President Obama deserves a few mornings to sleep in, and then it is time to get back to work. Upcoming federal tax and deficit reform have been grabbing headlines, but there are other D.C. policy reforms that could have a major effect on states and cities. These need to be on the president and Congress’ 2013 checklist.
Block-grant Medicaid to the states:
Medicaid is slated to increase by approximately 17 million Americans under the Affordable Care Act for adults whose income falls below 133% of the poverty line. But who pays for this expansion? The federal government:
The Medicaid expansion is a great deal for the states. The federal government will pay 100 percent of the costs of covering people who will be “newly eligible” for Medicaid for years 2014 through 2016. These are persons who would not be eligible under their states’ current programs. After 2016, states will start paying some of these costs, but the federal government will always cover at least 90 percent.
Will the federal government really have the funds to pay for 100% expansion of Medicaid and continue the payments that were already in place to states, including nursing home payments? I suspect that the new funding will not be there. Other budget priorities will knock this one to the bottom of the list.
The president and Congress have a chance of seeing positive acceptance for ACA Medicaid expansion if they agree to Republican governors’ request for block-granting Medicaid payments. This would give Medicaid funds to states in lump sums and allow each to administer their program in the way bested suited to local social and economic needs. It would make expanding and administering the program much easier at the state level.