What a 2nd Trump administration could mean for Medicaid: 5 notes

Changes could be coming for Medicaid in the next presidential administration. 

In his first term in office, President-elect Donald Trump's administration backed block grant funding for the program, and supported states implementing work requirements for Medicaid benefits. 

On Nov. 19, Mr. Trump nominated Mehmet Oz, MD, as CMS administrator. While Dr. Oz has spoken publicly about his support for expanding Medicare Advantage, he has few public comments on Medicaid. 

Here are five things to know about what Medicaid policy could look like during Mr. Trump's second term: 

1. Republican leaders are eyeing cuts to Medicaid spending to offset the costs of extending Mr. Trump's 2017 tax cuts, the Washington Post reported Nov. 18. The tax program is set to expire at the end of 2025.
   
   
2. Rep. Jodey Arrington, chair of the House Budget Committee, told the Washington Post a "responsible and reasonable work requirement" for Medicaid benefits could net $100 billion in savings. During Mr. Trump's first term in office, 13 states chose to implement work requirements in their Medicaid programs according to KFF.
   
   
3. Other Republicans have proposed converting Medicaid funding to block grants, rather than open-ended funding to states. Sen. John Cornyn, a Texas Republican, told Politico cuts to social security and Medicare are off the table to offset the cost of tax cuts, but curbing Medicaid spending could be a possibility.
   
   "Block grants make a lot of sense," he said.
   
   
4. Block grants were a part of Republicans' proposed policies to overturn the Affordable Care Act in 2017. The proposal failed in the Senate.
   
   In 2019, Tennessee applied for a waiver to receive a block grant in exchange for more flexibility in how it managed its state Medicaid program. The Trump administration approved the waiver in early 2021, though it was later rescinded by the Biden administration in 2023, according to the Georgetown University Center for Children and Families.
   
   
5. Some states are urging the Biden administration to approve Medicaid waiver requests before Mr. Trump takes office, Politico reported Nov. 18. Some states are seeking waivers that would affect their state budgets, while others are looking for approval to put Medicaid funding toward social services, including rent assistance.