Leaked Copy of House ACA/Medicaid Bill Includes Per Capita Caps

Last week, a leaked copy of legislation being drafted by Republican leadership in the House of Representatives that is intended to make significant changes to the fundingstructure of Medicaid, and to repeal and replace the Affordable Care Act, became available. The draft, dated February 4th, would effectively repeal almost all of the Affordable Care Act by 2020 and convert Medicaid funding to a per capita cap formula.  

While the draft represents a snapshot of House Republican thinking, many of the ideas it contains are still being discussed. Reportedly, Republican members of the Energy and Commerce Committee have been given access to a new version of the bill, in a reading room from which copies of the legislation cannot be removed. Sources among Democratic staff on the Hill indicate that they expect the bill to be released on Monday, followed by a markup in both the Ways and Means and Energy and Commerce Committees on Wednesday and Thursday. The new version will contain some changes from the February 4th draft, but the earlier version likely offers a look at the framework House Republicans will pursue. Some of the provisions in the bill most relevant to state developmental disability service systems include:

Funding Medicaid through Per-Capita Caps. The per-capita caps are divided up by category of eligibility, which includes:

  • Individuals age 65 or older;
  • Individuals who are blind or have a disability;
  • Children under the age of 19 who are not eligible via a CHIP program;
  • Individuals who qualify as newly eligible for the ACA expansion; and
  • Other adults who are not included in the prior groups.

The policy creates a spending baseline for each of the five eligibility categories, calculated based on Fiscal Year 2016 average per capita state spending on the population, increased by the percentage increase in the medical care component of the consumer price index (CPI) for all urban consumers from 2016-2019, plus one percentage point. This spending baseline would then be increased each year after 2019 by a percentage amount equal to the percentage increase of the medical care component of the Consumer Price Index for Urban Consumers (CPI-U) up to the current year, adding one percentage point.

States must provide CMS with reporting information on the medical assistance expenditures and enrollment information for each of the five eligibility categories used to calculate per-capita caps. States are provided with 100% FMAP for MMIS/eligibility system design, implementation, and installation as well as operations/maintenance in FY2018-FY2019 to support the development of systems to meet the reporting requirements. States are also provided with a 10% increase to Medicaid administration matching (for a total of 60% match) for expenses directly related to implementing the new data requirements. 

Eliminating the increased Federal matching rate (FMAP) for 1915k/Community First Choice services, effective in 2020, while otherwise leaving the program intact.

FMI: A copy of the leaked draft can be viewed at http://www.politico.com/f/?id=0000015a-70de-d2c6-a7db-78ff707e0000.