Trump administration weighs in on Medicaid expansion in Virginia, stirring confusion

Mick Mulvaney, director at the Office of Management and Budget, issued a statement that the agency’s Twitter account said was “on the Obamacare Medicaid expansion in Virginia.” The state’s legislature is working on a Medicaid bill that would expand the program to people making roughly $16,000 a year, a provision under Obamacare that 31 other states and the District of Columbia have implemented.

Mulvaney called the growth of Medicaid, which is funded by the government, “unsustainable” and said the Trump administration is committed to addressing it.

“The program has resulted in an explosion of state and federal spending, and abundant evidence suggests that new enrollees are not experiencing health improvements to justify the dramatic increase in cost,” he said. The statement also noted that Trump’s budget request supports repealing the expansion as well as state changes to Medicaid. The budget details that these changes include requiring certain Medicaid enrollees to work, volunteer, or take classes as a condition of staying enrolled in the program.

OMB did not respond to multiple requests for comment about whether the administration would try to block states from expanding Medicaid under Obamacare. An OMB official told the Associated Press that the tweet speaks for itself.

Jonathan Ingram, vice president of research at the conservative Foundation for Government Accountability, wrote on Twitter that he interpreted the tweet to mean the Trump administration was publicly opposing expansion of Medicaid in Virginia. He noted Virginia needs the approval of the administration to expand. Most of the program is paid for through federal dollars.

The Virginia governor’s office told the Washington Examiner that Gov. Ralph Northam, a Democrat who was sworn into office in January, was “confident” that Virginia would expand Medicaid coverage. Northam met with Health and Human Services Secretary Alex Azar on Saturday and was told a Medicaid application would be considered.

“They were assured that the Trump administration will continue to evaluate applications for expanded coverage, and would look favorably on waivers to connect Virginians with work and incentivize healthy choices,” Ofirah Yheskel, the governor’s press secretary, said in an email.

The agency in charge of overseeing Medicaid is the Centers for Medicare and Medicaid Services, a division of HHS, though its duty is to carry out the goals of the administration. Last summer, Iowa had a proposal under a different healthcare waiver that it said would help stabilize the Obamacare market. It had received a positive reaction from CMS even though lawyers said the proposal was illegal. Iowa eventually withdrew its plan, and multiple reports said Trump had asked CMS to deny the request.

An official at HHS did not answer questions about whether CMS would allow states to expand Medicaid. The official pointed only to the president’s budget proposal, which endorses a bill known as Graham-Cassidy that would overhaul Obamacare and roll back the Medicaid expansion. The Graham-Cassidy bill has not received enough support in Congress to pass.

“We typically do not comment on state plan amendments or waiver requests in Medicaid until they have been received and reviewed by the department,” the official said.

Americans for Prosperity in Virginia, part of a conservative political advocacy group founded by the Koch brothers, sent a letter to lawmakers highlighting Mulvaney’s statement and urging them to reject Medicaid expansion.

“Director Mulvaney has reiterated what we already know — expanding Medicaid is a bad deal for taxpayers and program enrollees,” the group’s state director, J.C. Hernandez, said in a statement. “Instead of pushing more able-bodied adults into a broken system, lawmakers should follow the administration’s lead and establish a more fiscally prudent, outcome-driven program.”

More states have suggested they will be considering Medicaid expansion, a move that has the support of the healthcare industry. Obamacare was originally written for all states to expand the program, but a Supreme Court decision made the provision optional. As Obamacare was originally written, states did not have to take into account any other factors besides income to provide Medicaid for residents.

Republicans in states balked at the move, saying they believe the Medicaid program should apply only to people with disabilities, pregnant women, children, and people in nursing homes. The Trump administration’s approval of work requirements for Medicaid in Indiana and Kentucky has resulted in some nonexpansion states now considering expansion.