Trump's Medicaid budget plan could hit states, enrollees hard
Skip to main content
Sister Publication Links
  • Modern Healthcare Metrics
MDHC_Logotype_white
Subscribe
  • Subscribe
  • Register
  • Login
  • News
    • This Week's News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Political complaint against Seema Verma dropped for 'insufficient evidence'
      House GOP leaders introduce drug-pricing bill to counter Pelosi plan
      IHI releases principles to improving patient safety measures
      Plan members unlikely to benefit from Supreme Court risk corridor battle
    • Not-for-profit hospitals stabilized by Medicare pay raise, DSH cut delays
      November was healthcare's second strongest hiring month of 2019
      Primary-care provider ChenMed to enter five new markets
      Lacking specialist access drives health disparities
    • Plan members unlikely to benefit from Supreme Court risk corridor battle
      Joan Budden
      Q&A: Priority Health CEO eager to share best practices with Total Health Care
      Silver-loading, CSR elimination lowered premiums for some rural enrollees
      Centene to sell Illinois plan to CVS Health
    • Capitol Building with pills
      Week Ahead: House to vote on drug bill; SCOTUS hears risk-corridor case
      MedPAC thinks hospice payments are too high
      MedPAC says ambulatory surgical centers don't need a pay raise
      States focus on healthcare costs to address coverage problems
    • Analysts to CommonSpirit Health: Show us the savings
      Smallest hospitals saw biggest earnings gains last month
      Sutter Health postpones financial filing
      doctor helping patient stock image Sandoz
      Sponsored Content Provided By Sandoz
      As hospital executives look to reduce costs, biosimilars offer a compelling option
    • astronaut
      Astronauts developed bloodstream issues in space
      Sponsored Content Provided By ABM Healthcare
      Protecting and Maintaining Medical Devices
      human hand robotic hand stock image
      Sponsored Content Provided By Deloitte
      The Health System of the Future: How Digital Health Technology is Transforming Care
      EHR
      EHR vendors most in-use throughout Medicare incentive program
    • IHI releases principles to improving patient safety measures
      MRIs of dense breasts find more cancer but also false alarms
      Flu season takes off quickly in Deep South states
      Uber driver says South Carolina hospital dumped patient on him
    • Trinity Health appoints new COO: Ben Carter
      Jim Allison playing the harmonica
      Documentary tells tale of Nobel winning researcher
      Seema Verma
      Seema Verma's bold initiatives land her in No. 1 Most Influential spot
      New CEO takes the helm at Lurie Children's Hospital of Chicago
    • Midwest
    • Northeast
    • South
    • West
  • Special Features
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Arkansas Children’s was a founding partner in Solutions for Patient Safety.
      Children's hospitals collaborate rather than compete on patient safety
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Linda Kenney
      Patient advocate recalls two medical errors that nearly killed her
      Aurora Aguilar
      Culture of silence contributes to lack of progress on patient safety
      Arkansas Children’s was a founding partner in Solutions for Patient Safety.
      Children's hospitals collaborate rather than compete on patient safety
      Kim Hollon
      Hospitals fall short of patient-safety goals 20 years after 'To Err is Human'
    • Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Paging Dr. Robot: Artificial intelligence moves into care
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • ProMedica doubles down on social needs data analysis
      Amazon taps first pharmacy for Alexa Rx management
      Trump administration unveils new price transparency rules
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
    • VA dives into artificial intelligence R&D
      Home health to pare down therapy services, up telehealth offerings
      Amazon launches medical transcription service
      Hospitals' uncompensated care continues to rise
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Value-based pay still struggles to improve costs, quality
      Hospitals sue HHS over negotiated price disclosure rule
      Bundled payments get a boost in two states with employee programs
      CMS wants primary-care docs to take on financial risk
  • Data/Lists
    • Rankings/Lists
    • Data Points
    • Modern Healthcare Metrics
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Steve Strongwater
      How Atrius Health stayed independent by not shying away from risk
      Why moving the VA to a new EHR was a pivotal decision
      Why AdventHealth's rebrand was more than a name change
    • Terry Shaw
      A diverse and inclusive culture should empower others
      Paving the path to diversity and inclusion
      The next step in healthcare evolution
      Breaking Bias: A road map to boost women and minorities into healthcare leadership
    • Dr. Richard Snyder
      Outdated privacy laws hinder coordinated care, especially in the fight against addiction
      David Dill and Keith Myers
      Healthcare partnerships are a proven path to better care, healthier communities
      Health systems need to devote more resources to caring for the caregivers
      Fawn Lopez and Bernard Tyson
      In remembrance and gratitude for a life well-lived
    • Letters: Let’s keep humanity in discussions about patient safety
      Hospital with money
      Letters: Let providers set their prices,
 and then publish them all
      Letters: Ambulatory surgery centers aren't getting a break on regulation
      Letters: Rising Medicaid spending isn't a windfall for providers
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Nominate
    • Award Programs
    • Previous Award Programs
    • Other Award Programs
    • Nominations Open - Top 25 Minority Leaders
      Nominations Open - Health Care Hall of Fame
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • Kronos webinar logo lockup
      Sponsored Content Provided By Kronos
      Webinar: The Future of Work in Healthcare
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Critical Connections: Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Minority Leaders Gala (2020)
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Politics & Policy
March 11, 2019 10:23 PM

