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A draft of a bill in Congress to repeal the Affordable Care Act leaked Friday, confirming that Republicans are advancing proposals that would significantly dial back federal funding for Medicaid. The low-income public insurance option covers more than 6 million...

Republican plans to end Medicaid expansion could cost New York billions

A draft of a bill in Congress to repeal the Affordable Care Act leaked Friday, confirming that Republicans are advancing proposals that would significantly dial back federal funding for Medicaid. The low-income public insurance option covers more than 6 million...

Republican plans to end Medicaid expansion could cost New York billions

A draft of a bill in Congress to repeal the Affordable Care Act leaked Friday, confirming that Republicans are advancing proposals that would significantly dial back federal funding for Medicaid. The low-income public insurance option covers more than 6 million New Yorkers. If the draft bill is adopted, New York would have to choose between taking away coverage from newly eligible Medicaid enrollees or spending billions from state coffers to maintain the status quo.

New York, along with 31 other states and Washington, D.C., opted to expand eligibility for Medicaid under the Affordable Care Act to include most people earning less than 138% of the national poverty level. In order to make expansion appealing to states, the federal government under former President Barack Obama offered to pick up a greater percentage of the tab for covering the newly eligible enrollees. The draft bill in Congress would eliminate federal support for Medicaid expansion in 2020.

If the federal government were to reduce matching funds for the expansion group to the standard Medicaid rate, New York would have to spend an additional $5.7 billion to maintain the expansion on its own, a 614% spending increase, according to an analysis by the Center on Budget and Policy Priorities, a national research institute. The analysis is based on spending projections for 2019.

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Beyond modifying who can enroll in Medicaid, the draft bill would fundamentally change how federal assistance for the program works. The bill proposes funding the program through capped payments to states, rather than through open-ended federal matching grants that can respond to unanticipated costs.

The future of New York's $8 billion Medicaid reform initiative, which was approved through a federal waiver, remains uncertain. But the draft bill does include $100 billion in federal funds for "state innovation grants" to support coverage for the neediest Medicaid enrollees.

Discussions about how to reform Medicaid are ongoing among federal lawmakers, according to Politico, which first reported on the leaked draft legislation.

For more health care coverage subscribe to Crain's Health Pulse.

A draft of a bill in Congress to repeal the Affordable Care Act leaked Friday, confirming that Republicans are advancing proposals that would significantly dial back federal funding for Medicaid. The low-income public insurance option covers more than 6 million New Yorkers. If the draft bill is adopted, New York would have to choose between taking away coverage from newly eligible Medicaid enrollees or spending billions from state coffers to maintain the status quo.

New York, along with 31 other states and Washington, D.C., opted to expand eligibility for Medicaid under the Affordable Care Act to include most people earning less than 138% of the national poverty level. In order to make expansion appealing to states, the federal government under former President Barack Obama offered to pick up a greater percentage of the tab for covering the newly eligible enrollees. The draft bill in Congress would eliminate federal support for Medicaid expansion in 2020.

If the federal government were to reduce matching funds for the expansion group to the standard Medicaid rate, New York would have to spend an additional $5.7 billion to maintain the expansion on its own, a 614% spending increase, according to an analysis by the Center on Budget and Policy Priorities, a national research institute. The analysis is based on spending projections for 2019.

Beyond modifying who can enroll in Medicaid, the draft bill would fundamentally change how federal assistance for the program works. The bill proposes funding the program through capped payments to states, rather than through open-ended federal matching grants that can respond to unanticipated costs.

The future of New York's $8 billion Medicaid reform initiative, which was approved through a federal waiver, remains uncertain. But the draft bill does include $100 billion in federal funds for "state innovation grants" to support coverage for the neediest Medicaid enrollees.

Discussions about how to reform Medicaid are ongoing among federal lawmakers, according to Politico, which first reported on the leaked draft legislation.

For more health care coverage subscribe to Crain's Health Pulse.

Brought to you by Crain's New York Business, Health Pulse is a subscription-only website focused on the business of health care. The site is updated every day with breaking news, research and unique information. Subscribe today and receive access to the site and the daily emails. Plus, twice a week we release a special report called Extra, featuring data and statistics.

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