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First, the bill would roll back the ACA’s commitment to providing Medicaid funding for the so-called “expansion population,” or otherwise able-bodied, non-pregnant adults who qualified by their incomes under the ACA’s new rules. The bill doesn’t automatically take coverage away from those people, but it does end what’s called the “enhanced federal medical assistance percentage,” or FMAP, for them, whereby the federal government pays the vast majority share of their Medicaid costs. After 2020, states will no longer be allowed to enroll additional expansion adults, though those already covered will be allowed to remain covered if they don’t become ineligible for more than a month. There’s a much more radical change to Medicaid in the bill, though, and it involves the restructuring of the program’s federal funding to a hard per-capita cap. The full ramifications of that restructuring can be viewed in detail here , but suffice to say that states will probably be receiving less federal funds than before, and will have much less flexibility year-to-year in their spending. Additionally, the funding increases scheduled to allow Medicaid funding to keep up with medical inflation have been reduced from the original draft bill. Further provisions: Bar providers that provide abortions from receiving Medicaid funding. Remove some state flexibility in increasing the home-equity limit for Medicaid eligibility, whereby people are barred from Medicaid coverage if they have too much home equity. Eliminate Essential Health Benefits requirements for certain Medicaid-covered plans, including requirements for mental-health services funding parity with other services. Increase the frequency at which Medicaid enrollees are tested for eligibility. Grant extra Medicaid provider reimbursement funds to states that didn’t expand Medicaid under Obamacare.

For the original version including any supplementary images or video, visit https://www.theatlantic.com/politics/archive/2017/03/obamacare-lite-yes-and-no/518772/

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