Trump's HHS Nominee Says Medicaid’s Coverage Guarantee Could End Under Block Grants

In response to questioning by senators, President Donald Trump’s pick to run the Department of Health and Human Services (HHS) said that the right to Medicaid could end under a block grant system.

As reported by CNN, in a contentious hearing before the Senate Finance Committee, Sen. Robert Menendez (D-N.J.) noted that Medicaid is currently an entitlement program under which anyone who meets eligibility criteria has the right to be covered.

"When you move to a block grant, do you still have the right?" Menendez asked the HHS nominee, Rep. Tom Price (R-Ga.).

"No," Price replied. "I think it would be determined by how that was set up."

Turning Medicaid into a block grant program has long been a Republican goal, and on January 22, President Trump's senior adviser Kellyanne Conway confirmed that the administration’s plans to replace the Affordable Care Act would include turning Medicaid into block grants to the states.  Conway claimed that converting Medicaid to block grants would ensure that “those who are closest to the people in need will be administering” the program.

But giving states more flexibility while shifting costs to them could result in radically changed eligibility rules.  For long-term care purposes, some have suggested that the look-back period for transfers might be extended to 10 years, or protections for community spouses eliminated.

In Louisiana, Gov. John Bel Edwards, a Democrat, told The New York Times that he was troubled by the prospect of a block grant with deep cuts in federal funds. “Under such a scenario,” he said, “flexibility would really mean flexibility to cut critical services for our most vulnerable populations, including poor children, people with disabilities and seniors in need of nursing home and home-based care.”

Because large portions of a block grant proposal could be achieved through budgetary reconciliation, it could pass the Senate without Democratic support, since it would only require 51 votes, according to the PBS Newshour's explanation of the block grant concept.