By Sarah Dobson, Director of Public Policy and Advocacy
As non-profit providers of services to all Medicaid constituents—children, youth and families, seniors, and people with disabilities—the 300 Lutheran social ministry organizations that make up the Lutheran Services in America network recognize the importance of Medicaid in providing high-quality health coverage to millions of Americans. That is why Lutheran Services in America has been leading the charge to preserve and protect Medicaid, rejecting any legislative proposal to cut, cap, or block grant the program.
This work has continued as the executive branch has recently been expanding the avenues states have to modify their Medicaid programs via the “1115 waiver” process. These waivers enable states to operate their programs in ways which would not normally be allowed under federal law. Under previous administrations, the Centers for Medicare and Medicaid Services (CMS) has not approved waivers which would implement work requirements or allow states to request the federal portion of their Medicaid funding via block grant or with per capita caps, but the Trump administration has indicated their willingness to approve such plans, and indeed, has already begun approving state plans implementing work requirements. Utah has recently submitted a waiver application including per capita caps, and states like Tennessee and Alaska have announced their intentions to apply for such waivers.
We have grave concerns about the administration’s decision to invite states to apply for block grants or per capita cap waivers because such changes would reduce access, stymie innovation, and decrease Medicaid enrollment. These changes would impact the health and well-being of people who rely on Medicaid for health coverage, and over time would likely drive up costs for states. That is why we recently sent a letter to CMS Administrator Seema Verma, expressing our continued opposition to policies that would allow states to apply for block grants or per capita caps for their Medicaid programs that would necessitate limiting enrollment or cutting services. It is our hope that CMS will rescind their guidance suggesting states apply for such waivers and that we can continue to work together to ensure that Medicaid is affordable, adequate, and accessible for everyone eligible.