The Trump administration is proposing an unprecedented change to Medicaid benefits as it considers allowing lifetime caps on coverage, a move that critics say would be detrimental to vulnerable low-income Americans who obtained coverage under Obamacare.
The move would continue the Trump administration’s push to inject conservative policies into the Medicaid program through the use of federal waivers, which allow states more flexibility to create policies designed to promote personal and financial responsibility among enrollees.
However, advocates say capping Medicaid benefits would amount to a massive breach of the nation’s social safety net designed to protect children, the elderly and the impoverished.
Arizona, Kansas, Utah, Maine and Wisconsin are among the first states to apply for waivers that would allow capping Medicaid benefits, but the Department of Health and Human Services could not comment on pending applications.
But the proposals appear to reflect the administration’s position that Medicaid coverage should be retained for vulnerable populations like children, pregnant women and those with disabilities. The administration has been open, however, to coverage limits for healthy adults, particularly those with no dependent children who gained coverage under Obamacare’s Medicaid expansion.
The specifics of the proposals vary:
- "Arizona and Utah both want a 5-year lifetime limit on coverage. Utah’s would apply only to childless adults and would come “with the expectation that they do everything they can to help themselves before they lose coverage,” according to the state’s waiver application."
- "In Arizona, time-limited coverage would only accrue during months when enrollees don’t meet their work requirements, which the state is also seeking in their waiver application. Wisconsin wants to limit lifetime coverage for childless adults to 48 months. Kansas would limit coverage to 36 months."
- "In Utah, Wisconsin and Kansas, the time-limited coverage would apply even to Medicaid enrollees who meet employment and work requirements."
- "In Maine, Medicaid enrollees who don’t meet program work requirements could only get up to three months of coverage in a 36-month period. And only in special circumstances could these enrollees get an extra month of coverage."
Critics have been quick to point out several issues with such proposals: increased costs associated with tracking individuals' benefits usage and work requirement status; loss of coverage for low-income Americans who will resort to costly emergency room visits; and the fact that such moves appear to fly in the face of Medicaid's stated mission.
Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities, said there’s a “50-50 chance” that the Trump administration approves the time limits.
“I feel like the Trump administration is hell-bent on trying to keep people out of coverage … So, I don’t know. I hope not, but I’m not holding my breath. And I guess I wouldn’t be too terribly surprised to see it approved,” said Schubel, a former senior policy advisor at HHS’ Center for Medicare and Medicaid Services during the Obama administration.