On January 30, 2020, CMS released a letter to state Medicaid directors outlining the agency’s block grant initiative titled “Healthy Adult Opportunity.” CMS will allow states to pursue either an aggregate cap or per-capita-cap approach to managing their Medicaid programs. The block grant option would impose an annual budgetary limit on the program, and would apply to optional populations that a state elected to cover and individuals enrolled as part of the ACA’s Medicaid expansion.