By NextBestFitGive the territories state-like Medicaid funding but keep separate programs
Remove the caps and apply the regular state matching formula, while each territory keeps running its own Medicaid program and eligibility rules.
Full inclusion chosen; parity would keep coverage tied to territory Medicaid eligibility.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Remove the Medicaid caps for the territories
- Apply the state matching-rate formula to the territories
- Require territories to meet state Medicaid eligibility standards
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- U.S. territories get capped, lower federal health funding
Removing funding caps and using the state matching formula ends recurring funding cliffs while preserving locally designed territory programs, with less change than full national inclusion. Medicare differences, including enrollment in its outpatient coverage, still need separate fixes.
- Solves only part of the problem
Keeping territory Medicaid eligibility rules leaves coverage short of universal enrollment.
Who's affected
- Residents of U.S. territories
- U.S. territories get capped, lower federal health funding: Capped and temporary federal funding leaves their health coverage less secure.
- Hospitals, clinics, and care organizations
- U.S. territories get capped, lower federal health funding: Territory providers are paid less than mainland peers.
- Doctors, nurses, and other clinicians
- U.S. territories get capped, lower federal health funding: Territory providers are paid less than mainland peers.
- Territory governments
- U.S. territories get capped, lower federal health funding: Temporary funding laws create recurring funding cliffs.
- Taxpayers and public budgets
- U.S. territories get capped, lower federal health funding: Capped territorial funding limits federal spending in the short term.
- Fix Medicare Part B enrollment and Medicare Savings Programs separately
Where it has been tried
- U.S. territories (ACA): The ACA gave the five territories $7.3 billion in extra Medicaid and CHIP funding through at least FY2019, a temporary version of this approach.