Federal Medicaid cuts and caps proposed in the House-approved American Health Care Act would result in a myriad of challenges for states, with some states more affected than others, according to a Kaiser Family Foundation analysis.
The analysis, published June 9, examines how states would be affected by the AHCA, which would restructure Medicaid's federal funding to a per capita cap or block grant. The bill also calls for ending enhanced federal contributions for the ACA's Medicaid expansion.
For the analysis, KFF researchers placed states in one of five designated categories based upon specific attributes that could affect how states would be able to respond to the Medicaid proposals in the AHCA and then assessed for 30 risk factors. The five categories are Medicaid policy choices, demographics, health status, revenue and budget choices and healthcare costs/access. The analysis also highlights states determined to be in the top five for each of these high risk factors.
The analysis found Florida, Georgia and Texas have the largest number of uninsured residents who are not eligible for Medicaid, but are also not eligible for tax credits on the marketplace because their income is still below the poverty line.
Overall, Medicaid expansion states' coverage and financing gains are at risk under the House-approved AHCA's proposal to end enhanced federal contributions for Medicaid expansion, but nonexpansion states "would lose the option to access enhanced federal matching dollars for coverage in the future," KFF said. The analysis specifically cites Arkansas, Kentucky, Oregon and Nevada as Medicaid expansion states that could face the biggest challenges if the enhanced federal contributions are eliminated.
KFF said states with limited Medicaid programs and "other challenging characteristics such as poor demographic indicators, poor health status, high cost healthcare markets and low state fiscal capacity" could be hardest hit as far as responding to per capita cap or block grant policies.
Read the full analysis here.