Set each state's contribution

Months −16 to 0 · HHS / Treasury / statesDiscuss this step

Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.

What	Today	Change	Trade-off
Section 1332 (ACA) and Section 1115 (Medicaid) waivers replacedYear 4 States & localities	States run reinsurance programs, Medicaid work requirements, managed-care designs, and pilots under waivers.	1332 reinsurance waivers end with the individual market; 1115 waivers limited to residual non-medical Medicaid. A new state-administered UHP option replaces them as the route for state innovation.	Ends coverage restrictions like work requirements; states lose broad waiver flexibility.
State provider taxes and intergovernmental transfers funding Medicaid endsYear 4 States & localities	States tax hospitals and nursing homes to draw federal Medicaid match.	End for acute care because there is no match to draw; the revenue is counted in state MOE calculations.	Ends a financing gimmick; states that relied on it must replace the revenue within their MOE.