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In a speech before the National Association of Medicaid Directors, Seema Verma outlined the administration’s vision and called for a “reset” of the federal-state partnership.
ARLINGTON, Va. — The Trump administration signaled Tuesday that major changes are around the corner regarding the relationship between states and the federal government when it comes to Medicaid, the program that provides health coverage for millions of low-income Americans.
In a speech before the country’s state Medicaid directors, Seema Verma, the head of the Centers for Medicare and Medicaid Services, outlined her vision for the agency and called for a “reset’ on the federal-state partnership. Verma also indicated her intention to give states greater leeway to alter their individual systems, a plan which could include approving waivers that allow states to impose work requirements on select adult enrollees.
“CMS believes that meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being, and health of Americans,” Verma said.
Work requirements for Medicaid enrollees have long been championed by advocates on the right, including Verma herself, but approval of these waivers would signal a sharp departure from past federal policy.
Eight states—Arizona, Arkansas, Indiana, Kentucky, New Hampshire, Maine, Utah and Wisconsin—have submitted requests to CMS that would make it mandatory for non-disabled adults enrolled in Medicaid to either work or engage in community service, but President Obama’s administration rejected these requirements across the board.
Verma made it clear in no uncertain terms what she thinks of the Obama administration’s position on these types of state waivers—framing the rejection of these work requirements as a form of “soft bigotry.”
“Believing that community engagement requirements do not support the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” Verma said. “Those days are over,” she added.
Critics of work requirements argue that these mandates are counterproductive to the goal of poverty reduction—in short, that barring people from accessing health care may keep them from being healthy enough to hold a stable job. And, many experts argue that those adult Medicaid enrollees who can work, already do work.
A Kaiser Family Foundation survey from February 2017 found that the majority (59 percent) of adults that would be considered for these work requirements are already working. And those who are not currently working report serious impediments to being able to have a job. More than one-third of those polled reported that an illness or disability prevented them from working, and anther 28 percent reported they were taking care of a home or a family member.
Verma made it clear throughout her address that her philosophy on the role of Medicaid differs considerably from her predecessors. Her view of past Medicaid reforms, including the expansion of the program as part of the Affordable Care Act, was that they represented growth of the Medicaid rolls, without an improvement in the quality of the service provided. The phrase she returned to over and over again in her speech categorized these reforms as giving people a “card without care.”
Verma also emphasized that work requirements wouldn’t be the only changes administration would be open to.. She indicated that under her leadership, CMS would seek to expedite the waiver process overall and break down the barriers that she sees as preventing state experimentation and innovation. The CMS head’s speech came after an announcement from the agency on Monday that along with streamlining the waiver process, the administration would double the lifetime of some state waivers—from five to ten years.
Verma did reaffirm her belief, as well as that of President Trump, that Medicaid is “central to our promise to the American people”—noteworthy in light of months-long GOP efforts to repeal and replace the ACA that would have involved a phasing out of that law’s Medicaid expansion—but the CMS chief also indicated that state officials should remain ready for even more change to come.
“We’re ushering in a new day for Medicaid at CMS—not closing the book, but turning the page and starting a new chapter,” Verma said.
Quinn Libson is a Staff Correspondent at Government Executive’s Route Fifty based in Washington, D.C.