Statement by Joan Alker on Medicaid Block Grant/Per Capita Cap Guidance

Following is a statement by Georgetown University Center for Children and Families Executive Director Joan Alker regarding the Trump Administration’s Medicaid block grant/per capita cap guidance announcement:

“The misguided, unlawful guidance issued by CMS today encourages states to gamble with the health and well-being of their residents and their budgets by trading in their guarantee of federal matching funds for a cap on federal funding on a portion of their programs. States already have a lot of flexibility in the Medicaid program. What this guidance does is to give states unprecedented new tools to make cuts to health care in their state. These cuts would also come with far less transparency and oversight.

None of us can accurately predict the future, but we know the unexpected happens. Under the current federal-state financial partnership, the federal government agrees to pay a fixed share of states’ Medicaid costs. If costs go up, the federal government shares in those higher costs. If states accept a fixed cap on federal funding to meet their health care needs, they may be able to get by in the short term, but they put the health of their citizens and future state budgets at serious risk down the road. Costs could rise faster than expected due to a recession, a new but costly breakthrough cancer treatment, or a public health emergency such as the spread of a new virus.  Without sufficient federal funding, states would likely have no choice but to make damaging cuts to their Medicaid programs, with the cuts growing larger over time. That means many more uninsured and underinsured people in states where the governor is willing to roll the dice on a block grant or per capita cap.

CMS should withdraw this guidance immediately.”

Joan Alker is the executive director of the Georgetown University Center for Children (CCF) and Families and is a nationally recognized expert on Medicaid policy. CCF, based at the Georgetown University McCourt School of Public Policy, is an independent, nonpartisan policy and research center with a mission to expand and improve high-quality, affordable health coverage.