Trump administration flouting Medicaid rules to allow states to kick people out of program

WASHINGTON, DC - MARCH 22: Health care activists participate in a rally in front of the Capitol March 22, 2017 on Capitol Hill in Washington, DC. Senate Democrats held the rally to highlight changes being sought in Medicaid in the Republican American Health Care Act. (Photo by Alex Wong/Getty Images)

In a review of records, the Los Angeles Times has found that the Trump administration is skirting the rules established to ensure the health of Medicaid patients in its rush to kick people off the program via work requirement waivers.

Federal rules still in effect direct states to assess the impact of the policies they implement on the people receiving care. The Times found that “None of the eight states that the administration has cleared to implement a Medicaid work requirement has in place a plan to track whether Medicaid enrollees find jobs or improve their health, two goals often touted by administration health officials.” Beyond that, more than half of the states that the administration has approved work requirement waivers in—nine of 17—have been “allowed by the Trump administration to proceed with their applications despite failing to calculate the number of people who could lose coverage, according to a review of state and federal Medicaid records.”

Joan Alker tracks Medicaid as executive director of the Georgetown University Center for Children and Families, a research organization that focuses on policy. She says that the Trump administration seems to be purposefully and regularly either ignoring or weakening the requirements in the regulations that states have independent analysis on the impact of their new rules. “There is a lot of hiding the ball here,” she told the Times. That means trying to avoid bad news, like the massive loss of coverage in states like Arkansas, where 18,000 people so far have been kicked off. “We know that health insurance coverage is very popular,” Alker said. “So taking it away, as some of these plans do, is not something the administration wants to talk about.”

As of now, Arkansas still hasn’t provided an approved research plan to show the impact of its rules, despite the fact that they were allowed to implement it back in June 2018. So far, states that are looking to implement work requirements including Arizona, Arkansas, Kansas, Michigan, New Hampshire, Oklahoma, South Dakota, Tennessee, and Wisconsin have not provided detailed plans for evaluating how the experiment will affect the Medicaid populations in their states.

This is a critical issue for Utah and Idaho, where Medicaid expansion passed as citizens’ initiatives in November, and where the legislatures are trying to blunt the bills by adding on restrictions like work requirements. Georgia and Oklahoma are also considering expanding Medicaid with waivers, possibly including work requirements. As it stands, there’s essentially no accountability in the federal government for how states use taxpayer money intended to provide Medicaid coverage.

It’s just one more way the Trump administration is flouting federal laws and norms to pursue a right-wing, extremist—not to mention kleptocratic—agenda.

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