House GOP releases bill to cut Medicaid funding

House Republicans released the long-awaited text of their Medicaid overhaul Sunday night, with provisions that will reshape much of the safety net program and shrink the Medicaid expansion.

Why it matters: The legislation skips some of the biggest changes Republicans had discussed — but it would reduce Medicaid spending by hundreds of billions of dollars, and could lead to significant coverage losses.

• It would also alter how many people will be able to retain or receive ACA coverage.

What's inside: Two of the more controversial policies that had been considered among the House GOP conference in recent weeks, per capita caps and lowering the federal match for states, weren't included in the final package.

Here's what is included:

• Work requirements, mandating at least 80 hours of work per month for people ages 19-64, with a range of exceptions like for pregnant women or the disabled.
• A ban on new or increased provider taxes, effectively freezing the taxes at current rates. States use those to help finance their share of Medicaid costs, and the change could squeeze state budgets, though some have called the tactic a gimmick.
• Capping new state-directed payments at the rate that Medicare pays providers.
• Cutting from 90 to 80% the federal share of costs (FMAP) for states that cover undocumented immigrants with state funds (currently seven states, per KFF).
• Imposing cost-sharing, capped at $35 per service, for Medicaid expansion enrollees with incomes at least at the federal poverty line.
• Increased eligibility checks, every six months rather than annually.

Also included is the codification of an ACA rule recently released by the Trump administration that makes it more difficult for individuals to enroll in ACA plans outside of the open enrollment period.

Between the lines: There are also several long-time GOP health care priorities not related to Medicaid insurance coverage in the bill, which include:

• Providing an inflationary update to Medicare physician pay for the first time in years.
• Banning PBM spread pricing in Medicaid.
• Implementing a PBM "delinking" policy in Medicare Part D and requiring transparency measures.
• Delaying Medicaid DSH cuts from FY 2026-2028 to FY 2029-2031.
• Delaying the Biden-era nursing home staffing measure.
• Banning larger organizations that provide abortions from receiving Medicaid funding.
• Prohibiting Medicaid and CHIP funding for gender-affirming care procedures.

What they're saying: "When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can't afford to undermine the program further by subsidizing capable adults who choose not to work," Chairman Brett Guthrie wrote in a Wall Street Journal op-ed.

• "The overwhelming majority of the savings in this bill will come from taking health care away from millions of Americans," said ranking member Frank Pallone.