�Թϲ�����

The Trump administration said on Thursday that it would allow states to cap Medicaid spending for many poor adults, a major shift long sought by conservatives that gives states the option of reducing health benefits for millions who gained coverage through the program under the Affordable Care Act. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said states that sought the arrangement — an approach often referred to as block grants — would have broad flexibility to design coverage for the affected group under Medicaid, the state-federal health insurance program for the poor that was created more than 50 years ago as part of President Lyndon B. Johnson’s Great Society. (Goodnough, 1/30)

In announcing changes to a portion of the safety-net program, senior administration officials avoided any mention of “block grants,” a polarizing concept, instead naming the initiative “Healthy Adult Opportunity.” Officials portrayed it as a “groundbreaking opportunity” for states to upgrade care, limit the program’s strain on their budgets and gain more freedom to shape Medicaid to local needs. “Our administration is committed to protecting and improving the lives of Medicaid recipients,” said Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services and the chief champion of the idea among President Trump’s aides. (Goldstein, 1/30)

A legal fight over the changes is likely. Democrats say the administration lacks the authority to approve structural changes to Medicaid that they say would hurt enrollment. Consumer advocates say the changes, including the limits on federal funding, will hurt the poor. Lawmakers in Alaska, Georgia, Tennessee and Utah have already shown some interest. Oklahoma Republican Gov. Kevin Stitt on Thursday said his state would be one of the first to pursue a block-grant program with moderate premiums and work requirements. (Armour, 1/30)

CMS Administrator Seema Verma, who’s crafted the politically sensitive and closely guarded plan for over a year, on Thursday encouraged state Medicaid directors to request budgeted federal payments to cover poor adults who enrolled through Obamacare’s Medicaid expansion in recent years. States who voluntarily cover adult populations outside of the Obamacare expansion could also receive capped funding. Some conservative states have expressed interest in block grants in recent years, but it's not clear how many will take up the Trump administration's new offer. (Roubein and Diamond, 1/30)

With the announcement, CMS is inviting states to design Medicaid plans that work with a new capped-funding approach; they have flexibility in how they design these plans and could be exempted from certain Medicaid requirements. For example, the plan would allow states to create a formulary to pick and choose which drugs are covered — normally Medicaid covers all drugs. In her remarks, Verma anticipated critics who might consider this an attack on the safety net. She spoke passionately about the purpose of Medicaid, calling it "a lifeline for millions of Americans." (Simmons-Duffin, 1/30)

The Trump administration on Thursday unveiled a powerful new tool for states to rein in prescription drug spending. But there’s a catch: States can only wield their newfound power if they accept a cap on the federal funding they get for their Medicaid program. The new tool on offer would effectively help states negotiate lower prices directly with pharmaceutical companies by denying coverage for certain drugs. Right now, unlike private insurers and some other federal providers, Medicaid programs must cover every single drug — a fact that some states say hampers their ability to get the best deal on pricey medicines. (Facher, 1/31)

Kaiser Health News: 5 Things To Know About Trump’s Medicaid Block Grant Plan

The Trump administration unveiled a plan Thursday that would dramatically revamp Medicaid by allowing states to opt out of part of the current federal funding program and instead seek a fixed payment each year in exchange for gaining unprecedented flexibility over the program. Medicaid, a federal-state health program that covers 1 in 5 Americans, has been an open-ended entitlement since its beginning in 1965. That means the amount of money provided by the federal government grows with a rise in enrollment and health costs. (Pradhan and Galewitz, 1/31)

In a letter Wednesday, three dozen House Democrats warned that block grants would be detrimental to the viability of Medicaid and patient outcomes because of the negative fallout it would have for Americans who get health care coverage through the "safety-net health program." "Medicaid block grants necessitate cost-cutting measures like restricting enrollment, decreasing provider reimbursement, and limiting eligibility and benefits through managed care," the representatives wrote in the letter, which was organized by Rep. Joe Kennedy, D-Mass. "These actions endanger the lives of the most vulnerable patients, the population Medicaid was created to protect." (McCausland, 1/30)

