The Trump administration said Tuesday it will encourage states to push people on Medicaid to find jobs, accusing President Obama of “stretching the safety net” by lumping able-bodied enrollees into the program and ignoring suggestions for how to wean people off the government dole.
Centers for Medicare and Medicaid Services Administrator Seema Verma said President Trump supports ideas designed to get people to “move up, move on, and move out” of the program, which is jointly funded by the federal government and states.
“Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration. Those days are over,” Ms. Verma told the National Association of Medicaid Directors.
She defined community engagement as working, volunteering, going to school or obtaining job training.
CMS said it will take a broader view of demonstration programs, known as “Section 1115,” that would allow states to request a Medicaid waiver from the administration and impose work requirements. And it will expedite its review of waiver applications.
Mr. Verma said CMS will also set up a scorecard system to figure out which reforms work and which do not.
Obamacare supporters and leading Democrats reacted angrily to the proposed changes, saying they amount to impediments to health care.
“Instead of helping vulnerable Americans get health care, the president and his administration have devised another way to put it farther out of reach,” said Sen. Ron Wyden of Oregon, the ranking Democrat on the Senate Finance Committee. “By opening the door to onerous obstacles for families who count on Medicaid as a lifeline, the Trump administration would be violating the core objectives of the program.”
Earlier this year, Mr. Trump backed GOP legislation to repeal and replace Obamacare that would have sharply curtailed federal spending on Medicaid.
The bills also would have phased out Mr. Obama’s vast expansion of the program to those making 138 percent of federal poverty.
Those efforts fell short, but Mr. Trump wants to revive a slimmed-down Obamacare repeal that would replace the 2010 law with state block grants. He hopes to have Congress act on that early next year.
As it stands, 31 states have expanded their Medicaid programs under Obamacare, citing generous matching funds from federal taxpayers, and Maine voters were deciding Tuesday whether to join them.
Maine Gov. Paul LePage urged residents to reject the ballot question, saying it would usher in a new form of costly welfare.
Ms. Verma said Mr. Obama’s decision to expand Medicaid under his 2010 health law — without firm incentives to move able-bodied people back off the rolls — put federal financing and regulation ahead of outcomes at the local level, potentially crowding out the most vulnerable as states struggle to pony up their share of funding.
“We fail to live up to that promise when Medicaid merely provides a card without care,” she said.
The Kaiser Family Foundation says six states — Arkansas, Indiana, Kentucky, Maine, Utah, and Wisconsin — have pending waiver requests that would require work as a condition of Medicaid eligibility, either in the expansion or the traditional Medicaid populations, as of September. Kentucky and Indiana would establish work requirements for both populations.
“Let me be clear to everyone in this room — we will approve proposals that promote community engagement activities,” Ms. Verma told Medicaid directors. “Every American deserves the dignity and respect of high expectations and as public officials we should deliver programs that instill hope and say to each beneficiary that we believe in your potential.”