The Trump administration is planning to fundamentally alter Medicaid, a move that could mean big changes to everything from health care to home and community-based services waivers for people with developmental disabilities. President Donald Trump and his top advisors have indicated that they support moving to a block grant system for Medicaid. Though details are scant, such a shift may mean significantly less funding for Medicaid and greater control at the state level.  Currently, Medicaid programs are administered by the states, but they must meet certain federal requirements. In exchange, states receive matching grants from Uncle Sam, with no set cap.