Block grants, per Capita Medicaid funding, choices to expand Medicaid eligibility but receive less federal support, and Medicaid Work Requirements were hallmarks of the American Health Care Act which passed in the US House but failed in the US Senate in 2017. Per capita caps are fixed amounts of money per person enrolled in Medicaid that may or may not cover the cost of care. Block grants are a single lump sum to cover Medicaid expenses regardless of enrollment or cost of care. While some states have explored additional mechanisms to reduce the number of recipients by not expanding Medicaid to those in the coverage gap between 100% and 138% of the Federal Poverty Guidelines, more than 40 states have Medicaid Expansion, including Pennsylvania, with more almost 750,000 enrollees. Under the ACA, the federal government paid 100% of the cost of Medicaid expansion coverage from 2014 to 2016, with the federal share then dropping gradually to 90% for 2020 and each year thereafter, leaving states to cover the small remaining share. In 2014, Pennsylvania floated the idea of work requirements with gradual loss of coverage in year 2 if recipients were non-compliant, a mix of eligibility exemptions for special circumstances, and a 20-hour per week of work or 12 hours of job training. In 2018, analysts estimated work requirements would cost Pennsylvania Taxpayers 3.4 billion dollars over 6 years and would result in 85,000 consumers losing health coverage. With the current inflation rate, the cost would be over $4.2 billion and put more than 1.2 million at risk of losing coverage. Pennsylvania has 2.9 million enrollees in Medicaid with 42% children and 33% representing people with disabilities, and pregnant women.
