Republican-led states pursue Medicaid changes: 7 things to know

Republican-led states are ramping up their efforts alongside President Donald Trump's administration to implement Medicaid changes including work requirements, block grants and drug testing, The Wall Street Journal reports.

Seven things to know:

1. While the ACA's Medicaid expansion decreased the nation's uninsured rate because more people became eligible for coverage, it has its critics.Those who have criticized the federal health law argue Medicaid expansion has pressured state budgets and benefited people who could instead get insurance through jobs, according to the report. More than 30 states and Washington, D.C., have expanded Medicaid.

2. President Trump's $4.75 trillion budget proposal for fiscal year 2020 would end Medicaid expansion funding. It would also nationally mandate work requirements as a condition of Medicaid coverage and proposes allowing states to receive fixed federal block grants or per capita caps for Medicaid spending, WSJ reports. States would also have flexibility to make Medicaid changes.

3. Meanwhile, at least 15 states have approved or have pending waiver applications for implementing Medicaid work requirements. They are:

  • Alabama
  • Arkansas
  • Arizona
  • Indiana
  • Kentucky
  • Michigan
  • Mississippi
  • New Hampshire
  • Ohio
  • Oklahoma
  • South Dakota
  • Tennessee
  • Wisconsin
  • Virginia
  • Utah

4. In Tennessee, lawmakers also are seeking permission to shift the state's federal Medicaid funding to a capped grant, according to WSJ.

5. In Utah, lawmakers reportedly are seeking federal approval for partial Medicaid expansion with an eventual fixed, per capita federal funding level for new Medicaid enrollees. Utah voters approved full Medicaid expansion in November, but lawmakers in February approved a Republican bill that would draw back the expansion to people who make up to 100 percent of the poverty line.

6. In Kentucky, lawmakers have considered requiring Medicaid enrollees with criminal or substance-abuse histories to pass drug tests to receive benefits, according to WSJ.

7. Proposed Medicaid changes have received pushback from Democrats as well as legal challenges. For instance, a district judge in Washington, D.C., recently heard oral arguments on lawsuits challenging the federal approval of work requirements in Arkansas and Kentucky, according to WSJ. Arkansas was the first state to impose work requirements.


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