Republican Congress Eyes Medicaid Reforms to Limit Spending Growth

Proposals focus on capping optional benefits and eligibility expansions while preserving core services for low-income Americans.

Medicaid spending has surged from $41 billion in 1985 to $824 billion in 2022, driven largely by state expansions of optional benefits and eligibility.
Republican lawmakers are considering reforms to curb rising costs, including capping federal funding growth for optional Medicaid expenditures.
Wealthier states currently claim disproportionate federal Medicaid funding, with Delaware receiving $24,639 per poor resident in 2021 compared to Alabama's $7,052.
Proposals aim to preserve full federal support for mandatory benefits while limiting matching funds for discretionary expansions and non-medical services.
Critics warn that reforms must avoid cutting essential benefits during economic downturns, which could leave vulnerable populations at risk.