House Republicans are putting cuts to Medicaid at the top of their list of budget cuts to help pay for their wide-ranging agenda that spans tax cuts, energy production and border security.
Republicans are eyeing changes to how much the federal government, as opposed to states, will contribute to Medicaid expenditures, a number called the federal medical assistance percentage (FMAP).
Republicans see Medicaid as a program rife with fraud and abuse and have long sought to rein in its spending.
The joint federal-state program provides health coverage for more than 70 million people, with the federal government covering anywhere from 50 percent to about 75 percent of the costs for traditional Medicaid but 90 percent for states that expanded coverage under the Affordable Care Act (ACA).
The House Budget Committee considered a plan Thursday that would instruct the Energy and Commerce Committee — which has jurisdiction over Medicaid — to find $880 billion in savings over the next 10 years.
Possible changes Republicans are floating include capping Medicaid spending on a per capita basis at a potential savings of $900 billion per year; rolling back the enhanced federal matching rate for ACA expansion states to save $561 billion; and lowering the 50 percent floor for the traditional Medicaid population, for a savings of up to $387 billion.
The latter change would primarily affect wealthier states such as California and New York, but every state would bear the brunt of reduced federal spending, forcing difficult trade-offs.
