Republican governors and congressional leaders met again in Washington last week-just days before Congress was scheduled to debate Medicaid reform-but were unable to come to any agreement on how Medicaid funds should be split among states.
Another disagreement between House and Senate Republicans is whether the federal entitlement to Medicaid should be retained. Under the House plan, states would be given almost complete control of the plan, including determining who would be eligible for benefits.
However, Senate moderates, including Senate Finance Medicaid subcommittee Chairman John Chafee (R-R.I.), oppose eliminating the federal entitlement. Their plan would maintain eligibility for some groups-such as poor pregnant women, poor children and disabled children-and would allow states to determine other eligibility criteria.
The GOP governors said they supported the House plan. However, Utah Gov. Mike Levitt, chairman of the Republican Governors' Association, said his group was "opposed unanimously to the inclusion of individual entitlements in (the Senate Medicaid reform) bill."
The GOP budget passed earlier this year calls for Medicaid spending to be $182 billion less over the next seven years than it would have been if lawmakers made no changes to the program.
The Congressional Budget Office estimates that Medicaid spending will increase at more than 10% a year, from $89 billion this year to $178 billion in 2002.
While the governors were unable to reach agreement on how to divide the Medicaid funds, they did agree to use as a baseline the amount each state received in 1994. That means no state would receive less than it does now, which is a victory for states such as New York that have high per-capita Medicaid spending levels.
Where the governors split, however, is on how future increases would be divided. States with rapidly growing Medicaid populations say they should receive a greater slice of the pie.