What Will Happen to Medicaid After the Election?

Medicaid provides benefits to the 1 in 5 Americans who can't afford a doctor or pay for the long-term health care services they need. The politicians whom voters elect to the White House, Congress and statehouses in November could well shape how low-income Americans get health care for decades to come.

Will Medicaid continue to serve as a medical safety net, as it has for 55 years? Will more states join the 37 that have chosen over the past decade to expand the program? Or will some states go in the other direction, using a new White House program that could cap how much will be spent on Medicaid? Likewise, will states add eligibility requirements and time limits for receiving Medicaid benefits?

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As those questions show, the future of Medicaid is very much in play in the coming elections. That means voters need to pay close attention to candidates’ positions on the program.

"There have been efforts to fundamentally change Medicaid and how it operates,” says Bill Sweeney, AARP senior vice president. “We are concerned that those proposals could have dire consequences for the most vulnerable in this nation.”

One such proposal was announced by the Trump administration in January. The Healthy Adult Opportunity option would give states the ability to create a block-grant-type Medicaid program in which they would get either an annual lump sum of money from the federal government to cover program costs or a fixed amount per month for each person it covers. Under these arrangements, state officials would be free to change benefits and make revisions to their Medicaid program without federal oversight.

Today roughly 60 percent of the funding for Medicaid — a $600 billion program that covers more than 72 million Americans — comes from the federal government. The rest is paid by states. The federal government issues guidelines for Medicaid, but each state designs its own program.

Congress has flirted with legislating a block grant program for Medicaid, but it has never gone beyond the talking stage. And it's expected that the new option offered by the White House will face court challenges.