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Making Sausage: Medicaid Block Grants in 115th Congress

Republicans have been talking about remodeling the Medicaid program through block grants or per capita caps for years.  Both block grants and per capita caps are designed to limit federal spending by providing a state with a set amount of federal money to fund its Medicaid program.  With the sweeping Republican victory, Republicans are in a position to move forward with these policies, primarily focused on block grants.  But, there are three main questions to consider in designing a block grant program, each of which could prove controversial.

Which populations would be included in the block grant?

Any block grant proposal must determine which populations are included in the block grant.  While some proposals have included all Medicaid populations, others have specifically excluded the elderly and disabled, leaving them in the existing Medicaid program.

What services would be covered by Medicaid under the block grant?

Currently, states are required to provide a set of mandatory services in order to receive federal funds.  A block grant proposal must consider and address whether the current set of services would still need to be covered under the block grant funds, and if not, what services would be covered.  Any reduction in the coverage of mandatory services would likely be hotly debated.

What federal funds would be provided to the states?

A block grant proposal must also determine what federal funds will be provided to the states.  Funding includes two parts: (1) the initial amount provided, and (2) how much is providing moving forward. In any block grant proposal written with the express purpose of reducing federal spending on Medicaid, the funding choices will be extremely controversial and perhaps rejected by states, including those with Republican governors.

While the road to Medicaid block grants may be open for Republicans come January, there are still many questions as to how such a policy would be implemented and how it will fit with other health reform proposals.

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Manager of Government Relations

Prior to joining ML Strategies, Eli was a legislative correspondent for US Senator Martin Heinrich (D-NM), where his experience included health care, education, child welfare, social security, food assistance, and poverty issues specifically as they relate to the Affordable Care Act, Medicare, and Social Security. Previously, Eli served as a legislative intern with Senator Heinrich. He also served as a legislative intern with Senator Dick Durbin (D-IL), where he worked on issues related to education, health, and commerce. Eli has also served as an intern at a political...

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Bridgette A. Keller, health system administration LAWYER, Mintz
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Bridgette applies her experience in health system administration and ethics in health care to her health law practice. Bridgette advises health care providers, ACOs, health plans, PBMs, and laboratories on a variety of regulatory, fraud and abuse, and business planning matters.

With a background in health care operations, Bridgette is able to provide clients with practical insight that includes a focus on the business implications of health care enforcement defense activities, internal investigations, regulatory compliance, and fraud and abuse analyses of proposed new procedures.

Bridgette's work also includes a focus on ethics in health care principles. As a health care ethicist with the Department of Veterans Affairs National Center for Ethics in Health Care (NCEHC), Bridgette provided technical guidance on health care ethics problems to VA stakeholders, VA Central Office staff, and field-based consultants. She also collaborated on the development of an ethics consultation program and educational materials. Prior to her appointment at the NCEHC, Bridgette served as the Outpatient Clinic Coordinator at the Manhattan Campus of the VA New York Harbor Healthcare System and completed the Graduate Health Administration Training Program at the Washington DC VA Medical Center. Her health care management experience includes outpatient clinical operations, customer service, performance improvement, program development and implementation, data analysis, and supervision of staff.

Bridgette is trained in Lean/Six Sigma thinking and as an examiner for the Baldrige Criteria for Performance Excellence.

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