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Establishing a Medicaid Block Grant 1 (March 17, 2017)

handle is hein.congrec/cbo3402 and id is 1 raw text is: CONGRESSIONAL BUDGET OFFICE Keith Hall, Director U.S. Congress Washington, DC 20515 March 17, 2017 Honorable Diane Black Chairman Committee on the Budget U.S. House of Representatives Washington, DC 20515 Re: Establishing a Medicaid Block Grant Dear Madam Chairman: Among the possibilities for making structural changes to the Medicaid program that would lead to federal savings are proposals that would cap the amounts states receive from the federal government to operate the program. For example, either overall caps-implemented with block grants at amounts that would not change with fluctuations in enrollment-or per-enrollee caps could generate budgetary savings in greater or lesser amounts depending on how they are designed. Besides the decision about whether to set overall or per-enrollee caps, other key design choices would significantly affect the level of federal spending, including these: * What categories of program spending and eligibility to include in the spending limits, * Which year's spending to use as the base and what growth factor (or percentage rate) to use to increase the caps over time, * How much flexibility to grant to states to make changes to the program, and * How to treat the optional expansion of coverage under the Affordable Care Act. The effects of various choices could interact in complicated ways. ' For additional information about those design choices, see Congressional Budget Office, Options for Reducing the Deficit: 2017 to 2026 (December 2016), Health Option 2, pp. 221-230, www.cbo.gov/budget- options/2016/152229. www.cbo.gov

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