On January 30, the Centers for Medicare & Medicaid Services (CMS) released its long-rumored guidance on Medicaid block grants. This letter to state Medicaid directors invites states to restructure their Medicaid programs in a radical manner previously rejected by Congress, by capping federal funding at an artificially low level. This new effort from the Trump administration, misleadingly titled Healthy Adult Opportunity (HAO), ought to have little appeal to state governments for reasons of basic math. The proposal is also in stark violation of Medicaid law, and it represents a major threat to tens of millions of Medicaid beneficiaries.
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