Trump To Change Medicaid Funding Rules, Threatening Healthcare For Millions
President Donald Trump promised during his 2016 campaign that he would not touch entitlements, including Social Security, Medicare and Medicaid — but that promise flew out the window as he loaded his administration with conservatives long bent on overhauling the nation’s social safety net.
Now, after the courts shot down his prior attempt to gut Medicaid, Trump is looking to another move that could threaten healthcare access for tens of millions of Americans.
The “Healthy Adult Opportunity”, unveiled by the administration on Thursday, “would encourage states to cut benefits and narrow eligibility for residents who qualify under the Affordable Care Act’s Medicaid expansion provision,” Michael Hiltzik explained in The Los Angeles Times.
Under the guise of “new levels of flexibility” for states in implementing their Medicaid programs, the new rules would lock states into capped Medicaid funding — effectively instituting a block grant situation.
Together with the Children’s Health Insurance Program (CHIP), Medicaid serves more than 70 million Americans, Hiltzik noted, with cost of about $600 billion shared between states and the federal government.
Medicaid was expanded in 2010 with the Affordable Care Act, which extended coverage to childless low-income adults, and Republicans have been eager to roll that expansion back ever since.
This latest attack on the program “would allow states to impose work requirements or premiums on Medicaid recipients, even though work rules have been overturned in the federal courts,” and enrollees could be suspended if they fail to pay premiums after a grace period.
It would also allow states to rework their Medicaid programs to “cover only sufferers from specific conditions — ‘such as individuals with severe mental illness, individuals needing treatment for substance use disorder, or individuals with HIV/AIDS,’ the Centers for Medicare and Medicaid Services said in a letter to state Medicaid directors dated Thursday.”
States could also reduce access to prescription drugs under the new rules.
But the biggest and most dangerous change by far, Hiltzik wrote, is the move to capped funding: “The proposal would allow states to run Medicaid under an “aggregate” cap determined by previous yearly spending, or a per capita limit based on population growth.” Such a move would make it difficult — if not impossible — for state’s to address negative shocks like disease outbreaks, natural disasters or economic catastrophes, all of which would require a lengthy process for states to renegotiate spending caps with the federal government.