Current law: States design benefit packages, provider reimbursement levels and eligibility, within federal parameters, and the federal government's match rate varies depending on the wealth of the state, ranging from 50% to 73%.
AHCA: Starting in 2020, the federal contribution would be a dollar figure for various groups within Medicaid, which would only be allowed to grow by either the medical component of the Consumer Price Index or medical CPI plus 1 percentage point. The aged and disabled adults would be under the more generous per capita cap. Each state's base figure would be based on historic per enrollee spending.
BCRA: Starting in 2020, the House version of the per capita cap would take effect, excluding children who are on disability. Instead, they would be under the old match. Starting in 2025, the per capita cap would grow at standard inflation, which is substantially lower than medical CPI. States would have more flexibility on how to set the base rate.
The HHS secretary would be required to even out the base rates for states by increasing low-spending states' contributions by at least 0.5% but not more than 2%. The secretary would also be required to penalize states that spend 25% or more above the average spending limit, within the same parameters. However, "low density states," which are Alaska, the Dakotas, Montana and Wyoming, would be exempt. Current per enrollee spending for seniors, for example, has 21 states that spend at least 25% above the national average, including those five, but also near the top are Connecticut, Delaware, Indiana and New Mexico.