The Trump Administration took several steps this past week in support of its efforts to transform the Medicaid program. In testimony before Congress on Thursday, March 14, HHS Secretary Alex Azar confirmed the agency is engaging in discussions with states interested in receiving federal Medicaid funding through block grants. The same day, oral arguments were heard in challenges to the Section 1115 work and community engagement waivers granted in Kentucky and Arkansas, with Judge Boasberg indicating he will issue an opinion by April 1, 2019. On March 20, residents of New Hampshire filed a lawsuit in the United States District Court for the District of Columbia challenging approval of New Hampshire’s 1115 waiver that requires enrollees to engage in 100 hours a month of work or community engagement as a condition of eligibility. The case is Philbrick v. Azar.

CMS released guidance to help states evaluate 1115 demonstrations. Section 1115 of the Social Security Act requires the “periodic evaluation” of approved demonstrations. In a blog post, CMS Administrator Verma stated that monitoring standards will provide information to “quickly understand the impacts that a given demonstration is having, allowing the state to make course corrections if necessary.” 

On Friday, March 15, CMS announced the approval of Ohio’s Section 1115 demonstration application that will implement work and community engagement as an eligibility requirement. Beneficiaries that have gained coverage as a result of expansion under the ACA will be required to work or participate in community engagement activities for 80 hours a month in order to remain eligible for Medicaid coverage. Ohio is the 9th state that has received approval to implement work and community engagement requirements under an 1115 demonstration. Vermont has since notified CMS that the state will not implement the state plan containing a work requirement.

Finally, the Trump Administration’s budget for fiscal year 2020 provides additional insight into the administration’s vision for the Medicaid program. The budget proposal would require “that able-bodied, working-age individuals find employment, train for work, or do community service in order to receive welfare benefits.” The Administration also proposes to permit states to increase co-payments for non-emergency use of the emergency department and to update regulations to “clarify” that non-emergency medical transportation services is a “strictly optional” benefit.