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WASHINGTON — Under the GOP’s vision for overhauling Medicaid, the program could struggle to afford expensive breakthrough treatments, cutting off its recipients from the latest medical innovations, warn policy experts and patient advocates.

Republican plans to institute some kind of Medicaid spending cap would mark a fundamental change in the nature of the program. Right now, the federal government (with mandatory matching funds from the states, which actually administer Medicaid) pays whatever costs recipients incur for care that is covered by the program.


The most recent versions of the GOP plan, however, would institute a per-capita spending cap, meaning states would receive a set dollar amount for each person eligible for the program. In turn, states would likely be given more flexibility to decide who is eligible for Medicaid, what to require of them, and what care is covered. Republican lawmakers argue that the program must be changed if it is to be fiscally sustainable.

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