Trump's Medicaid budget plan could leave states and enrollees hanging

Harris Meyer
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    The $1.5 trillion Medicaid cuts and the national work requirement in President Donald Trump's new proposed budget inject fresh uncertainty into the fate of current state efforts by Republicans to overhaul the healthcare program for poor and disabled Americans.

    While details in the budget document are sparse, it appears the administration wants to replace the existing state waiver process for testing changes with a new national program granting states unfettered flexibility to customize their Medicaid programs, accompanied by tight federal spending caps. That's similar to the Senate Republicans' Graham-Cassidy plan to repeal and replace the Affordable Care Act in 2017, which failed to pass.

    Trump's proposal could eliminate the need for the CMS to develop guidelines for states to apply for waivers to receive federal Medicaid funding in the form of block grants or with per-capita spending caps, which the agency reportedly is in the process of drafting.

    In addition, a national work requirement for Medicaid beneficiaries could short-circuit pending legal challenges to CMS approval of Kentucky and Arkansas' work requirement waivers. A federal judge in Washington will hear arguments in those lawsuits Thursday.

    The plan also would end the ACA's premium subsidies to help people with income up to 400% of the federal poverty level buy private health insurance. Instead, it would offer $1.2 trillion over 10 years to fund a "market-based health care grant," a block grant to the states. It's not clear how that would relate to Medicaid.

    Experts believe the administration would need Congress to pass legislation to implement these proposals, though the budget plan leaves that unclear. While the Republican-controlled Senate might consider such legislation, it would have no chance of passing the Democratic-controlled House.

    There are major doubts about whether governors and state lawmakers, both Republicans and Democrats, would support these proposals because they would lead to greatly reduced federal Medicaid funding and force them to implement work requirements.

    On the other hand, many state leaders might welcome the greatly enhanced flexibility the Trump proposals would offer them. In addition, the proposal to grant states a block grant or per-capita system initially might give some states more money, though eventually they would receive significantly less.

    "Some governors would like this, particularly if they won't be in office when the financial squeeze is on," said Joseph Antos, a conservative health policy analyst at the American Enterprise Institute. "But the people running Medicaid and the state budget will object, saying the block grant could hurt the state if there's an unanticipated increase in enrollment or per-enrollee costs."

    The Trump budget would reduce federal Medicaid spending by $1.48 trillion over 10 years, with most of the reduction apparently due to the establishment of block grants or per-capita caps, whichever each state chooses, according to Edwin Park, a Medicaid expert at Georgetown University. Starting in 2021, federal Medicaid spending would grow annually at the Consumer Price Index, which is about two percentage points slower than actual Medicaid spending growth.

    Of that $1.48 trillion in total reduced spending, $130 billion would result from the imposition of a work requirement in all states, which likely would push many people off the Medicaid rolls. It's not clear whether the requirement would apply to the entire Medicaid population or just to people who are enrolled through ACA Medicaid expansion.

    The budget proposal would end Medicaid expansion funding. It also would allow states to restore asset tests to determine people's eligibility for Medicaid, which would reduce enrollment. The Affordable Care Act eliminated asset tests for Medicaid healthcare coverage.

    Some Republican-led states, including Utah and Tennessee, are moving to ask the CMS for waivers to receive their federal Medicaid payments in the form of block grants or capped funding, so they can enjoy greater flexibility in designing benefits and setting eligibility.

    One question is whether the Trump administration's new move to tie that flexible capped funding to big spending reductions will change those GOP officials' minds.

    "No," said Paul Edwards, deputy chief of staff to Utah's Republican Gov. Gary Herbert.

    But Trump's cap-and-cut proposal worries providers and patient advocates.

    "These cuts will leave vulnerable Americans in the lurch and make it more difficult for clinicians and hospitals to meet their healthcare needs," said Chip Kahn, CEO of the Federation of American Hospitals.

    Other experts believe conservative ideology may trump fiscal reality as Republican state officials push forward with block grant waiver requests, even if the Trump budget proposal goes nowhere.

    "I can't imagine that any governor who's allowed to go forward with a Medicaid block grant demonstration doesn't realize the price is a lot less money," said Sara Rosenbaum, a health policy professor at George Washington University. "It leaves you scratching your head about why any governor would go for it."

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    Modern Healthcare
    Copyright © 1996-2019. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Special Features
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Data Points
      • Modern Healthcare Metrics
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Critical Connections: Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Minority Leaders Gala (2020)
      • Webinars
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing