Set each state's contribution

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

Every concrete action this step requires, who is responsible, and when it happens relative to enactment.

#	Action	Owner	When	Trade-off
0.1.1	Compute each state's MOE: its 2024 Medicaid + CHIP + Medicare buy-in spending, indexed to per-capita national health spending growth.	CMS OACT	Month −16	Indexing MOE to national per-capita growth is predictable but ignores states' different demographic trends.
0.1.2	Compute each state's offsetting gains: state-employee premiums ended, Medicaid administration ended, new income-tax revenue from wage pass-through.	CMS OACT / Treasury	Month −16	Counting offsetting gains makes the deal attractive but relies on estimates states may dispute.
0.1.3	Share savings: states receive a share of any national savings below the spending growth target.	HHS / Treasury	Month −12	Sharing savings gives states a stake in cost control, but reduces savings available to lower taxes.
0.1.4	Set up monthly MOE payments from each state to the national trust fund.	Treasury / states	Month −6 to 0	Monthly payments give the trust fund steady cash but strain state cash flow in downturns.