Trump's administrator will try to let states limit Medicaid benefits

Texas Capitol

Texas Capitol

Verma said the Medicaid law allows for state waivers to promote experimentation, and the plan does not cross any red lines set by Congress.

Although the administration asserted that the rules would give states "new levels of flexibility" in running their Medicaid programs, in fact they would lock them into annual caps for Medicaid that could not be exceeded.

Also, the agency said that for the first time, participating states will have more negotiating power to manage drug costs by adopting a formulary similar to those provided in the commercial market, with special protections for individuals with HIV and behavioral health conditions. Instead of the benefits of the full program - which saves lives, boosts maternal and infant health, and cuts the poverty rate - people in states that apply for this program could get something less or nothing at all.

Lee has said that if the block grant deal is not a good one for Tennessee, he will not pursue it. Republican governors in Oklahoma and Arkansas welcomed the offer, but it's unclear how many states will take it up. "Work requirements were a way for them to kind of help save face, to expand Medicaid, but still be able to make it appear as though they were remaining true to their conservative bona fides".

One potential twist is whether GOP-led states that have refused the Affordable Care Act's Medicaid expansion would be more receptive under the terms proposed by Verma. Exempting the impoverished parents, children, pregnant women, elderly and disabled people covered by a state's traditional Medicaid plan, it would apply only to able-bodied adults under 65 who are either impoverished but childless or somewhat less poor, regardless of family size.

The Center for Medicare and Medicaid Services Administrator Seema Verma discusses the Healthy Adult Opportunity program at HHS headquarters on Thursday morning. Those requirements include a job, community service or attending training or education for at least 80 hours a month.

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Verma said the federal government would monitor a state's performance, acting not only as a fiscal bean counter but also to protect Medicaid recipients.

The federal government notified Gov. Gavin Newsom's administration Friday that it is rejecting California's Medicaid financing proposal, a decision that could cost the state $1.2 billion starting next year.

With this announcement, the Trump administration is delivering on a longtime conservative ideal - block grants for Medicaid have been discussed for almost as long as Medicaid has existed, going back to the Nixon administration. The handful of states that have obtained such waivers, however, have been sued by people who lost coverage, and their courts have been sympathetic to their complaints. "President Trump is once again breaking the law and a promise he made to the American people".

It is a huge part of the health care system, and the Trump administration has been fully committed, since day one, to shrinking it. She says the state needs to get serious about addressing the opioid crisis, rural hospital closures, and the recent drop in the number of poor children covered by TennCare, Tennessee's version of Medicaid. She noted it is weighing down state budgets - consuming almost 29% in fiscal 2017 - and squeezing out other priorities. "We shouldn't have to tell someone with a disability to get on a wait list for services because we're diverting precious resources to cover someone who doesn't potentially qualify", said Verma, referencing working-age adult enrollees added under the Obama administration's expansion of the program. Those changes will disproportionately affect people with more serious health issues, she said. Trump's budgets have continued to call for limits on the federal share of Medicaid.

"The Healthy Adult Opportunity represents an innovative and historic approach to surmounting Medicaid's structural challenges", she said.

Bagley called that "a particularly galling bit of double-speak", since throwing enrollees out of Medicaid can hardly be judged "consistent" with a program aimed at signing people up for coverage.

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