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 UdallHillicon Valley: House panel takes on election security | DOJ watchdog eyes employee texts | Senate Dems urge regulators to block T-Mobile, Sprint deal | 'Romance scams' cost victims 3M in 2018 Dems urge regulators to reject T-Mobile, Sprint merger Dems wary of killing off filibuster 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 SchumerNational emergency declaration — a legal fight Trump is likely to win House Judiciary Dems seek answers over Trump's national emergency declaration Mandatory E-Verify: The other border wall MORE (N.Y.), Maria CantwellMaria Elaine CantwellSenate votes to extend key funding mechanism for parks White House poised to take action on AI, 5G Overnight Energy: States press Trump on pollution rules | EPA puts climate skeptic on science board | Senate tees up vote on federal lands bill MORE (Wash.), Jeff MerkleyJeffrey (Jeff) Alan MerkleyThe border deal: What made it in, what got left out Lawmakers introduce bill to fund government, prevent shutdown Dems wary of killing off filibuster MORE (Ore.) Heidi HeitkampMary (Heidi) Kathryn HeitkampOvernight Energy: Trump taps ex-oil lobbyist Bernhardt to lead Interior | Bernhardt slams Obama officials for agency's ethics issues | Head of major green group steps down Trump picks ex-oil lobbyist David Bernhardt for Interior secretary On The Money: Shutdown Day 27 | Trump fires back at Pelosi by canceling her foreign travel | Dems blast 'petty' move | Trump also cancels delegation to Davos | House votes to disapprove of Trump lifting Russia sanction MORE (N.D.), Martin HeinrichMartin Trevor HeinrichOvernight Defense: Dems aim to block use of defense funds for wall | Watchdog issues new warning on Syria withdrawal | Trump wants to 'watch Iran' from Iraq Senate Dems introduce bill to block Trump from using military funds to build wall Puerto Rico statehood supporters pin hopes on House action MORE (N.M.), Catherine Cortez MastoCatherine Marie Cortez MastoSchumer urging ex-congressional candidate Amy McGrath to run against McConnell Mark Kelly launches Senate bid in Arizona Former McCain chief of staff says he will not run for Senate in Arizona in 2020 MORE (Nev.), Elizabeth WarrenElizabeth Ann WarrenDNC punts on measure to reduce role of corporate PAC money Bill Maher to Dems: ‘Let’s not eat our own’ in 2020 Newsom endorses Kamala Harris for president MORE (Mass.) and Tina SmithTina Flint SmithContractor back pay not included in shutdown deal Push to include contractor back pay in funding deal hits GOP roadblock Dems seeking path to Senate majority zero-in on Sun Belt MORE (Minn.), as well as Republican Lisa MurkowskiLisa Ann MurkowskiThe Hill's 12:30 Report — Presented by Kidney Care Partners — Trump escalates border fight with emergency declaration On The Money: Trump declares emergency at border | Braces for legal fight | Move divides GOP | Trump signs border deal to avoid shutdown | Winners, losers from spending fight | US, China trade talks to resume next week The Hill's Morning Report — Presented by the American Academy of HIV Medicine — Trump, Congress prepare for new border wall fight 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.