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War On Health Care: Trump Administration’s Block Grant Guidance Puts Medicaid on the Chopping Block

By January 29, 2020No Comments

Washington, DC – Tomorrow, the Trump administration is taking another step to sabotage Americans’ health care by issuing new guidance that could severely limit state funding for those enrolled in Medicaid expansion under the Affordable Care Act. A perennially unsuccessful conservative priority dating back to Ronald Reagan, block grants are a blatant attempt to gut coverage and kick people off the rolls. Block grants would reduce funding for states and have repeatedly been rejected by Congress. In response to the administration’s pending proposal, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“Once again, President Trump is taking cruel and unnecessary action to sabotage a program that is a lifeline to millions of Americans. The administration’s benefit-slashing block grants – which Congress has rejected time and time again – target Americans who have gained coverage through Medicaid expansion, one of the Affordable Care Act’s most successful and popular provisions. Medicaid has been in President Trump’s crosshairs since day one; with this new block grant guidance along with proposed budget cuts, onerous paperwork requirements, and his lawsuit that would overturn Medicaid expansion, President Trump is putting Medicaid on the chopping block and putting millions of Americans health care at risk.” 


Experts, Patient Groups Confirm Block Grants Would Hurt Patients: 

American Cancer Society Cancer Action Network, American Diabetes Association, And 25 Other Patient Groups Said Blocks Grants “Will Reduce Access To Quality And Affordable Health Care For Patients WIth Serious And Chronic Health Conditions.” “Per capita caps and block grants are designed to reduce federal funding for Medicaid, forcing states to either make up the difference with their own funds or make cuts to their programs that would reduce access to care for the patients we represent. As the gap between the capped allotment and actual costs of patient care increases over time, states will likely limit enrollment, reduce benefits, lower provider payments or increase cost-sharing for patients. States like Utah and Tennessee are already moving forward with deeply troubling proposals in anticipation of new federal guidance promoting these capped financing arrangements. Simply put, block grants and per capita caps will reduce access to quality and affordable healthcare for patients with serious and chronic health conditions and are therefore unacceptable to our organizations. We strongly oppose policies that would allow states to apply for block grants or per capita caps for their Medicaid programs.” [American Diabetes Association, 7/18/19

Center On Budget And Policy Priorities: Medicaid Block Grant Guidance “Threatens The Well-Being Of Both Low-Income And Vulnerable Medicaid Beneficiaries And Those Who Provide Their Care.” “The combination of eligibility restrictions, weaker beneficiary protections, greater financial risk for states, and reduced federal oversight threatens the well-being of both low-income and vulnerable Medicaid beneficiaries and those who provide their care. Medicaid’s coverage guarantee means that coverage is there when it’s needed: people who lose their jobs or get sick can enroll when they qualify and receive a core set of health care services that all states must cover. Ending that guarantee — or eliminating the federal oversight that ensures that states, health plans, and providers comply with it — would worsen access to care, health, and financial security for Medicaid enrollees and very likely increase uncompensated care costs for hospitals and other providers.” [Center On Budget And Policy Priorities, 6/27/19

Center For American Progress: Medicaid Block Grants “Would Not Only Critically Undermine The Federal Government’s Mandate To Provide Affordable Health Care For Low-Income, Vulnerable Populations, But They Would Also Reduce Overall Funding For The Program And Shift Medicaid Responsibility To The States.” “Efforts to implement Medicaid block grants and per-capita caps using Section 1115 waivers would not only critically undermine the federal government’s mandate to provide affordable health care for low-income, vulnerable populations, but they would also reduce overall funding for the program and shift Medicaid responsibility to the states. If state Medicaid costs were higher than expected due to increased enrollment as a result of economic shocks or natural disasters, states would be forced to either supplement their Medicaid program from other funding sources, increase taxes, or reduce services provided to enrollees.” [Center For American Progress, 8/7/19

Rachel Sachs, Associate Professor Of Law At Washington University In St. Louis, And Nicole Huberfeld, Health Law Professor At Boston University School of Public Health, Said Block Grants “Would Very Likely Involve Disenrollment And Other Cost-Cutting Measures That Endanger The Lives Of The Most Vulnerable Patients.” “States already have significant flexibility within the Medicaid program, which always has been state specific. The administration’s desired policy change attempts to bypass the law, raising serious separation of powers concerns. And capped spending would very likely involve disenrollment and other cost-cutting measures that endanger the lives of the most vulnerable patients. Under a capped spending policy, it is foreseeable that states would face cost-cutting choices that harm the health of Medicaid beneficiaries of all kinds and especially those relying on access to care such as the medications necessary to manage chronic diseases and other life-threatening conditions.” [Health Affairs, 7/24/19

Peter Edelman, Faculty Director Of The Georgetown Center On Poverty & Inequality, Said “Block Grants Create A Powerful Incentive For States To Reduce Assistance Even As Need Rises.” “With fixed funding levels, block grants create a powerful incentive for states to reduce assistance even as need rises. After all, they get to keep the ‘savings’ in what essentially becomes a slush fund. As has been seen in the TANF program created by the 1996 welfare law, states have used the malleability of the block grant to make it harder for people to receive benefits. As a result, the number of families experiencing poverty who receive TANF has fallen precipitously.” [Washington Post, 1/22/17