When Congress returns next week, Republican leaders intend on advancing legislation repealing and replacing the Affordable Care Act – legislation which would currently include the possible redesign of the Medicaid program. Medicaid today provides coverage to more than 70 million children and poor, disabled or elderly Americans. Whatever changes Congress may make, ensuring that all of Medicaid’s participants retain access to care is critically important. We’re very concerned about Medicaid restructuring being used as a vehicle to make cuts to this vital program that serves the most vulnerable in our communities. If the objective of redesign is to provide more flexibility to the states, that can best be achieved through the expanded use of waivers rather than a wholesale redesign of the program. Waivers allow states to innovate new ideas that best serve their situations and fit their population’s needs while maintaining the integrity of the program, and President Trump’s pick to head CMS, Seema Verma, has a long track record of helping to craft new waiver proposals. Redesigning Medicaid, such as through block grants or per capita caps, could lead to substantial changes in benefits and payments and limit the availability of care for patients. Medicaid reform must also ensure that both states that expanded Medicaid under the ACA receive equitable treatment along with states that did not. Federal funds already allocated for Medicaid expansion should be earmarked to finance future Medicaid redesign efforts, rather than be siphoned away from the program. And states that have yet to expand Medicaid need additional support for the care of their citizens. The bottom line is that Medicaid is an already underfunded program that pays providers less than the cost of care. For the sake of the neediest patients and the hospitals that serve them, federal funding for Medicaid must not be reduced.