Recently Georgia Governor Nathan Deal announced that his state would be joining the growing number of states electing not to expand their Medicaid programs pursuant to the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). During an interview at the GOP Convention in Clearwater, Florida, Deal stated, “No, I do not have any intentions of expanding Medicaid…I think that is something our state cannot afford.” He went on to cite the fact that although the expansion, which would add an estimated 600,000 residents to the program, would be wholly funded by the federal government during the initial three years, subsequently, the state would be on the hook for ten percent of the cost — an estimated $4.5 billion over ten years.
The day after this interview, the governor’s spokesperson, Brian Robinson, was quick to add that the governor’s statement only barred Medicaid expansion under PPACA as the law stands now. Governor Deal would certainly be open to expanding the program if the law was altered to provide block grants to the states, and he was waiting until the results of November’s election to officially make the expansion decision, in hopes that a Romney administration and GOP-led Congress would support block grants. Under the block grant scheme, the federal government would issue each state a set amount of funds designated for Medicaid, which each state would be free to use for their program as it sees fit. Most importantly, the state would not be responsible for paying a portion of that amount to receive the grant.
Critics of the block grant system caution that while states could use the grants for Medicaid expansion, they would also have the freedom to make cuts to their programs by reducing provider payment rates, imposing more stringent eligibility requirements, and limiting beneficiary coverage. Georgia Budget and Policy Institute Director, Tim Sweeney, raised concern that Georgia’s Medicaid program is already underfunded and that the block grant approach would provide the state with less revenue than an expansion under PPACA. “The details are very important,” he stated.