Fold Medicaid and CHIP into UHP

Year 4 (dual eligibles and children earlier) · States; UHADiscuss 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
Medicaid (acute care) absorbedYears 1–4 Federal programs	84.3M enrollees; state-run with federal match (FMAP); income eligibility varies by state (10 states have not expanded); ~75% in managed care; annual redeterminations.	Folded into UHP by age wave; acute-care eligibility rules, redeterminations, and managed-care contracts end. States pay a maintenance-of-effort amount instead of their share. Federal share of Medicaid $596.7B → $596.7B State Medicaid share → UHP maintenance-of-effort payment $345.7B → $345.7B	Enrollees go from the lowest-paying payer to the same rate as everyone; states lose program control.
Medicaid non-medical supports amendedYear 4 Federal programs	Some states use Medicaid for housing supports and social-needs pilots (e.g., 1115 waivers).	A residual, optional Medicaid continues for non-medical supports with federal match.	Keeps innovation in social supports; continues some state-by-state variation.
ACA Basic Health Program (NY Essential Plan, MN MinnesotaCare, OR Bridge) absorbedYears 1–4 Federal programs	State programs for people just above Medicaid income.	Absorbed into UHP.	Simplification; states lose a policy tool they built.
State Medicaid agencies amendedYears 3–5 States & localities	Run eligibility, managed-care contracting, and payment.	Wind down acute-care functions; some staff join UHA regional offices.	Administrative savings; job losses in state government.
County indigent-care programs & public hospital subsidies amendedYear 4 States & localities	Counties fund care for uninsured residents.	Need largely ends; county funds can shift to public health.	Local budget relief; counties must decide whether to keep public hospitals.