What Are Medicaid Per Capita Caps and How Will They Affect Me?

Medicaid per capita caps are a feature of the American Health Care Act (AHCA), which is a bill passed by the U.S. House of Representatives in May. Although the AHCA is far from becoming law, and, in fact, may never become law, Medicaid per capita caps are a popular means of altering the payment structure between states and the federal government for state Medicaid programs.

Currently, the federal government pays for a certain share of the cost of medical care for individuals, while state governments pay for the remaining share. On the other hand, Medicaid per capita caps allow the federal government to put a limit on the total amount of funding that it would provide for each enrollee, with the states funding the remainder of care. If, as proposed, the cap went into effect in 2020, then the amount of the cap would be based upon states’ spending per enrollee in 2016. Thereafter, the amount of the cap would adjust according to the Consumer Price Index for Medical Care (CPI-1), and changes in the number of enrollees in specified eligibility categories.

Some researchers who analyzed the potential impact of Medicaid per capita caps on the American population made several interesting conclusions. For instance, putting Medicaid per capita caps into effect during the 2000s would have reduced funding for more than half the states. The required increases in state Medicaid funding would vary widely, from no changes in state funding to a 77% increase in state Medicaid funding to provide the current levels of service. Additionally, states with lower levels of Medicaid spending per enrollee, ironically, would be more likely to see funding decreases than those with higher levels of spending.

The overall impact of Medicaid per capita caps is unknown at this point, but it is likely to have a significant effect on many senior citizens. This can lead to seniors receiving substandard care, which, in turn, easily can lead to abuse and neglect. The nursing home abuse lawyers of Boller & Vaughan pride themselves on advocating on behalf of clients who suffer injuries at the hands of their caregivers, no matter whether those injuries from result from abuse or neglect in a nursing home or in any type of long-term care facility. We can seek compensation for you through the legal system, while you and your family can concentrate on healing, recovering from any trauma that you might have experienced, and moving on with your life. Don’t hesitate to contact our office today and learn how we can help.


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