Trump Administration Encouraging States to Make Controversial Changes to Medicaid
Health Care

Trump Administration Encouraging States to Make Controversial Changes to Medicaid

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The Trump administration is encouraging red states to make controversial conservative changes to Medicaid without seeking congressional approval, The Hill’s Nathaniel Weixel reports.

The Centers for Medicare and Medicaid Services last week granted Ohio’s request to impose work requirements on beneficiaries. The approval came a day after a court hearing on challenges to work requirements in Arkansas and Kentucky. The requirements introduced in Arkansas have reportedly led to 18,000 people losing coverage — and the early data provides little evidence that the program is helping drive people into the workforce.

“To approve it the day after the court hearing was pretty in-your-face,” Joan Alker, executive director of the Georgetown University Center for Children and Families, tells Weixel. “It’s a statement of, ‘we’re going to push forward with our policy regardless of what a judge thinks.’”

The White House’s 2020 budget blueprint would impose a national work requirement on Medicaid and proposes shifting the program to a system of block grants or per capita caps under which states would be allowed more flexibility to change their Medicaid programs.

The block grants and per capita caps failed to pass Congress as part of the Republican Obamacare repeal efforts in 2017, and they are unlikely to gain traction in the current divided Congress. But the Trump administration “has also been quietly trying to sell states on the merits of imposing block grants, or a per-person spending cap, without congressional approval,” Weixel reports.

Critics say the administration’s moves represent an improper attempt to bypass Congress.

“This is a separation of powers issue,” Georgetown’s Alker tells The Hill. “Congress retains the authority to change Medicaid. The waiver was not intended to allow the executive branch to rewrite the Medicaid statute.”

The Trump administration has fervently defended its approach, and Health and Human Services Secretary Alex Azar told the Senate Finance Committee last week that discussions on changes such as block grants have been instigated by states. But a Medicaid lobbyist tells The Hill that the administration has been seeking out states open to testing new models.

Why it matters: Besides the constitutional issues at play, the administration’s efforts could have significant health care implications. “As GOP-led states move to further restrict Medicaid, the divide between red and blue states is likely to mean wider geographic disparities in health-care coverage and access,” The Wall Street Journal’s Stephanie Armour wrote last week.

The bottom line: If the Trump administration does push ahead with additional waivers along these lines, expect more uproar from Democrats — and more challenges in court.