The block grant will apply to the ObamaCare Medicaid expansion population’s “able-bodied” people. Advocates argue this gives an incentive for GOP governors in expansion states to roll back benefits and spending. Anyone who is covered by traditional state Medicaid programs, disabled or eligible for long-term care is excluded. Other low-income adults, children, pregnant women, elderly adults, and people with disabilities will also be excluded. (Weixel, 1/30)

The American Medical Association immediately announced its opposition, saying that federal caps on Medicaid funding “would increase the number of uninsured and undermine Medicaid’s role as an indispensable safety net.” The bipartisan National Governors Association also tweeted out its concerns, saying that the change “would significantly curtail the longstanding flexibility states have to fund and pay for services in their Medicaid programs, which could negatively impact beneficiaries.” (Ollove, 1/30)

Families USA executive director Frederick Isasi immediately criticized the Trump administration guidance Thursday, warning that it could wreak havoc on Medicaid beneficiaries and state budgets. "With state budgets already stretched thin, accepting Medicaid block grants could likely amount to willful fiscal malpractice and blatant disregard for the needs and interests of states and families," he said. (Brady, 1/30)

The bottom line: The courts will ultimately decide how much of this agenda survives, but within the administration, it’s been full steam ahead since the beginning. The Medicaid cuts in the repeal-and-replace bills sparked big protests and scared away moderate Republican senators, but CMS is still pursuing block grants. It didn’t stop approving work requirements after work requirements ran into problems In court. And while some of the White House’s ideas on drug pricing or the Affordable Care Act have faltered or been discarded, its push to reframe Medicaid has been consistent. (Baker, 1/31)

The block grant proposal, being called Healthy Adult Opportunity, could find some support in North Carolina, one of the 14 states that have so far resisted expanding Medicaid to low-income adults. A standoff between Gov. Roy Cooper, a Democrat, and Republican state lawmakers over Medicaid expansion has left the state without a budget, after Cooper vetoed a proposed budget in June because it didn’t have a path to expansion. (Ovaska and Engel-Smith, 1/31)

Democrats including Ohio’s U.S. Sen. Sherrod Brown on Thursday criticized a new Trump administration Medicaid plan as a backdoor way to cut the program’s spending and jeopardize health care for the people it covers. The director of the Center for Medicare and Medicaid Services, Seema Verma, described her agency’s new Healthy Adult Opportunity initiative as a "groundbreaking new policy” that would provide “an innovative and historical approach to surmounting Medicaid’s structural challenges.” (Eaton, 1/30)

A new federal initiative on Medicaid could wind up altering Georgia’s waiver proposal on extending coverage to low-income adults. The Trump administration said Thursday that it’s encouraging states to seek a cap on federal Medicaid funding for covering working-age adults, in exchange for more state autonomy in running that program. (Miller, 1/30)

Connecticut will reject an offer from the Trump administration to convert a part of its HUSKY program into block grants, a proposal that would likely limit benefits and enrollment. “This is an ill-conceived and unnecessary change that could fundamentally degrade a critical public health program, “ said Department of Social Services Commissioner Deidre Gifford, whose agency oversees the the state’s Medicaid program, known as HUSKY. (Radelat, 1/30)

Initial Trump administration guidance for states that want to reshape portions of their Medicaid programs with a block grant is far narrower and has a different focus than a proposal being pursued by TennCare. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, described Tennessee's proposal as “something different” than a block grant model unveiled by her agency on Thursday. Verma, however, said the TennCare plan is still being considered. (Kelman and Ebert, 1/30)

Gov. Tony Evers' administration is seeking to delay Wisconsin's work requirement for childless adults on Medicaid until April. The requirement, passed under former Republican Gov. Scott Walker, was originally scheduled to begin Nov. 1. But in September the Democratic Evers administration requested more time. (1/30)