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 UdallSenate confirms Trump's nominee to lead FDA Overnight Defense: House passes compromise defense bill | Turkey sanctions advance in Senate over Trump objections | Top general says military won't be 'raping, burning and pillaging' after Trump pardons Senate panel advances Turkey sanctions bill despite Trump objections 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 SchumerTurf war derails bipartisan push on surprise medical bills Senate confirms Trump's nominee to lead FDA CEO group pushes Trump, Congress on paid family, medical leave MORE (N.Y.), Maria CantwellMaria Elaine CantwellLet's enact a privacy law that advances economic justice There's a lot to like about the Senate privacy bill, if it's not watered down Hillicon Valley: House passes anti-robocall bill | Senators inch forward on privacy legislation | Trump escalates fight over tech tax | Illinois families sue TikTok | Senators get classified briefing on ransomware MORE (Wash.), Jeff MerkleyJeffrey (Jeff) Alan MerkleyMcConnell says he's 'honored' to be WholeFoods Magazine's 2019 'Person of the Year' Overnight Energy: Protesters plan Black Friday climate strike | 'Father of EPA' dies | Democrats push EPA to abandon methane rollback Warren bill would revoke Medals of Honor for Wounded Knee massacre MORE (Ore.) Heidi HeitkampMary (Heidi) Kathryn HeitkampPro-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 Trump wins 60 percent approval in rural areas of key states MORE (N.D.), Martin HeinrichMartin Trevor HeinrichSenators want FERC to protect critical infrastructure from Huawei threats Senate reviews Interior, FERC nominees criticized on ethics This week: House to vote on Turkey sanctions bill MORE (N.M.), Catherine Cortez MastoCatherine Marie Cortez MastoSenate confirms Trump's 50th circuit judge, despite 'not qualified' rating Democrats challenge South Carolina law requiring voters to disclose Social Security numbers Bicameral group of Democrats introduces bill to protect immigrant laborers MORE (Nev.), Elizabeth WarrenElizabeth Ann WarrenDemocrats ask if they have reason to worry about UK result Buttigieg releases list of campaign bundlers Krystal Ball rips Warren's 'passive-aggressive' swipes at rivals MORE (Mass.) and Tina SmithTina Flint SmithDemocrats will win back the Senate majority in 2020, all thanks to President Trump On The Money: Fed faces crossroads as it weighs third rate cut | Dem presses Mnuchin on 'alleged rampant corruption' | Boeing chief faces anger at hearing | Trouble for House deal on Ex-Im Bank Democrats renew push for contractor back pay from government shutdown MORE (Minn.), as well as Republican Lisa MurkowskiLisa Ann MurkowskiThe Hill's Morning Report — Sponsored by AdvaMed — House panel delays impeachment vote until Friday Senate gears up for battle over witnesses in impeachment trial McConnell: I doubt any GOP senator will vote to impeach Trump 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.