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 UdallOvernight Defense: Foreign policy takes center stage at Democratic debate | House delivers impeachment articles to Senate | Dems vow to force new vote on Trump's border wall Democrats vow to force third vote on Trump's border wall emergency declaration Overnight Defense: War powers fight runs into impeachment | Kaine has 51 votes for Iran resolution | Trump plans to divert .2B from Pentagon to border wall 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 SchumerSchumer votes against USMCA, citing climate implications Senators are politicians, not jurors — they should act like it GOP senator: 2020 candidates must recuse themselves from impeachment trial MORE (N.Y.), Maria CantwellMaria Elaine CantwellFive tech stories to watch in 2020 Hillicon Valley: House panel unveils draft of privacy bill | Senate committee approves bill to sanction Russia | Dems ask HUD to review use of facial recognition | Uber settles sexual harassment charges for .4M Key House committee offers online privacy bill draft MORE (Wash.), Jeff MerkleyJeffrey (Jeff) Alan MerkleyEnvironmentalists, Oregon senators oppose DOT increasing transport of natural gas by rail Senate Democrat says he is concerned intelligence community is 'bending' Soleimani presentations Democrats conflicted over how to limit Trump's war powers MORE (Ore.) Heidi HeitkampMary (Heidi) Kathryn HeitkampSusan Collins set to play pivotal role in impeachment drama Pro-trade group launches media buy as Trump and Democrats near deal on new NAFTA The Hill's Morning Report — Biden steadies in third debate as top tier remains the same MORE (N.D.), Martin HeinrichMartin Trevor HeinrichHealth care, spending bills fuel busy year for K Street Schumer introduces bill requiring GDP measure inequality Senators want FERC to protect critical infrastructure from Huawei threats MORE (N.M.), Catherine Cortez MastoCatherine Marie Cortez MastoSenate Democrats launch investigation into Trump tax law regulations DSCC endorses combat veteran MJ Hegar in Texas race to unseat Cornyn Senate confirms Trump's 50th circuit judge, despite 'not qualified' rating MORE (Nev.), Elizabeth WarrenElizabeth Ann WarrenEx-Obama official on Sanders-Warren feud: 'I don't think it played out well for either of them' Former Vermont Governor: Sanders 'will play dirty' Hill.TV's Krystal Ball rips Warren over feud with Sanders MORE (Mass.) and Tina SmithTina Flint SmithKlobuchar releases names of bundlers Living in limbo may end for Liberians in the US Collins announces Senate reelection bid MORE (Minn.), as well as Republican Lisa MurkowskiLisa Ann MurkowskiPaul predicts no Republicans will vote to convict Trump Seven things to know about the Trump trial Trump's trial a major test for McConnell, Schumer 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.