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Last night, a package of amendments, called a Manager’s Amendment, was released for the American Healthcare Act (AHCA). Many of the amendments are of a technical nature to correct typographical errors, change section numbers, and adjust the effective dates of certain provisions. While many of these amendments impact the legislation in a significant way, we have focused our analysis on the major policy changes this packages of amendments makes to the original bill.

Medicaid Expansion 

The original bill continued to give state the option to expand Medicaid until 2020. This has now been amended to only allow states to expand Medicaid until the end of 2017.

States that have already expanded Medicaid will still receive an enhanced reimbursement for newly eligible individuals until 2020. After 2020, enhanced reimbursement will only be available for individuals enrolled before 2020 that remain continuously enrolled.

States that have not expanded Medicaid, but choose to do so by the end of 2017, will not receive enhanced reimbursement at all.  

Medicaid Work Requirements

The newly released amendments will also allow states to impose a work requirements in Medicaid for nondisabled, nonelderly, nonpregnant adults as a condition of coverage. This means that, like some other safety net programs, individuals will need to show that they are employed or are participating in certain other activities (like job training or education) to retain Medicaid benefits.

Increased Medicaid Funding for Elderly and Disabled

As we have discussed previously, the original bill changes the way Medicaid is funded. Instead of matching the money Georgia spends on Medicaid, the AHCA will pay Georgia a certain amount of money per person that is enrolled in Medicaid. We further discussed that this amount of money would be initially based on how much Georgia spends this year and will be increased each year. This increase is based on a standard formula that applies to all types of Medicaid enrollees. The newly release amendment changes this standard formula for elderly and disabled enrollees to increase the amount states receive for these two populations.

Medicaid Block Grants

The newly released amendment also allows states the option of choosing to fund their Medicaid program for certain populations by receiving what is called a block grant from the government rather than receiving a set amount per beneficiary.  Under a block grant, states would get a fixed federal grant to be used to fund the federal share of its Medicaid program and be given considerable flexibility in determining who and what would be covered. States would only be allowed to utilize block grants to fund Medicaid for their adult and children populations; Medicaid programs for the elderly and the disabled would still be reimbursed on a per enrollee basis.

Financial Assistance for Older Individuals

Many in the media predicted that this amendment would adjust the tax credit amount for those between ages 50 and 64 to provide for additional financial assistance. The newly release amendment does NOT do this. Rather, the press release issued by the Energy and Commerce Committee implies that changing the tax credit for older individuals will be handled when the Senate takes up the bill.