* There has been virtually no change to the Medicaid expansion provisions (only substantive change we have identified is states allow state to include Medicaid expansion population in block grants)
Per capita caps:
* There has been no change in the Medicaid per capita caps. The bill still has the same initial growth rate and the more restrictive growth rate beginning in 2025.
* There have been no changes to the carve out from caps for "blind and disabled children." (We had heard some talk about it being expanded). In case you missed it,here is a blog about why it doesn't protect children with disabilities.
* That means that the revised bill still will have, based on the recent CBO, $772 billion in cuts to Medicaid, and will cut Medicaid by 35% by 2036, and 15 million people with lose Medicaid.
* The bill still cuts the enhanced match for 1915(k) Community First Choice.
* The bill creates a new 1915(l) HCBS program. It is a four year demo from 2020-2023, with a limited amount of attached funding ($8 billion), meaning only a few states could take advantage of it. The 15 states with low density populations are given priority.
* The new 1915(l) program at best could assist a small handful of states' HCBS programs for a short period of time. It does nothing to address the likely reduction, elimination, and growing waitlists for optional HCBS programs that will occur in every other state across the country. And for all states, this demonstration ends right as the Senate's even more restrictive caps kick in and does nothing to address the estimated 35% reduction in Medicaid funding by 2036.
* This new 1915(l) program is only a fraction of the cut in funding to Community First Choice and doesn't even make up for the loss of that program's enhanced match.
There are a number of changes to private market side (which are included in the summary linked above), including changes that could impact people with pre-existing conditions. We still expect a CBO score and, at least at this point, for the bill to move forward to a motion to proceed shortly after that.