The head of the Centers for Medicare and Medicaid Services, Seema Verma, said Thursday that the Trump administration was obligated to follow the law in handling applications from states to expand their Medicaid programs under Obamacare.
“If a state files a state plan amendment, by law there is a certain period of time that we have to respond to that, and those are set in law,” Verma said during a wide-ranging interview with reporters at the Department of Health and Human Services.
Under Obamacare, all states were initially required to expand Medicaid to people making less than roughly $16,000 a year, regardless of other factors such as whether they had a disability or were working. The provision was made optional by the Supreme Court, resulting in 32 states and D.C. moving to expand the program.
The remaining states don’t want to expand Medicaid or are still considering it, though the Trump administration has openly expressed its disapproval and tried to repeal Obamacare or alter parts of it.
Virginia is one state where the legislature is fighting over a plan to expand the program. President Trump’s budget chief, Mick Mulvaney, issued a statement March 1 calling the growth of Medicaid, which is funded by the government, “unsustainable” and said the Trump administration is committed to addressing it.
His statement raised questions about whether the White House would reject state expansions or delay their requests.
Republicans have long said that Medicaid programs should cover only the most vulnerable populations, including people with disabilities, pregnant women, and people in nursing homes. To align the program closer to that goal, Verma has announced that the administration will allow states who apply for it to add requirements that enrollees work or prepare for work as a condition of staying enrolled in the program. The provision offers multiple exemptions for vulnerable populations.
“What we are talking about is an expansion to able-bodied adults and we are putting them into a program that was designed for disabled people, and I think there is an inherent issue there,” Verma said in Thursday’s interview. “Medicaid needs to be the safety net for that population that really has no other place to turn. I think there has been a lot of concern about putting able-bodied adults into that program and what it does to the actual Medicaid program.
“We have been trying to move to a place where we are more flexible with states so that they are putting able-bodied adults in the program that it is a program that works for that population,” she continued.
She suggested that although the position of the Trump administration may clash with states, it is bound by law.
“That is a state-level decision,” Verma said about Medicaid expansion. “Ultimately from the agency perspective we have to follow the law.”
