Capitol Correspondence - 03.25.19

Circumventing Congress: Administration Encourages States to Make Changes to Medicaid

Share this page

ANCOR is sharing this article by The Hill because it highlights the Administration’s interest in exploring ways to change Medicaid without having to go through Congress. ANCOR has been following Administration Medicaid efforts since January, when news broke that the White House is considering an agency-based proposal to block-grant Medicaid. Block grants are also discussed in this article. ANCOR opposed 2017 Congressional efforts to reform Medicaid into a block grant program because as written, the proposals would have affected the stability of supports which people with disabilities rely on to live life like everyone else. ANCOR will keep members informed on the Administration’s Medicaid efforts and whether there is a need for action.

As written by The Hill:

“The Trump administration is pulling out all the stops to encourage red states to make conservative changes to Medicaid without congressional input.

Administration officials are pushing ahead and granting approvals to states seeking to impose work requirements on Medicaid recipients, even in the face of legal challenges and large-scale losses in the number of people covered.

Last week, the Centers for Medicare and Medicaid Services (CMS) granted Ohio’s request for work requirements, the ninth such approval since President Trump took office.


But the administration’s efforts are much broader than work requirements.

Azar has also been quietly trying to sell states on the merits of imposing block grants, or a per-person spending cap, without congressional approval.

Azar revealed those discussions for the first time during a Senate hearing last week.


Azar’s admission raised hackles among Democrats, who fiercely oppose the idea, which would limit the amount of money going to Medicaid. Democrats argue the changes require harmful cuts in the program.


A Medicaid lobbyist said the administration has been actively seeking out states willing to experiment with new models of financing Medicaid that have never been previously approved.


Administration officials are also drafting a guidance or regulation that would make it easier for states to apply for a capped payment or block grants, another controversial move.

Allowing states to impose those same changes by statutory waiver, without congressional approval, would be extremely controversial and have widespread implications about the use of executive power.”