Trump Admin. Rejects 3-Year Medicaid Limit, Leaves Tribal Work Rules To States

Administrator of the Centers for Medicare and Medicaid Services Seema Verma, right, looks on as President Donald Trump speaks during a meeting on women in healthcare in the Roosevelt Room of the White House, Wednesday, March 22, 2017, in Washington. (AP Photo/Evan Vucci)
Evan Vucci/AP

The Trump administration is rejecting a proposal by Kansas to kick people off of Medicaid after three years, and also plans to allow states to exempt American Indian tribal members from Medicaid work requirement rules.

The twin announcements came in a speech Monday morning given by the Trump administration’s top Medicaid and Medicare official, Seema Verma, to the American Hospital Association.

The rejection of Kansas’ waiver application, which would would have removed people from the Medicaid rolls after three years, follows the administration’s decision to grant several states permission to enact policies to shrink their Medicaid rolls. It’s the first state flexibility waiver the administration has rejected, though the agency previously told Idaho in a letter that their proposal for gutting Obamacare regulations was unlawful.

Verma told the conference Monday that her agency is still dedicated to policies designed to move people off Medicaid. But she said Kansas’ lifetime limit proposal was a bridge too far, adding: “The Medicaid program remains a safety net for those that need it most.”

“We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them,” Verma said. 

The move is likely to discourage other states for applying for their own Medicaid lifetime limits, as Arizona, Maine, Wisconsin, and Utah have already done.

Verma also announced that Centers for Medicare and Medicaid Services (CMS) is dropping its claim that exempting Native Americans from Medicaid work requirements would be a civil rights violation. That claim had angered both tribal leaders and members of Congress by suggesting that American Indians are a race rather than a sovereign government.

Verma said that her staff now believes that if states want to exempt tribal populations from their Medicaid rules, they should be free to do so.

“We believe we can give states flexibility and discretion to implement the community engagement requirements with respect to local tribal members,” she said. “We look forward to working with states and tribes to try to help them achieve their goals and determine how to best apply community engagement to serve their populations.”

A CMS spokesperson added that the agency is instructing states seeking Medicaid waivers “that they need to work with tribal governments as part of the development of their demonstration proposal.”

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