Guidance for Block Grant Waivers Threatens the Medicaid Health Insurance Safety Net
Washington, DC – In yet another attempt to transform Medicaid and the Affordable Care Act (ACA) through administrative action, the Centers for Medicare and Medicaid Services issued guidance encouraging states to apply for waivers to block grant Medicaid funding at the state level. This guidance aims to radically restructure Medicaid, which provides health insurance coverage to 74 million people nationally. Over its 50 year history, Congress has designated Medicaid as an open-ended, federal-state entitlement program, providing access to health care for older adults, people with disabilities, children, families, and low-income adults. The state entitlement funding structure means the federal government pays its share of however much a state spends on health care. If a state has unexpected health care costs – for example, to respond to a natural disaster, an epidemic, an economic downturn — the federal government continues to support the state. Block grants, in contrast, provide states with a low and finite amount of federal funds, and when states exceed that amount, the state must bear the costs or cut back on coverage.
“This is an underhanded attempt by the President to do what even a Republican Congress refused to do as recently as the failed Affordable Care Act repeal effort in 2017. People across the country in both political parties called their legislators and stopped that attempt to slash Medicaid,” said Leo Cuello, NHeLP’s director of health policy. “After that failure, the administration attempted to circumvent Congress and transform Medicaid through other means such as restrictive work requirements, which courts so far have found illegal. Apparently desperate to cut health care coverage, the administration is seeking to fund harmful block grants. And make no mistake, these block grants would be devastating for any state that attempts to implement them, and any irresponsible state leader that pursues this policy will be acting against his or her state’s interests – harming the state budget, rural hospitals, state health insurance coverage—and the people who depend on Medicaid for their health insurance coverage.”
Jane Perkins, Legal Director for the National Health Law Program, echoed these sentiments: “While not unexpected, today’s announcement by Administrator Verma is certainly disappointing. This is just one more example of the Trump administration attempting to explode the Medicaid Act that Congress has written. The document issued today by CMS appears to re-write bedrock provisions of Medicaid, an activity which is beyond the scope of CMS’s power. Only Congress is tasked with making these changes. Our legal team is carefully investigating the enforcement and litigation options at this time.”
For additional comment from Perkins or Cuello, please contact NHeLP’s acting Director of Communications Andy DiAntonio at [email protected] or 703.615.0786.
