How states want to shrink Medicaid
By Jeff Stein, January 12, 2018
Indiana hopes to make Medicaid enrollees pay a fee if they smoke cigarettes. Arizona wants to put a five-year limit on how long its poor residents can be enrolled in the program.
These proposals are part of a host of changes that mostly conservative states have unsuccessfully sought for years to overhaul Medicaid, a federal insurance program for the poor and disabled.
Now, the Trump administration is giving at least some of these initiatives the green light. On Thursday, health officials issued new guidance to state Medicaid directors, saying the administration would allow states to impose work requirements on certain Medicaid recipients — a first in the program’s 53-year history.
Perhaps the most dramatic changes being sought are in Arizona, Utah and Kansas, which are seeking to create unprecedented “lifetime caps” on Medicaid. Currently, poor Americans in every state can remain on Medicaid as long as they qualify. All three states have sought to create new policies with unprecedented limitations on the number of years participants could stay on Medicaid — up to five years in Arizona and Utah, and up to three years in Kansas.
It’s unclear if the Trump administration will permit lifetime caps. The Obama administration rejected similar requests. Trump officials have given no indication they plan to approve them.
Critics slammed the proposals.
“We’d see a dramatic increase in the number of uninsured,” said Daniel Derksen, professor of public health at the University of Arizona, about how that provision would impact his state. “You’d also see the rate of closure for rural and critical-access hospitals go up — those are the vulnerable parts of the health community that could only absorb a certain amount” [of uncompensated and charity care].
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