March 15, 2017

Under the ACA Repeal Bill, Utah Medicaid Stands to Lose Millions over a 10-Year Period

Nationally, Medicaid Spending Cuts in House GOP Plan Would Total $880 Billion Over 10 Years and Grow Over Time Nationally, Medicaid Spending Cuts in House GOP Plan Would Total $880 Billion Over 10 Years and Grow Over Time

Congress’ health plan bill, the American Health Care Act, proposes a major restructuring to the Medicaid program. The proposal would cap the federal funding states receive on a per-Medicaid beneficiary basis, starting in 2020. Using retrospective data, Voices for Utah Children investigated the impact of these changes on Utah’s state budget, had they been enacted a decade earlier.

The chart below illustrates the Utah budget impact of the Medicaid per capita cap allotment, if it had gone into effect a decade ago. The scenario is based on the American Health Care Act and state Medicaid annual reports. Given inflation and rising health care costs, Utah could expect the budget gap for the coming years to significantly exceed what it would have been in the past.

AHCA budget projection Utah

The proposed Medicaid caps would be based on states’ per-beneficiary spending, set in fiscal year 2016, and would rise annually to match growth in the medical care component of the Consumer Price Index (M-CPI). States are already locked into their capped amount. However, according to Congressional Budget Office forecasts, Medicaid costs per beneficiary are expected to rise 0.2 percentage points faster each year than the capped amount.

Consequently, states would get less federal funding than under current law and could expect to see cuts growing each year.

States would be expected to make up any excess costs or cut benefits to enrollees. Any unanticipated health care cost growth, such as a Zika outbreak or a new opioid treatment drug, would not be accounted for in the federal per capita cap amount. 

As retrospective data illustrate, Utah consistently would have less available funding for health care costs. Today over 200,000 children rely on Medicaid coverage, including children with special health care needs. The majority of Medicaid enrollees (63%) are children. The Congressional proposal would create situations where state lawmakers choose which health services vulnerable children are eligible to receive, and which services or benefits they will not be eligible to receive. These are decisions best left up to health care providers, not politicians.

The American Health Care Act puts children’s health care and coverage at risk. Changes to Medicaid’s financing structure through a per capita cap would create large shortfalls in Utah’s state funding. These shortfalls would inevitably lead to limits placed on the program, such as a reduction in benefits, cuts to provider payments or fewer children covered. This unprecedented restructuring of the Medicaid program puts Utah children’s health care and coverage at risk.

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For 30 years now, Voices for Utah Children has called on our state, federal and local leaders to put children’s needs first. But the work is not done. The children of 30 years ago now have children of their own. Too many of these children are growing up in poverty, without access to healthcare or quality educational opportunities.

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