Feds Offer Medicaid Block Grant “Healthy Adult Opportunity” for Medicaid Expansion Population

The Centers for Medicare and Medicaid has published an executive order that allows States to apply for a Medicaid block grant program beginning on January 30th called “Healthy Adult Opportunity.” The program allows states to convert a portion of Medicaid into block grants for “able-bodied” adults 19-64 years old who are a part of the Medicaid expansion population.   This block grant option would not impact Medicaid eligibility for individuals who qualify for Medicaid based on a disability or who are in need of long term care services and supports.  It is geared toward adults who are presumably able to work. 

States will have the opportunity to: 

• Set additional conditions of eligibility that promote state and federal program objectives, like community engagement
• Establish flexible cost-sharing structure within broader federal limits
• Choose a lower eligibility income standard or limit to a subset of individuals (e.g., individuals with substance use disorder) at the regular federal

States that choose this block grant option will be given a specified amount to serve that Medicaid population and are responsible for any spending outside of the block grant amount.   The administration argues that this will allow states to more closely monitor their spending and focus their efforts on the most vulnerable populations.  In North Carolina, the General Assembly would still need to take some action on closing the insurance gap through expansion of Medicaid to be eligible for this block grant.  To be clear, states that have already expanded Medicaid to close the insurance gap may continue as they have in the past.  The NC House is considering a bill, H655, which does focus on expanding Medicaid with work requirements. 

CMS Block Grant Links

• Healthy Adult Opportunity State Medicaid Director Letter
• Health Adult Opportunity 1115 Application Template
• Healthy Adult Opportunity Press Release
• Healthy Adult Opportunity Fact Sheet

Medicaid Facts and Figures

NC Health News has published a more in-depth article on the Trump block grant proposal and the impact on North Carolina

Kaiser Health News has also done a good analysis of the Trump proposal.