Trump administration blocks states from using Medicaid to respond to coronavirus crisis

WASHINGTON — 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 Donald 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 not 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 Barack 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.

States need similar flexibility now, said Jacey Cooper, who directs Medi-Cal, as California’s mammoth Medicaid program is called.

“Getting an emergency declaration would really help us get services to people who need it,” said Cooper. Medi-Cal currently covers about 13 million low-income Californians.

Among other things, Cooper said the state wants to shorten lengthy verification procedures to quickly enroll people. Public health experts fear that gaps in insurance coverage make controlling coronavirus more difficult because patients who don’t have insurance won’t seek medical attention and testing they fear they can’t afford.

California and other states also want to ensure that mobile clinics and other temporary facilities set up to handle a crush of patients can bill Medicaid, which also would require a waiver.

And a number of states with large homeless populations — including California, Washington and New York — are interested in potentially using Medicaid funding to help homeless victims of coronavirus who need not only medical care but also housing and other services.

The easiest way to speed Medicaid waivers is a declaration from the president of a national emergency. Obama issued such a declaration in 2009 during the H1N1 outbreak.

On Thursday, the American Medical Association, the American Hospital Association and the American Nurses Association sent a joint letter to Vice President Mike Pence calling for the president to issue a declaration.

But the White House hasn’t indicated whether Trump will make such a move.

State leaders are wary of criticizing the president directly, fearing that he may attack them personally or retaliate against their states.

Last week, Trump called Washington Gov. Jay Inslee a “snake” after the governor, a Democrat, criticized the administration’s slow coronavirus response.

That’s left states with a more limited set of Medicaid options that CMS outlined Thursday afternoon. These include small steps such as allowing hospitals to more easily enroll patients in Medicaid.

In California, Cooper said CMS officials have been helping the state develop a plan. But she noted California needs significantly more flexibility.

For example, state health officials do not want to have to send people to hospitals to get rapidly enrolled in Medi-Cal, potentially exposing them to the virus.

“We need help sooner rather than later,” Cooper said.

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