There have been a lot of assaults on Medicaid lately, at both the federal and state levels. We’re happy that Washington State has been supportive of Medicaid and its enrollees (see below). But recent threats at the federal level could impact our state in the future, adding up to more war on Medicaid. The recent House Budget Committee’s Republican budget plan calls for implementing the Medicaid “reforms” proposed in the House-passed repeal and replace bill from 2017. It would cap federal Medicaid payments to states, cut them by $834 billion over the first 10 years, and reduce program enrollment by one sixth, or 14 million, by 2026. Projected savings from cuts in “Medicaid and other health” programs (not including Medicare) would amount to $1.5 trillion over 10 years. Other conservative proposals seek to transition Medicaid to block grants.

Medicaid Work Requirements: A judge blocked Kentucky’s federally-approved Medicaid work requirements in an outstanding decision that recognizes that these requirements are inconsistent with Congress’s intent to improve health coverage. We applaud the excellent legal work by the National Health Law Program, the Kentucky Equal Justice Center, Southern Poverty Law Center and Jenner & Block. Immediately after the court’s decision, Kentucky’s Governor responded by cutting dental and vision benefits for enrollees. (Learn more about the case in this Facebook Live video from the National Health Law Program.) A New York Times editorial criticized the Administration’s move toward Medicaid work requirements. They point out that health care is a prerequisite to employment, they require significant administrative costs to administer, and data already shows that a clear majority of Medicaid recipients who can work already do so. The editorial board concludes that work requirements are aimed at stigmatizing Medicaid instead of improving health or cutting costs.

Drug Costs: The Administration denied a Massachusetts request to establish a closed drug formulary and negotiate directly with manufacturers for rebates. The state sought this authority in order to reduce the growth in drug spending while maintaining access to necessary medications. An Oklahoma request to advance specific Medicaid value-based purchasing arrangements with drugmakers was approved. Oklahoma will be able to tailor agreements with manufacturers for the health outcomes of Medicaid enrollees for each drug, which could result in extra rebates to the state if clinical outcomes are not achieved. Experts  expressed skepticism about the potential for using this approach to reduce drug spending.

Expansion in Maine: After a state Medicaid expansion passed by referendum in Maine last year, the Governor refused to implement it and a court recently required the state to comply. Now, the Governor has vetoed a bill to fund the expansion, and the Legislature was unable to reach the two-thirds vote necessary to overturn his veto. The funding bill allotted $60 million to help fund a law that 59% of voters approved by referendum last year. A court battle continues.