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January 30, 2020

States Should Reject Medicaid Block Grants, Says NPAF

New guidance from the Centers for Medicare and Medicaid Services (CMS) could fundamentally change the Medicaid program in a way that hurts patients and renders critical health services inaccessible, said the National Patient Advocate Foundation (NPAF) today.

The guidance, which CMS touts as allowing states to “potentially achieve new levels of flexibility,” while “providing taxpayers with greater budget certainty,” will allow states to cap a portion of spending for the program for the millions of patients who gained coverage under the Affordable Care Act.

“The Medicaid expansion saved lives. If we want to lower systemic costs, we need to find an approach that isn’t about slashing benefits and reducing access,” said Alan Balch, CEO of NPAF.

Medicaid has always operated with a coverage guarantee: people who qualify can enroll and receive a core set of health care services that all states must cover through an unlimited federal match. Traditionally, states can then choose to offer additional benefits, such as prescription drug coverage.

Under the CMS guidance, states could opt instead for a fixed federal funding amount based on a pre-determined budget for its adult Medicaid population. As a result, states could cover fewer drugs, eliminate emergency transportation and stop offering retroactive coverage – all essential elements of coverage for the patients who work with Patient Advocate Foundation.  

“CMS claims that this approach will not take health care coverage away from the most vulnerable in society, but as total costs exceed the funding caps, CMS will wind up creating a vulnerable population,” said Balch. “We intend to work to make sure that states understand that they will only be hurting their own citizens if they take up this bad offer to modify their programs.”

NPAF joined 27 other nonprofit, non-partisan organizations in protesting block grants and per capita caps in a letter to CMS