supplemental payments and increased by an inflationary factor multiplied by
the number of enrollees in each group. In 2021 and beyond, per enrollee
amounts are based on the prior year amounts increased by an inflationary
factor. The inflationary factor for the elderly and blind/disabled groups is
medical CPI plus 1 percentage point. The inflationary factor for children,
expansion adults, and other adults is medical CPI.
- States with medical assistance expenditures exceeding the target amount for a
fiscal year will have payments in the following fiscal year reduced by the
amount of the excess payments.
Decrease per capita cap target medical assistance expenditures by the amount of
certain expenditures required by political subdivisions of certain states that are
unreimbursed by the state beginning in FY 2020 – as written appears to apply only to
New York.
1
Add state option to elect Medicaid block grant instead of per capita cap for certain
populations for a period of 10 fiscal years, beginning in FY 2020 – if option is not
extended at the end of 10 FY period, per capita cap provisions apply.
- States may elect block grant for children and nonexpansion adults or only for
nonexpansion adults. States can set conditions of eligibility (except that
states must cover mandatory pregnant women and children and infants born
to eligible pregnant woman for1 year, depending on the category elected),
- Block grant payments shall only be used for “block grant health care
assistance” instead of “medical assistance” under Title XIX (Medicaid). States
must provide hospital care, surgical care and treatment, medical care and
treatment, obstetrical and prenatal care and treatment, prescribed drugs,
medicines, and prosthetic devices, other medical supplies and services, and
for children under 18, health care (but not Early, Periodic, Screening,
Diagnosis and Treatment services). States determine cost sharing and delivery
system. Federal Medicaid requirements for statewideness, amount, duration,
and scope, reasonable standards for determining eligibility for and the extent
of medical assistance, and free choice of provider do not apply.
- The total block grant amount for the initial FY is based on the state’s target
per capita medical assistance expenditures for the FY multiplied by the
number of enrollees in the category(ies) elected and the federal average
medical assistance matching rate for the state for FY 2019. In subsequent
FYs, the total block grant amount for the prior FY is increased by annual CPI
for urban consumers. The federal portion of block grant funds payable to
states is based on the CHIP enhanced FMAP, with the state funding the
difference. States can rollover unused block grant funds into the next FY as
long as they continue to elect the block grant option. States must contract
with an independent entity to audit its expenditures for each FY to ensure
spending is consistent with these provisions.
- State must submit plan to Secretary, which is deemed approved unless
Secretary determines within 30 days that plan is incomplete or actuarially
unsound.
Provide 100% FMAP for MMIS and eligibility systems for FY 2018 and FY 2019 and
increase other administrative matching to 60% for expenses related to implementing
new data requirements.
Repeal Medicaid DSH cuts for FY2020 - FY2025; exempt non-expansion states from
DSH cuts for FY2018 - FY 2019
Provide $10 billion over 5 years (FY2018 – FY 2022) to non-expansion states for
safety-net funding (applies to states not adopting the expansion by July 1 of the
previous year). Allotments based on the number of individuals in the State with
income below 138% of FPL in 2015 relative to the total number of individuals with
income below 138% of FPL for all the non-expansion States in 2015. Payments 100%
funded by the federal government in FY 2018-2021 and 95% in FY 2022. Payments to
providers may not exceed providers’ costs in providing health care services to