BY TONY PUGH
February
05, 2018 06:58 PM
Updated February 07, 2018 06:08 PM
WASHINGTON
After allowing states to impose work requirements for
Medicaid enrollees, the Trump administration is now pondering lifetime limits
on adults’ access to coverage.
Capping health care benefits — like federal welfare benefits
— would be a first for Medicaid, the joint state-and-federal health plan for
low-income and disabled Americans.
If approved, the dramatic policy change would recast
government-subsidized health coverage as temporary assistance by placing a
limit on the number of months adults have access to Medicaid benefits.
The move would continue the Trump
administration’s push to inject conservative policies into the Medicaid program
through the use of federal waivers, which allow states more
flexibility to create policies designed to promote personal and financial
responsibility among enrollees.
However, advocates say capping Medicaid benefits would amount to a
massive breach of the nation’s social safety net designed to protect children,
the elderly and the impoverished.
In January, the Trump administration approved waiver requests from
Kentucky and Indiana to terminate Medicaid coverage for able-bodied enrollees
who do not meet new program work requirements. Ten other states have asked to
do the same.
“We must allow states, who know the unique needs of their
citizens, to design programs that don’t merely provide a Medicaid card but
provide care that allows people to rise out of poverty and no longer need
public assistance,” said a statement posted on Twitter on Monday by Medicaid
administrator Seema Verma.
At least five states — Arizona, Kansas, Utah, Maine and Wisconsin
— are seeking waivers from the Trump administration to impose lifetime Medicaid
coverage limits. The Department of Health and Human Services said it could not
comment on the pending applications.
But the proposals appear to reflect
the administration’s position that Medicaid coverage should be retained for
vulnerable populations like children, pregnant women and those with
disabilities. The administration has been open, however, to coverage limits for
healthy adults, particularly those with no dependent children who gained
coverage under Obamacare’s Medicaid expansion.
Critics say Medicaid time limits will pose an enormous
administrative burden by requiring states to track recipients’ employment, eligibility
and disability status. It could also shave valuable coverage months from people
with health problems that impede their ability to work.
In addition, low-wage workers who may not get health coverage
through their jobs could also reach their Medicaid coverage limit “as if it’s
their fault that their job isn’t offering insurance,” said Leonardo Cuello,
director of health policy at the National Health Law Center. “And this would
happen to thousands upon thousands of people across the country,” if the policy
catches on nationwide.
Others argue that attaching time limits and work requirements to
Medicaid coverage does not meet a basic requirement of HHS waiver experiments
and demonstration projects: to further the objectives of the Medicaid program,
such as improving coverage, health outcomes and access to providers.
“All of these policies that we are seeing are inconsistent with
the objectives of Medicaid. They don’t seem to seem to have a legal basis and,
as such, our stance is that they should not be approved. And we will work very
hard with our partners to make that opinion well known,” said Suzanne Wikle, a
senior policy analyst at the Center for Law and Social Policy.
Time limits, work requirements, eligibility lockouts and similar
policies are part of a new wave of Medicaid restrictions that appear to have
gained favor with the Trump administration. In a March 2017 letter to the nation’s governors, Verma
said HHS would review and approve “meritorious innovations” for Medicaid “that
build on the human dignity that comes with training, employment and
independence.”
They also pledged to streamline and expedite the waiver process,
which can take more than six months.
But unlike capping cash welfare assistance or food stamp benefits,
time-limiting health coverage runs the risk of pushing sick people into costly
emergency rooms where they’ll receive indigent care paid for by taxpayers.
“I think you have to be very thoughtful here in a way that’s quite
different from cash assistance,” said Gail Wilensky, a senior fellow at Project
HOPE who ran the Medicaid program from 1990 to 1992 under President George H.W.
Bush. “It depends on what the safeguards and defaults are in a program like
this. Otherwise it does not make a lot of sense and seems to be cruel and
inappropriate.”
Arizona and Utah both want a 5-year lifetime limit on coverage.
Utah’s would apply only to childless adults and would come “with the
expectation that they do everything they can to help themselves before they
lose coverage,” according to the state’s waiver application.
In Arizona, time-limited coverage would only accrue during months
when enrollees don’t meet their work requirements, which the state is also
seeking in their waiver application. Wisconsin wants to limit lifetime coverage
for childless adults to 48 months. Kansas would limit coverage to 36 months.
In Utah, Wisconsin and Kansas, the time-limited coverage would
apply even to Medicaid enrollees who meet employment and work requirements.
In Maine, Medicaid enrollees who don’t meet program work
requirements could only get up to three months of coverage in a 36-month
period. And only in special circumstances could these enrollees get an extra
month of coverage.
The Obama administration previously denied Arizona’s request for
Medicaid coverage limits and work requirements, saying they didn’t meet the
program’s goal of ensuring coverage for vulnerable populations.
Jessica Schubel, a senior policy analyst at the Center on Budget
and Policy Priorities, said there’s a “50-50 chance” that the Trump
administration approves the time limits.
“I feel like the Trump administration is hell-bent on trying to
keep people out of coverage … So, I don’t know. I hope not, but I’m not holding
my breath. And I guess I wouldn’t be too terribly surprised to see it
approved,” said Schubel, a former senior policy advisor at HHS’ Center for
Medicare and Medicaid Services during the Obama administration.
The Department of Health and Human Services said it could not
comment on the pending applications.
Tony Pugh: 202-383-6013, @TonyPughDC
http://www.mcclatchydc.com/news/politics-government/article198549039.html
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