Trump health chief reveals talks with states on Medicaid block grants

Greg Nash

Health and Human Services (HHS) Secretary Alex Azar revealed Thursday that his department is in talks with states about instituting block grants in Medicaid without congressional approval.

“We have discussions with states where they will come in and suggest ideas,” Azar said at a Senate hearing in response to questions from Sen. Bob Casey Jr. (D-Pa.). “There may be states that have asked about block granting, per capita, restructurings around especially expansion populations … It’s at their instigation.”

{mosads}Imposing block grants in Medicaid has long been a major conservative goal for the health insurance program for the poor. Democrats fiercely oppose the idea, and a similar idea known as per capita caps, because both limit the amount of money going to Medicaid, which Democrats argue would require harmful cuts in the program.

Republicans say the move allows for more state flexibility and is more fiscally sustainable.

The changes were a key part of the GOP ObamaCare repeal and replacement plans in 2017.

Allowing states to impose the changes without congressional approval would be extremely controversial in itself and could provoke legal challenges.

States could potentially make the changes without congressional approval if the Trump administration granted them a waiver.

The Hill and other outlets reported in January that the Trump administration is working on guidance to states encouraging them to apply for block grants or per capita caps on their Medicaid programs.

Azar’s comments are some of the first public remarks from the administration about the potential move.

“The answer is yes, you’re having those conversations,” Casey replied to Azar’s comments on Thursday. “Do you know how many states [you are having conversations with]?”

“I do not know exactly how many,” Azar said.

Utah, in particular, is at the center of attention over the issue.

The state’s GOP legislature and governor last month moved to repeal the state’s voter-approved Medicaid expansion and replace it with a smaller expansion.

The smaller expansion would make people with incomes up to 100 percent of the federal poverty level eligible for Medicaid, instead of up to 138 percent of the poverty level, as it is under the standard Medicaid expansion.

The Trump administration is currently deciding whether to approve that request from Utah.

Utah officials told The Washington Post last month that they had heard from Trump administration officials that it could be possible to combine the smaller Medicaid expansion with a per capita cap on the funds.

Azar seemed to hint at the direction of discussions on Thursday when he said that the caps could apply to “expansion populations,” meaning imposing a cap on spending for people newly eligible for Medicaid under the expansion.

Casey countered that Democrats will fight any Medicaid cuts.

“To say that I and many others will fight these cuts with an unyielding passion is an understatement,” Casey said.

On the talks between HHS and states, Casey said, “We need to know what’s happening in those conversations.”

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