Trump officials say no to lifetime limits on Medicaid

The Trump administration's promise of unprecedented flexibility to states in running their Medicaid programs hit its ...

Posted: May 8, 2018 5:51 PM
Updated: May 8, 2018 5:51 PM

The Trump administration's promise of unprecedented flexibility to states in running their Medicaid programs hit its limit.

On Monday, the Centers for Medicare & Medicaid Services rejected a proposal from Kansas to place a three-year lifetime cap on some adult Medicaid enrollees. Since Medicaid began in 1965, no state has restricted how long beneficiaries could remain in the entitlement program.

"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," CMS Administrator Seema Verma said Monday at an American Hospital Association meeting in Washington, D.C.

Arizona, Utah, Maine and Wisconsin have also requested lifetime limits on Medicaid.

This marked the first time the Trump administration has rejected a state's Medicaid waiver request regarding who is eligible for the program.

Critics of time limits, who say such a change would unfairly burden people who struggle financially throughout their lives, cheered the decision.

"This is good news," said Joan Alker, executive director of Georgetown University's Center for Children and Families, a Medicaid advocate. "This was a bridge too far for this CMS."

Related: States aren't waiting on Washington to require poor residents to work

Alker's enthusiasm, though, was tempered because Verma did not also reject Kansas' effort to place work requirements on some adult enrollees. That decision is still pending.

CMS has approved work requirements for adults in four states - the latest, New Hampshire, winning approval Monday. The other states are Kentucky, Indiana and Arkansas.

All these states expanded Medicaid under the Affordable Care Act to cover everyone with incomes of more than 138% of the federal poverty level ($16,753 for an individual). The work requirements would apply only to adults added through that ACA expansion.

Kansas and a handful of states, including Alabama and Mississippi, that did not expand the program want to add the work requirement for some of their adult enrollees, many of whom have incomes well below the poverty level. In Kansas, an individual qualifying for Medicaid can earn no more than $4,600.

Adding work requirements to Medicaid has also been controversial. The National Health Law Program, an advocacy group, has filed suit against CMS and Kentucky to block the work requirement from taking effect, saying it violates federal law.

The Kansas proposal would have imposed a cumulative three-year maximum benefit only on Medicaid recipients deemed able to work. It would have applied to about 12,000 low-income parents who make up a tiny fraction of the 400,000 Kansans who receive Medicaid.

Kansas Gov. Jeff Colyer, a Republican, responded to the announcement saying state officials decided in April to no longer pursue the lifetime limits after CMS indicated it would not be approved.

Related: The high cost of taking away prisoner's Medicaid coverage

"While we will not be moving forward with lifetime caps, we are pleased that the Administration has been supportive of our efforts to include a work requirement in the [Medicaid] waiver," Colyer said in a statement. "This important provision will help improve outcomes and ensure that Kansans are empowered to achieve self-sufficiency."

Eliot Fishman, senior director of health policy for the advocacy group Families USA, applauded Verma's decision.

"The decision on the Kansas time limits proposal that Seema Verma announced today is the right one. CMS should apply this precedent to all state requests to impose time limits on any group of people who get health coverage through Medicaid - including adults who are covered through Medicaid expansion," he said. "Time limits in Medicaid are bad law and bad policy, harming people who rely on the program for lifesaving health care."

Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 482902

Reported Deaths: 9425
CountyCasesDeaths
Harrison33063488
Hinds31021589
DeSoto30610358
Jackson23687348
Rankin21340370
Lee14909220
Madison14166271
Jones13404227
Forrest13160240
Lauderdale11601305
Lowndes10443176
Lamar10214130
Pearl River9098221
Lafayette8241137
Hancock7514112
Washington7102150
Oktibbeha6964124
Monroe6514164
Neshoba6475201
Warren6464164
Pontotoc630393
Panola6250126
Marshall6126123
Bolivar6115144
Union574186
Pike5613136
Alcorn537290
Lincoln5303131
George471472
Scott459196
Leflore4476140
Prentiss446779
Tippah446480
Itawamba4444100
Adams4416116
Tate4394101
Simpson4335112
Wayne433066
Copiah431787
Yazoo423386
Covington415792
Sunflower4148104
Marion4099104
Leake397586
Coahoma3957100
Newton370875
Grenada3556104
Stone350860
Tishomingo336289
Attala325387
Jasper314162
Winston304691
Clay296473
Chickasaw287065
Clarke282190
Calhoun266141
Holmes262187
Smith250649
Yalobusha221047
Tallahatchie220450
Walthall211058
Greene209045
Lawrence206833
Perry199953
Amite198452
Webster196542
Noxubee178939
Montgomery172454
Jefferson Davis168342
Carroll162137
Tunica153334
Benton142535
Kemper138640
Choctaw127026
Claiborne126834
Humphreys126637
Franklin116728
Quitman103926
Wilkinson101936
Jefferson91333
Sharkey63020
Issaquena1926
Unassigned00

Alabama Coronavirus Cases

Cases: 787421

Reported Deaths: 14022
CountyCasesDeaths
Jefferson1114521765
Mobile708161234
Madison49744633
Baldwin36201495
Shelby36186315
Tuscaloosa33818548
Montgomery33135678
Lee22590220
Calhoun21140410
Morgan19795335
Etowah19188462
Marshall17659274
Houston16788386
St. Clair15408305
Cullman14568258
Limestone14553188
Elmore14444264
Lauderdale13486281
Talladega12932236
DeKalb12174237
Walker10561330
Blount9693157
Autauga9652137
Jackson9363158
Coffee8847175
Dale8584173
Colbert8508184
Tallapoosa6661181
Escambia6585121
Covington6432167
Chilton6372144
Russell605355
Franklin5779101
Chambers5398134
Marion4789120
Dallas4694189
Clarke462279
Pike461597
Geneva4396117
Winston425295
Lawrence4112108
Bibb408581
Barbour346570
Marengo326285
Butler318190
Monroe318153
Randolph305256
Pickens304474
Henry301358
Hale292285
Cherokee289455
Fayette279073
Washington245248
Crenshaw237970
Cleburne235251
Clay228365
Macon219258
Lamar196243
Conecuh181846
Lowndes170758
Coosa169935
Wilcox159736
Bullock149243
Perry136437
Sumter124436
Greene121243
Choctaw73427
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