Dr Gail Wilensky Raises Questions About Medicaid's Matching Grant Structure

As Republicans work to reform Medicaid, they must contend with questions about the appropriate financial support level and the grant structure of the program, according to Gail Wilensky, PhD, of Project HOPE.

Transcript (slightly modified)

Medicaid has been a huge point of contention within the Republican Party. Do you think something will give?

I think there are 2 big questions about Medicaid. One is the financial support level. Are we talking about trying to extract, going forward, large sums of money? Are we talking about very modestly slowing the spend rate that we’ve seen on Medicaid? And the second is what should the structure be. I have much more sympathy with the move to a per capita block grant with some outcome metrics as a requirement, provided that the baseline makes sense and the rate of increase is appropriate for the different populations affected.

The reason I believe that is that we have seen in the past couple of decades most of the new money that has come in through Medicaid has been federal money, and much of the supposedly state match has been creative financing that just moves money around and then gives it back to the state. It has indicated some serious questions about the viability and validity of a matching grant in Medicaid. I think that continues to exist.

So, the structure is one thing. It’s now our only open-ended entitlement program left in the United States. Medicare, because of the IPAB structure, actually has a limit in place. I think questioning that is one idea. It is having a base structure and a growth rate that is appropriate, that is a whole different level of debate. People unfortunately are mixing the two up.