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 UdallThomas (Tom) Stewart UdallSenate Democrats increase pressure for FBI investigation of Kavanaugh Trump administration weakens methane pollution standards for drilling on public lands Senate Dems want DOJ review of Giuliani's work for foreign entities 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 SchumerTrump, GOP regain edge in Kavanaugh battle READ: President Trump’s exclusive interview with Hill.TV The Hill's 12:30 Report — Trump slams Sessions in exclusive Hill.TV interview | Kavanaugh accuser wants FBI investigation MORE (N.Y.), Maria CantwellMaria Elaine CantwellPartisan politics at independent agency draws bipartisan rebuke Senators share their fascination with sharks at hearing Poll: Majority of Americans support Roe v. Wade MORE (Wash.), Jeff MerkleyJeffrey (Jeff) Alan MerkleyDem senator calls on Kavanaugh to withdraw after second allegation Feinstein calls for hold on Kavanaugh consideration Overnight Energy: Warren bill would force companies to disclose climate impacts | Green group backs Gillum in Florida gov race | Feds to open refuge near former nuke site MORE (Ore.) Heidi HeitkampMary (Heidi) Kathryn HeitkampGOP plays defense on ObamaCare’s pre-existing conditions Doug Jones to McConnell: Don't 'plow right through' with Kavanaugh Heitkamp knocks GOP challenger for 'disturbing' comments on Kavanaugh allegations MORE (N.D.), Martin HeinrichMartin Trevor HeinrichA Senator Gary Johnson could be good not just for Libertarians, but for the Senate too Election Countdown: What to watch in final primaries | Dems launch M ad buy for Senate races | Senate seats most likely to flip | Trump slump worries GOP | Koch network's new super PAC Rand Paul endorses Gary Johnson's Senate bid MORE (N.M.), Catherine Cortez MastoCatherine Marie Cortez MastoSenate Democrats increase pressure for FBI investigation of Kavanaugh Ten years later: Wounds run deep from 2008 crash Attorneys general races in spotlight as parties build bench, fight feds MORE (Nev.), Elizabeth WarrenElizabeth Ann WarrenDemocrats opposed to Pelosi lack challenger to topple her More Massachusetts Voters Prefer Deval Patrick for President than Elizabeth Warren Trump's trade war — firing all cannons or closing the portholes? MORE (Mass.) and Tina SmithTina Flint SmithElection Countdown: Trump confident about midterms in Hill.TV interview | Kavanaugh controversy tests candidates | Sanders, Warren ponder if both can run | Super PACs spending big | Two states open general election voting Friday | Latest Senate polls Farm bill must protect working lands conservation programs Kavanaugh becomes September surprise for midterm candidates MORE (Minn.), as well as Republican Lisa MurkowskiLisa Ann MurkowskiKavanaugh accuser set to testify Thursday Kavanaugh accuser agrees to testify next week Murkowski says she’ll wait until Ford testifies before making decision on Kavanaugh 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.