Senators warn against placing Medicaid work requirements on tribes

Senators warn against placing Medicaid work requirements on tribes
© Greg Nash

A bipartisan group of senators is warning the Trump administration against placing Medicaid work requirements on tribes in the U.S.

The administration told tribal leaders in January in a letter that it was unable to require states to exempt American Indians and Alaska Natives from Medicaid work requirements because it is "constrained by statute." 

Such exemptions would be an illegal racial preference, the administration argues. 

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The senators, led by Tom UdallThomas (Tom) Stewart UdallEPA deputy says he's not interested in Pruitt’s job Latina Leaders to Watch 2018 Overnight Energy: Spending bill targets Pruitt | Ryan not paying 'close attention' to Pruitt controversies | Yellowstone park chief learned of dismissal through press release MORE (D-N.M.), argue not exempting tribes would violate federal law and court decisions that state tribes are not a racial group but political communities. 

"The views expressed [by the administration] fail to recognize the unique legal status of Indian tribes and their members under federal law, the U.S. Constitution, treaties, and the federal trust relationship," Udall and the senators wrote in the letter to Health and Human Services (HHS) Secretary Alex Azar. 

Several states have submitted waivers to the Trump administration asking to put work requirements on some Medicaid beneficiaries — mostly low-income, childless adults who gained coverage through ObamaCare's Medicaid expansion.

But the administration's view is that the requirements would also apply to tribes in states that have the waivers approved.

Medicaid services 50 percent of patients at some tribally operated health systems, 40 percent of patients at federally operated Indian Health Service facilities and 25 percent of all American Indian and Alaska Natives nationwide, the senators note. 

Work requirements could hamper access to health care for these groups, they wrote. 

According to the letter from the senators, Centers for Medicare and Medicaid Services Administrator Seema Verma told members of the Secretary's Tribal Advisory Committee that the HHS Office for Civil Rights (OCR) interpreted that an exemption would be considered "race based."

"Tribal leaders and organizations confirmed to our offices that other department officials have continued to cite OCR's interpretation in meetings with tribal leaders on several subsequent occasions," reads the letter from the senators, which was also signed by Democrats Charles SchumerCharles (Chuck) Ellis SchumerData confirm that marijuana decriminalization is long overdue Pollster: Kavanaugh will get Dem votes Democrats slam Trump for considering Putin’s ’absurd’ request to question Americans MORE (N.Y.), Maria CantwellMaria Elaine CantwellSenators share their fascination with sharks at hearing Poll: Majority of Americans support Roe v. Wade The Hill's Morning Report — Sponsored by Better Medicare Alliance — Protests and anger: Washington in turmoil as elections near MORE (Wash.), Jeff MerkleyJeffrey (Jeff) Alan MerkleySunk judicial pick spills over into Supreme Court fight Controversial Trump judicial nominee withdraws Anti-Trump protesters hold candlelight vigil by White House MORE (Ore.) Heidi HeitkampMary (Heidi) Kathryn HeitkampHistory argues for Democratic Senate gains Polling analyst: Same Dems who voted for Gorsuch will vote for Kavanaugh Dems pressure GOP to take legal action supporting pre-existing conditions MORE (N.D.), Martin HeinrichMartin Trevor HeinrichCNN congressional correspondent talks about her early love of trolls and family Overnight Energy: DNC to reject fossil fuel donations | Regulators see no security risk in coal plant closures | Senate committee rejects Trump EPA, Interior budgets Energy commission sees no national security risk from coal plant closures MORE (N.M.), Catherine Cortez MastoCatherine Marie Cortez MastoOn The Money: Trump rips Fed over rate hikes | Dems fume as consumer agency pick refuses to discuss border policy | Senate panel clears Trump IRS nominee Dems pressure GOP to take legal action supporting pre-existing conditions Dems press Trump consumer bureau pick over Puerto Rico response MORE (Nev.), Elizabeth WarrenElizabeth Ann WarrenOn The Money: Trump 'ready' for tariffs on all 0B in Chinese goods | Trump digs in on Fed criticism | Lawmakers drop plans to challenge Trump ZTE deal On The Money: Trump rips Fed over rate hikes | Dems fume as consumer agency pick refuses to discuss border policy | Senate panel clears Trump IRS nominee Dems fume as Trump's consumer bureau pick refuses to discuss role in border policy MORE (Mass.) and Tina SmithTina Flint SmithCVS Health CEO 'surprised' by Azar's comments on drug prices Overnight Health Care: Kentucky gov cancels Medicaid dental, vision benefits | Collins voices skepticism court will overturn Roe v. Wade | Dems press 'middlemen' on drug costs Pair of Dem senators probe drug pricing 'middlemen,' distributors over high costs MORE (Minn.), as well as Republican Lisa MurkowskiLisa Ann MurkowskiThis week: GOP mulls vote on ‘abolish ICE’ legislation Dem infighting erupts over Supreme Court pick McConnell: Senate to confirm Kavanaugh by Oct. 1 MORE (Alaska). 

HHS has provided "little insight" into the "legal and policy foundation" for their beliefs, the senators wrote, citing conversations with tribal leaders and other groups.