Medicaid provides coverage for low income individuals and families with low or no out-of-pocket costs for care; assistance to low-income Medicare beneficiaries; coverage for long-term services and supports, and financing for safety-net hospitals, clinics and states. The two key Medicaid issues in the campaign focus around financing and the ACA Medicaid expansion.
ACA Medicaid Expansion. Effective January 1, 2014, ACA expanded Medicaid eligibility millions of non-elderly adults with income at or below 138% of the federal poverty level (FPL) – about $16,394 for an individual in 2016. The law also provided for 100% federal funding of the expansion through 2016, declining gradually to 90% in 2020 and future years. The Supreme Court ruling on the ACA in June 2012 effectively made the Medicaid expansion optional for states. As of September 2016, 32 states (including the District of Columbia) have implemented the ACA Medicaid expansion.
Financing. States administer their own Medicaid programs within federal requirements, and states and the federal government jointly finance the program. Under current law, federal Medicaid payments are guaranteed with no pre-set limit based on a formula set in statute that pays a larger share of program costs in poorer states. The financing structure allows states and the federal government to increase spending when there is increased demand or need (to respond to recessions, epidemics, emergencies or increases in medical or drug costs); however, it also makes federal financing more unpredictable and harder to control.
Where the Candidates Stand
Hillary Clinton. Hillary Clinton supports policies to maintain and strengthen the current Medicaid program and financing structure. Hillary Clinton would encourage and incentivize states to expand Medicaid by providing states with three years of full federal funding for newly eligible adults, whenever they choose to expand. Clinton would also continue to make enrollment easier and launch a campaign to enroll people who are eligible but not enrolled in coverage.
Donald Trump. Donald Trump supports a Medicaid block-grant and a repeal of the ACA (including the Medicaid expansion). He has said he would cover the low-income uninsured through Medicaid after repealing the ACA. The House Republican Plan, which is part of a larger package designed to replace the ACA and reduce federal spending for health care, would offer states a choice between a Medicaid per capita allotment or a block grant.