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. 

ADVERTISEMENT

The senators, led by Tom UdallTom UdallOvernight Defense: Milley reportedly warned Trump against Iran strikes | Pulitzer Prize-winning photographer killed in Afghanistan | 70 percent of active-duty military at least partially vaccinated Biden nominates former Sen. Tom Udall as New Zealand ambassador Senate Democrats befuddled by Joe Manchin 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 SchumerChuck SchumerBiden discusses agenda with Schumer, Pelosi ahead of pivotal week CEOs urge Congress to raise debt limit or risk 'avoidable crisis' If .5 trillion 'infrastructure' bill fails, it's bye-bye for an increasingly unpopular Biden MORE (N.Y.), Maria CantwellMaria Elaine CantwellDelta variant's spread hampers Labor Day air travel, industry recovery Wyden asks White House for details on jet fuel shortage amid wildfire season Air travel hits pandemic high MORE (Wash.), Jeff MerkleyJeff MerkleyDemocrats revive filibuster fight over voting rights bill Senate backers of new voting rights bill push for swift passage Stacey Abrams backs Senate Democrats' voting rights compromise MORE (Ore.) Heidi HeitkampMary (Heidi) Kathryn HeitkampProgressives prepare to launch counterattack in tax fight Business groups aim to divide Democrats on .5T spending bill On The Money: Powell signals Fed will soon cut stimulus MORE (N.D.), Martin HeinrichMartin Trevor HeinrichOvernight Equilibrium/Sustainability — Presented by Schneider Electric — Deadly Ida floodwaters grip southeast US David Sirota: Seven Democrats who voted against fracking ban trying to secure future elections Deadly extreme heat has arrived: here's how policymakers can save lives MORE (N.M.), Catherine Cortez MastoCatherine Marie Cortez MastoFormer Sen. Heller to run for Nevada governor Top Hispanic group endorses Cortez Masto for reelection Conservation group says it will only endorse Democrats who support .5T spending plan MORE (Nev.), Elizabeth WarrenElizabeth WarrenFederal Reserve officials' stock trading sparks ethics review Manchin keeps Washington guessing on what he wants Warren, Daines introduce bill honoring 13 killed in Kabul attack MORE (Mass.) and Tina SmithTina Flint SmithOvernight Energy & Environment — Presented by Climate Power — Democratic leaders vow climate action amid divide Manchin puts foot down on key climate provision in spending bill On The Money — The Democratic divide on taxes MORE (Minn.), as well as Republican Lisa MurkowskiLisa Ann MurkowskiEmboldened Trump takes aim at GOP foes The Hill's 12:30 Report - Presented by Facebook - DC prepares for Saturday of festivals & Jan. 6 demonstration Republican leaders misjudged Jan. 6 committee 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.