ATLANTA – State lawmakers were teed up last month to discuss ways of expanding Medicaid under the Affordable Care Act that have been favored in other conservative states.

But that was before Donald Trump’s stunning victory, which has made an overhaul of the controversial Obamacare law all but certain.

With that, talk of growing Georgia’s health insurance program for the poor, even on a limited basis, came to an abrupt end.

Georgia was one of 19 states that did not initially expand Medicaid under Obamacare, which would have extended healthcare coverage to more people, forgoing additional federal dollars.

That doesn’t mean Georgians will be immune to the repeal of Obamacare that Trump has vowed as president and that congressional leaders seem poised to make good on.

Trump has tapped a Georgian, U.S. Rep. Tom Price, who has been one of the loudest critics of the federal healthcare law, to oversee efforts to repeal and replace it.

With the future so uncertain, questions linger over how Medicaid will be funded and how changes will affect coverage gained by as many as 20 million people nationally under Obamacare, including a half-million Georgians who signed up for insurance through the law’s new health insurance exchanges.

Trump has said he favors distributing federal Medicaid dollars as block grants, giving states a set amount as well as leeway in how they run the program. It’s an approach favored by conservatives, including high-ranking Republicans in Georgia.

The idea has already raised some concerns, though.

For one, Jimmy Lewis, CEO of HomeTown Health, which represents dozens of rural hospitals in Georgia, said their potential to suffer “can be huge” if a block grant is not handled properly.

“The problem with a block grant is when you come to the state and say, ‘Here’s one chunk of money, y’all figure out what to do with it,’ the lobbying interests go to work, and the people who win are the very large hospital systems who employ every lobbyist and organization they’ve got to capture as much of that block grant money,” he said.

Others worry that a block-grant model would almost certainly lead the state to cut off or reduce aid when needs exceed the money available.

Georgia is already among the lowest spenders on Medicaid, said Laura Harker, a health policy analyst with the left-leaning Georgia Budget and Policy Institute. She said a block grant, typically based on historical spending, could force the state to make some hard choices.

“It would block their ability to be able to provide access to more people as the program grows, even if there’s a downturn or a natural disaster,” she said. “There’s not as much flexibility to have additional help.”

The program is now designed to respond to need, as it did during the recession when 150,000 people joined the state’s Medicaid rolls.

But where some see limitations, others see room to maneuver.

“The key word is flexibility, and that’s what block grants provide,” said Brian Robinson, spokesman for a task force created by the Georgia Chamber of Commerce. “They let states decide how they’re going to run their programs and give them much more discretion when it comes to building and executing their state healthcare programs.”

The business group has led the recent effort to address the state’s healthcare woes — including high rates of uninsured residents — by exploring alternatives to traditional Medicaid expansion.

In August, a task force delivered three options for expanding the program, requiring a waiver under the federal healthcare law. Its report sparked dialogue among conservatives who’ve otherwise been shut off to the prospect of expanding the program.

That momentum, though, seemed to stall when Trump became president-elect.

“What we’re hoping is that this is not a setback but a boon,” Robinson said.

The task force’s recommendations include work and cost-sharing requirements, such as premiums or contributions to a health savings account. They are the types of changes now being discussed on the federal level.

Harker, the healthcare policy analyst, called a work requirement “really dangerous,” especially in rural areas where job opportunities and training programs are scarce.

“It just really restricts access to a doctor and to the care that they need,” she said.

This is the type of change that will be hotly debated in the coming months, even years, as a Republican-controlled House, Senate and White House grapple with how best to reform the massive law.

Some in the state’s healthcare community expected upheaval, regardless of who became the next president.

“The first thing we expected, no matter who won, was major change and probable major chaos associated with that change,” Lewis said. “Because if we believe that the system is as financially distressed as it is, and we do, then there were major corrections that had to occur.”

Jill Nolin covers the Georgia Statehouse for CNHI’s newspapers and websites. Reach her at jnolin@cnhi.com.