Six Cassidy-Graham State Funds Flow Analyses

The post below is an inventory of six separate analysis of the flow of funds between states under Cassidy-Graham-Heller-Johnson in 2026 compared to current law as projected by the Congressional Budget Office. I am collecting and collating the information.

Center for Budget Policy and Priorities is a liberal think tank. They use the 2016 budget baseline and attempt to approximate eligibility through the Current Population Survey. They analyse state funding swings in millions of dollars.
The New York Times uses Census, Kaiser Family Foundation, CBPP and CMS data to estimate per capita changes in expenditure by state in 2026.
Manatt is a program design and evaluation consulting firm. They are using 2017 as their cost baseline year with 2015 Medicare spending variations to simulate state level risk adjustment.  I am using Table 1-A. They are evaluating just the change of federal flows to the state due to the block grants and not Medicaid. CBPP looks at both so it is an apples to kiwi fruit comparison.

Avalere is another consulting and analysis firm with their own estimates.  They are looking at total cumulative swing with billions of dollars as their unit of account.  Data is extracted from figure 1.  I will just show direction as I can not merge that data consistently.  If there is a figure of under $1 billion dollars, I am using $500 million as a placeholder.

Kaiser Family Foundation released their analysis on September 21. I am looking only at Table 1, which measures the change in ACA coverage elements (Medicaid Expansion and Exchange subsidies) for the time period 2020-2026.

The Center for Medicare and Medicaid Services (CMS), Office of the Actuary released their numbers on Thursday night. I am just looking at the calendar year 2026 one year net swings in millions of dollars.

My data is here. I show direction and size for CBPP, Manat, Avalere, Kaiser and CMS and direction only for the New York Times .

More analysis below the fold:

CBPP and the New York Times have the same sign in all cases. Manat  goes in the same direction with 42 states when compared to CBPP/NYT and agrees with Avalere in 41 states.  Avalere agrees with CBPP and NYT in direction forty eight times. Kaiser shares the direction of CBPP/NYT 46 times. Kaiser and Avalare share agreement 45 times while Kaiser and Manat agree 43 times. CMS agrees with the other analyses between forty five and forty seven times.

Manat projects that California and New York see federal funds flow decrease by less than $5 billion per state for the block grants by $11 and $13 billion instead of the $28 and $19 billion dollars that these states would lose under the CBPP projections from the combination of block grants and Medicaid per capita caps.

There is going to be a lot of variance based on assumptions that are made for the baseline year, inflation rates, medical inflation rates and a variety of other factors.  The impressive thing, to me, is the general agreement on direction by these five different methods.