Despite promises from the Trump administration to restructure Medicaid and reduce its funding by hundreds of billions of dollars, state Medicaid directors say it's unlikely there will be major changes to the program.
On Monday, the Trump administration released a budget proposal that projected cutting Medicaid spending by at least $600 billion over a 10-year period, assuming the program is converted to a per capita cap program as outlined in the American Health Care Act.
Andy Slavitt, former acting CMS administrator, said at the Avia Network Summit Tuesday that President Donald Trump's proposed budget represented a regression to when Medicare and Medicaid was implemented in 1965. "What we saw today is a budget cut to Medicaid that forces us to revisit the progress of 1965," he said.
But several Republican lawmakers said on Monday and Tuesday that the budget is dead on arrival. State Medicaid directors said those comments and the Senate's work to write its own health reform bill from scratch make them unsure that Medicaid spending will be slashed.
"I'm betting on a stalemate on major reform," Joe Moser, who recently resigned from his post as Indiana's Medicaid director, said at a managed Medicaid conference Tuesday.
Moser said lawmakers will see pushback from states over their plans to cut billions in federal funding without offering states substantive new flexibility , such as the ability to alter eligibility requirements or provider rates.
Congress would have to give states those privileges, which could be necessary for Medicaid programs to survive, according to Claudia Schlosberg, interim Medicaid director for Washington, D.C.
"I'm not sure that that's something that this Congress and this president are going to achieve," Schlosberg said. "Without that, we end up with massive cuts and no way to really manage the program."
Despite repeated public pronouncements that the CMS under the Trump administration would become more friendly to states by offering new flexibility and less regulatory burden, Medicaid directors on the conference panel Tuesday said it's been business as usual thus far. The CMS has failed to respond to waivers, state plan amendments and rate requests for months after receiving them.
"I've seen a shift a tone, but I haven't seen a shift in terms of actual change," said Mike Randol, Kansas' Medicaid director.
Some of the directors said they wondered whether they would have to make dramatic waiver requests to see any policy movement in their states.
Deb Florio, Rhode Island's Medicaid director, highlighted a recent request from Wisconsin to drug test people as a condition of Medicaid eligibility.
"Will it be an era of making deals with the new administration?" Florio said. "If I drug test everyone, will you give me a $1 billion to help with drug treatment in my state?"