off the charts
POLICY INSIGHT
BEYOND THE NUMBERS

What If Chairman Ryan’s Medicaid Block Grant Were Already in Effect?

House Budget Committee Chairman Paul Ryan’s proposal to block-grant Medicaid would cut federal funding by one-third by 2022 and even more after that, we recently explained.  To help show how states would likely fare under the proposal over time, we compared how much federal funding they would have received under the block grant if it had been in effect for fiscal years 2001-2010 to what they actually received (excluding the temporary funding increases that the White House and Congress provided during the last two recessions). We found that the Ryan block grant — which the House passed as part of Chairman Ryan’s overall budget — would have cut federal Medicaid funds to most states by more than 35 percent by 2010 and to several of them by more than 50 percent. Every state would have received substantially less from the federal government than it actually received, but some states would have received much, much less.
  • States would have received $555 billion — or 31 percent — less over the 2001-2010 period.
  • In 2010 alone, the cuts in federal funding would have totaled about $81 billion, or 37 percent (see table).
To cope with cuts of this size, states would have to boost their own funding substantially or, more likely, sharply scale back their Medicaid programs by tightening eligibility, shrinking benefits, and cutting reimbursement rates to providers. Such changes would add millions to the number of uninsured Americans.  Last year, when Chairman Ryan included a similar Medicaid block-grant proposal in his budget, the Urban Institute estimated that it would prompt states to drop between 14 million and 27 million people from Medicaid by 2021 — in addition to the 17 million people who would no longer gain coverage because of the Ryan budget’s repeal of the health reform law’s Medicaid expansion.
Estimated Cuts If Ryan Medicaid Block Grant Had Been in Effect, 2001-2010 ($ millions)
STATE Reduction in Federal Funds, 2010 Percentage Cut, 2010
NATION $80,724 37%
Alabama 1,015 31%
Alaska 407 53%
Arizona 4,477 71%
Arkansas 1,444 49%
California 7,109 34%
Colorado 808 40%
Connecticut 718 26%
Delaware 335 52%
DC 432 35%
Florida 4,397 46%
Georgia 1,885 37%
Hawaii 305 41%
Idaho 490 52%
Illinois 2,757 36%
Indiana 1,597 41%
Iowa 688 35%
Kansas 488 33%
Kentucky 1,308 33%
Louisiana 1,383 30%
Maine 445 30%
Maryland 1,564 44%
Massachusetts 1,853 32%
Michigan 2,656 36%
Minnesota 1,447 38%
Mississippi 1,278 41%
Missouri 2,311 45%
Montana 229 36%
Nebraska 207 21%
Nevada 380 50%
New Hampshire 121 18%
New Jersey 1,105 22%
New Mexico 1,418 57%
New York 5,707 23%
North Carolina 2,645 39%
North Dakota 99 23%
Ohio 4,073 42%
Oklahoma 1,109 44%
Oregon 927 37%
Pennsylvania 3,666 36%
Rhode Island 268 27%
South Carolina 1,235 35%
South Dakota 157 31%
Tennessee 1,946 35%
Texas 6,561 42%
Utah 491 40%
Vermont 363 49%
Virginia 1,445 45%
Washington 918 26%
West Virginia 444 24%
Wisconsin 1,531 39%
Wyoming 86 32%
Source:  CBPP analysis based on CMS Medicaid spending data.  To determine states’ block grant amounts under the Ryan proposal, we use federal Medicaid spending in 1998 as the base, adjusted annually by national population growth and the growth in the Consumer Price Index.  We exclude federal Medicaid spending related to temporary federal matching rate increases in 2003, 2004, 2009, and 2010.