The Trump administration just denied Kansas’ request to create an unprecedented “lifetime limit” on Medicaid, a federal insurance largely for the poor and disabled.
“We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them,” Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said during an American Hospital Association meeting on Monday.
Lifetime coverage limits cap access to coverage. Had CMS approved Kansas’ request, Medicaid members would have been limited to a three-year lifetime limit. Four other states (Arizona, Maine, Utah, and Wisconsin) also sought to implement lifetime caps for Medicaid.
The Trump administration has been allowing states to impose sweeping changes to Medicaid; most notable was it’s approval of Kentucky’s work requirements in February. But it appears as if lifetime limits went too far this time.
That said, lifetime limits weren’t exactly popular. Two-thirds of people surveyed by the Kaiser Family Foundation say “Medicaid should be available to low-income people for as long as they qualify, without a time limit, while one-third say it should only be available to low-income people for a limited amount of time in order to provide temporary help.” The policy would have especially hurt low-wage workers who may not get coverage through their employers and reached the Medicaid limit through no fault of their own.
Work requirements and time limits aren’t the only ways states are overhauling their Medicaid programs. In addition to approving Indiana’s work requirements, CMS approved a provision that requires Medicaid enrollees to pay a premium surcharge if they smoke cigarettes. Verma also okay-ed Arkansas’ coverage lockout, which drops an individual from coverage if they fail to meet the work requirement for three months. And the Trump administration permitted Iowa to end “retroactive eligibility” — meaning, providers will no longer be reimbursed for treating patients who likely qualified for coverage, but weren’t yet enrolled. Roughly 40,000 Iowans had their benefits reduced.
The Trump administration could approve other punitive policies, as well. For example, Wisconsin is trying to mandate drug screening and testing for Medicaid beneficiaries. And Arkansas is still waiting to hear back on whether CMS will greenlight “partial expansion” — a policy that allows a state to limit Medicaid expansion to people with incomes up to 100 percent of the poverty level, rather than the 138 percent envisioned under the Affordable Care Act, while still receiving enhanced federal funding.