first_imgATLANTA — When President-elect Donald Trump takes office in January, Republicans will have the opportunity to pull off something they have wanted to do for years — overhaul Medicaid, the program that provides health care to tens of millions of lower-income and disabled Americans.Any changes to the $500 billion-plus program hold enormous consequences not only for recipients but also for the states, which share in the cost.Trump initially said during the presidential campaign that he would not cut Medicaid, but later expressed support for an idea pushed for years by Republicans in Congress — sending a fixed amount of money each year to the states in the form of block grants. Backers say such a change in the Medicaid formula is one of the best ways to rein in spending, but critics say big cuts would follow.Currently, the federal government pays an agreed-upon percentage of each state’s Medicaid costs, no matter how much they rise in any given year.Republicans have argued that states have little incentive to keep expenses under control, because no state pays more than half the total cost. Both House Speaker Paul Ryan and Trump’s pick for secretary of health and human services, Georgia Rep. Tom Price, want to switch to block grants.Key questions facing Republicans will be how the funding is structured and how much flexibility will be given to the states.“It’s exciting because you know it’s not going to be the same as it was, and it’s nerve-wracking because you know it’s not going to be the same as it was,” said Terry England, a Republican state lawmaker who chairs the House budget committee in Georgia.last_img