On June 22, Speaker of the House Paul Ryan (R-WI) unveiled his plan to replace the Affordable Care Act and fundamentally restructure the Medicaid and Medicare programs. The proposal is not a detailed legislative draft, but a blueprint for expected action in the next Congress. The proposal provides states the option to choose a block grant for the Medicaid program or a per capita cap. A block grant provides a set amount of federal spending regardless of enrollment. A per capita cap does adjust for enrollment while establishing a limit on how much to reimburse states per enrollee. Either option is a fundamental restructuring of Medicaid financing with the goal of achieving federal savings. If costs are above per enrollee amounts, the states would need to cover the costs or make cuts to provider reimbursement, eligibility, or services, or shift costs to individuals receiving services or their family members. The plan proposes to give states additional flexibility to increase cost sharing, add waiting lists, and limit benefits. Additionally, the plan proposes to add a work requirement to the Medicaid program, end the option to expand Medicaid, and phase out the increased federal match for the states that have already expanded Medicaid. The Arc is very concerned about the impact of these major changes on people with disabilities and their family members and will continue to provide input to Congress about these proposals.