Trump administration blocks states from using Medicaid to respond to coronavirus crisis
Despite mounting pleas from California and other states, the Trump administration isn't allowing states to use Medicaid more freely to respond to the coronavirus crisis by expanding medical services.
In previous emergencies, including the 9/11 terrorist attacks, Hurricane Katrina and the H1N1 flu outbreak, both Republican and Democratic administrations loosened Medicaid rules to empower states to meet surging needs.
But months into the current global disease outbreak, the White House and senior federal health officials haven't taken the necessary steps to give states simple pathways to fully leverage the mammoth safety net program to prevent a wider epidemic.
That's making it harder for states to quickly sign up poor patients for coverage so they can get necessary testing or treatment if they are exposed to coronavirus.
And it threatens to slow efforts by states to bring on new medical providers, set up emergency clinics or begin quarantining and caring for homeless Americans at high risk from the virus.
"If they wanted to do it, they could do it," said Cindy Mann, who oversaw the Medicaid program in the Obama administration and worked with states to help respond to the H1N1 flu crisis in 2009.
One reason federal health officials have not acted appears to be President Trump's reluctance to declare a national emergency. That's a key step that would clear the way for states to get Medicaid waivers to more nimbly tackle coronavirus, but it would conflict with Trump's repeated efforts to downplay the seriousness of the epidemic.
Another element may be ideological: The administration official who oversees Medicaid, Seema Verma, head of the government's Centers for Medicare and Medicaid Services, has been a champion of efforts by conservative states to trim the number of people enrolled in Medicaid.
The steps that California, Washington and other states hit hard by the epidemic want to take would likely increase the number of people enrolled in the program.
"Medicaid could be the nation's biggest public health responder, but it's such an object of ire in this administration," said Sara Rosenbaum, a Medicaid expert at George Washington University. "Their ideology is clouding their response to a crisis."
Verma's office did provide responses to questions about how her agency, known as CMS, is handling states' concerns about Medicaid and coronavirus.
Medicaid, the half-century-old government safety net program, and the related Children's Health Insurance Program provide health insurance to more than 70 million low-income Americans, many of whom gained coverage through the 2010 Affordable Care Act.
To control fraud, the program has extensive rules dictating who is eligible and what kinds of medical services can be covered; federal officials can penalize states that don't scrutinize who receives benefits.
During major disasters, CMS has traditionally loosened these rules.
In 2005, for example, two weeks after Hurricane Katrina struck New Orleans, the administration of President George W. Bush told states that it would grant waivers so they could rapidly enroll people into Medicaid who had been displaced by the storm.
This meant simplified applications for enrollees and no requirement that states verify applicants' income or other information to grant coverage.
Similarly, in 2009, after President Obama declared a national emergency in response to H1N1, Secretary of Health and Human Services Kathleen Sebelius invited states to seek waivers from Medicaid rules to make it easier for medical providers to quickly treat patients without worrying about their eligibility for government assistance.