Obamacare isn’t the only health care program being targeted by President Trump and congressional Republicans.  Medicaid, the health care financing program for low-income Americans – jointly funded by the federal government and the states – has been identified as a program in need of dramatic reform.  Although proposed Republican reforms to the program differ, common key features include limiting federal outlays and devolving decision-making to the states.  State policymakers, including those in my home state of Texas, have called on the federal government to transform federal Medicaid funding into a block grant, an idea that appears to have the support of Trump administration and congressional Republicans.  Although there are aspects of shifting federal Medicaid funding to state block grants that could be very attractive to state policymakers, there are also significant potential negative ramifications depending on the details of the funding structure.