New Medicaid chief urges states to crack down

WASHINGTON — Hours after she was sworn in, the Trump administration’s top official for Medicaid and her boss dispatched a letter to the nation’s governors, urging states to alter the insurance program for poor and disabled people by charging them insurance premiums, requiring them to pay part of emergency room bills and prodding them to get jobs.

The letter, sent Tuesday night by Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services, and Health and Human Services Secretary Tom Price, also derides the Medicaid expansion that 31 states including Iowa and the District of Columbia adopted under the Affordable Care Act.

The expansion extended Medicaid to 11 million people with incomes of up to about $16,000 for a single person or nearly $34,000 for a family of four but “was a clear departure from the core, historical mission of the program,” the letter said.

Asked for comment on the letter, a spokesman for Iowa Gov. Terry Branstad sidestepped the issue: “Gov. Branstad extends his congratulations and is proud to see that Seema Verma was confirmed as the new CMS Director. She worked very closely with Iowa in obtaining the federal waiver for the Iowa Health and Wellness Plan and Medicaid Modernization. She fully understands the complexities of the Medicaid system and we look forward to working with her in her new role,” spokesman Ben Hammes said in an email.

The three-page letter does not mention that, for the first three years, the federal government paid the entire cost of covering the expansion group and still pays nearly all of that.

The message from Verma and Price signals an initial step toward redesigning the program along lines that conservatives have long favored. Both officials have in the past railed against a system that requires states to get federal permission to “modernize” their Medicaid programs, but the letter makes no mention of eliminating that requirement.

A particular concern among critics is the possibility that Medicaid might require people to be employed or training for jobs to qualify for benefits, even though many are disabled.

The letter stops short of urging an outright work requirement, saying the agency will “review and approve meritorious innovations that build on the human dignity that comes with training, employment and independence.”

Rod Boshart of The Gazette contributed to this report.