system would impose a fixed dollar amount per enrollee. If costs exceeded the cap amount, the state would be responsible for the shortfall.
In addition to proposing significant changes to the mechanism of funding, the plan also seeks to add a work requirement to the Medicaid program. Under this provision, states could adopt a requirement that "able-bodied adults be seeking a job, employed, or participating in an education, training, or approved community program." It further says, "This policy would allow states to use Medicaid dollars to provide a defined contribution in the way of premium assistance or a limited benefit to work-capable adults who are working or preparing for work." There is no definition included in the plan for what qualifies as "able-bodied" or "work-capable".
The plan is a blueprint rather than a detailed budget proposal. As such, it is considered a guideline for Congress to use moving into the next budget cycle. ANCOR will continue to monitor legislative activity and apprise members if interest and activity surrounding Medicaid funding structures increases.