Trump Administration's Block Grant Guidance Targets Cuts to Medicaid Again And Hurts Families and States

Families USA executive director Frederick Isasi released the following statement regarding the Centers for Medicare and Medicaid Services' guidance for block-granting Medicaid. 

"Families USA vehemently opposes the Trump Administration's Medicaid guidance that would allow states to block grant their programs for potentially large cuts in federal Medicaid support. The concept is very clear: Tempt governors with extra-funding or minor flexibilities upfront and then years later, perhaps under a different governor, "cash the check" and slash federal support for the Medicaid program. Having spent many years working with governors and Medicaid programs, block grants are possibly the worst Medicaid idea ever presented to states by a federal Administration. They would allow the federal government to off-load shared Medicaid responsibility at the expense of deep cuts to state budgets, vital programs supported by states, and the people who rely on those programs.

Today's announcement about the so-called, "Healthy Adult Opportunity," essentially gives states the green light to indiscriminately (or discriminately) cut the Medicaid program, with no oversight and no consequences.

Here is what we know about it:

• All adults under age 65, with few exceptions, are at risk. This means coverage and benefits for our most vulnerable -- pregnant women, children 19 and older, and kids in foster care are on the chopping block; and
• CMS is offering states less oversight and only the potential of savings in exchange for taking on huge amounts of financial risk, putting state taxpayer dollars and constituent lives at risk.

Despite the pretty picture the Trump administration is trying to sketch about putting forth a more patient-centered approach for Medicaid, the truth is this proposal does not put the patient first or strengthen Medicaid. With state budgets already stretched thin, accepting Medicaid block grants could likely amount to willful fiscal malpractice and blatant disregard for the needs and interests of states and families. Any governor or state legislature that accepts this nonsensical offer from the Trump administration could not only hurt the millions of families that rely on Medicaid, they could be pouring gasoline on state budget crises that are already ablaze with cuts and program closures.

In my years of work with governors, Medicaid program directors, and legislatures, their number one Medicaid concern is that the federal government might reduce federal support for their programs. Why in the world would states ever agree to block grants, which could guarantee that such cuts would occur? It is concerning that governors of states where Medicaid expansion has been debated will feel pressure to follow this guidance. One example is Oklahoma, where Medicaid expansion will appear as a ballot initiative this November. Other examples are Alaska and Georgia.

Beyond being morally reprehensible, this guidance is illegal. Period. The Trump administration does not have jurisdiction to waive Medicaid's financing structure by fiat -- that must be done through Congress. Further, block-granting Medicaid fails to promote the fundamental objective of the program, which is to serve low-income and working individuals and families. When President Trump and Republican leaders in Congress tried this in 2017, millions of Americans lifted their voices in opposition. The President lost. Now he is attempting an illegal end-run around his failed political effort and trying to take health care away from millions.

While today's announcement applies directly to non-elderly adults, the Trump administration has proposed mandatory caps on federal Medicaid financing for all Medicaid populations. The 72 million people who depend on Medicaid will suffer because of this terrible vision for Medicaid: parents, children with complex health care needs, pregnant woman, and the elderly in nursing homes. And research indicates that when parents have difficulty accessing healthcare insurance, coverage for their children also becomes difficult. If states allow the federal government to off-load its responsibilities for these people, they are putting wrongheaded ideology ahead of the people's needs. Is this really who we are as a nation?"

Eliot Fishman, Families USA senior director of health policy, added, "Any state taking this offer is engaging in fiscal malpractice. Furthermore the Administration is acting lawlessly. None of the statute regarding Medicaid match rates can be waived administratively."

We are better than this, and we--the American people--must hold the Trump administration and Republican members of Congress accountable."