Understanding Harmful Federal Proposals and Advocating to Protect Medicaid

The new administration in Washington and some members of Congress have proposed drastic changes to the Medicaid program.  Advocates and others believe Medicaid block grants, per-capita caps, work requirements and new cost-sharing measures would be devastating to state Medicaid programs, Medicaid consumers, and the safety-net providers that serve them.

Enhancing and Protecting Medicaid During Coronavirus Response

As part of its response to the coronavirus, the federal government has enacted a temporary increase in the federal share of Medicaid (FMAP). New York typically gets a 50 percent federal share; during the coronavirus public health crisis the share has been increased to 56 percent. In order to be eligible for the enhanced FMAP, all states are held to a Maintenance of Effort (MOE) provision that prohibits states from making changes to their Medicaid program. Changes in eligibility or benefits cannot occur while a state is receiving enhanced FMAP (currently planned through the end of October, but likely to be extended in subsequent federal relief efforts). Several of this year’s enacted budget provisions are in violation of the MOE tied to receipt of the temporary FMAP increase. In order for New York to receive the enhanced FMAP the budget allows the Governor to delay implementation of any provision until 90 days after the State COVID-19 disaster emergency declaration expires.

It is critically important for the MOE to remain in place. Governor Cuomo has urged Congress to remove the MOE to allow him flexibility in making cuts to Medicaid. Doing so would put any Medicaid program in peril, not just in New York.

Several national advocacy groups have been pushing Congress to retain the MOE, including Community Catalyst and FamiliesUSA. Medicaid Matters has signed their letters to Congress and has encouraged coalition members to do the same.

Dozens of New York advocacy groups and organizations signed on to a letter regarding Medicaid and the importance of the MOE to the New York Congressional delegation from the New York chapter of Health Care for America Now (HCAN).  The letter is available here.

Here is media coverage on the New York-specific Medicaid MOE exemption in the HEROES Act: Eyeing Medicaid Cuts, Cuomo Puts His Stamp On A $3 Trillion Stimulus Bill (Gothamist, 5/15/20)

Advocates are encouraged to send messages to their own members of Congress to urge the New York-specific Medicaid maintenance of effort (MOE) exemption be removed.  Templates and instructions are available here.

At the end of July 2020, the Senate Majority put out their Coronavirus relief proposal, the HEALS Act.  Medicaid Matters joined Citizen Action of New York, the New York chapter of Health Care for America Now, and the Metro-NY Health Care for All Campaign to put out a statement on the importance of protecting Medicaid and other programs in the next Coronavirus relief package.

National advocacy organization Community Catalyst statement on the HEALS Act is here.

A side-by-side of the House HEROES Act and the Senate HEALS Act by the Progressive Caucus Action Fund is here.

Block Grants and Spending Caps

State-by-State Toolkit Highlights Challenges in Capping Medicaid Funding (Manatt; February 2017)

Medicaid Financing: Dangers of Block Grants and Per Capita Caps Lessons from TANF and CCDBG (Center for Law and Social Policy; February 2017)

Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans (Kaiser Health News; January 2017)

Medicaid Block Grant Would Slash Federal Funding, Shift Costs to States, and Leave Millions More Uninsured (Center on Budget and Policy Priorities; November 2016)

What Would Block Grants or Limits on Per-Capita Spending Mean for Medicaid? (Commonwealth Fund; November 2016)

Medicaid: A Vital Health Coverage Program (Families USA issue briefs and fact sheets on block grants, per-capita caps, and more; August 2016)

Work Requirements

Medicaid Works: No Work Requirement Necessary (Center for Law and Social Policy; April 2018)

Medicaid and Work Requirements: New Guidance, State Waiver Details and Key Issues (Kaiser Family Foundation; January 2018)

The Problem With Work Requirements for Medicaid (JAMA Forum; January 2018)

Work Requirements in Social Safety Net Programs (Urban Institute; December 2017)

Work as a Condition of Medicaid Eligibility: Key Take-Aways from TANF (Medicaid and CHIP Payment and Access Commission; October 2017)

Impacts on Children

How Restructuring Medicaid Could Affect Children (Georgetown Center on Children and Families, issue brief; Feb 2017)

Top Five Threats to Children and Families Posed by a Medicaid Block Grant (Georgetown Center for Children and Families blog post; Nov. 2016)