How Do AHCA Amendments Affect Medicaid?

US capitol building

The US House of Representatives is scheduled to vote on the American Health Care Act (AHCA) today, Thursday, March 23, 2017. To put it mildly, there are more than a few opinions out there about AHCA. The GOP bill repeals and replaces the Affordable Care Act, often called the ACA or Obamacare. If the bill passes in the House, it will move on to the Senate for consideration. [UPDATE: The AHCA was pulled before a vote was taken in the House.]

Repealing the ACA was one of the issues President Trump campaigned on. Another bullet point in his campaign’s healthcare position statement was a switch to block grants (lump sums) to states to reduce federal involvement in and oversight of Medicaid. Block grants came up in the amendments to the AHCA from House Republicans on Monday. Here’s a quick overview of some of these last minute amendments related to Medicaid.

End Expansion

The original bill included phasing out Medicaid expansion for certain childless, able-bodied adults, and an amendment accelerates the process. The ACA included an enhanced Federal Medical Assistance Percentage (FMAP) for Medicaid expansion. In short, the FMAP is the percentage rate of expenses that the federal government pays states. Among other changes, there is an AHCA amendment that limits the enhanced FMAP to states that expanded Medicaid coverage to the specified able-bodied adults as of March 1, 2017 (a date that has already passed).

Allow Work Requirements

Also in the amendments is a 5 percent increase in federal assistance for a state that institutes a work requirement for able-bodied adult Medicaid recipients. Able-bodied essentially means not disabled, not elderly, and not pregnant. The amendment allows for a variety of definitions of “work” and for exceptions to the requirement.

Family work status statistics available for 2015 indicate that 63 percent of nonelderly Medicaid recipients have at least one full time worker and another 14 percent have a part time worker, for a total of 77 percent.

Offer Block Grants

At the present time, Medicaid funding involves the federal government paying states for a certain percentage of program expenses, as mentioned above in the FMAP discussion. The percentage varies by states.

The current bill includes a per capita cap system, which means the state gets a set amount per person enrolled.

An amendment offers a block grant option (not applicable to elderly and disabled participants), which would give the state a fixed amount not tied to the number of participants. That approach means the amount to the state wouldn’t adjust for increases in enrollment. The block grant approach gives states a lot of leeway in deciding who gets covered and what services are available to them.

Members of individual provider types, like facility or home care, raise the question of who will win and who will lose state by state as different groups vie for resources.

How About You?

How do you see a change from the ACA affecting your job?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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