While You Are Busy Watching President Trump's Endless Stream of Shenanigans, The House is Quietly Working to Dismantle Medicaid

This past Wednesday, the House Committee on Energy and Commerce, Subcommittee on Health held a legislation hearing entitled, “Strengthening Medicaid and Prioritizing the Most Vulnerable.” The purpose was to discuss three discussion drafts including the “Prioritizing the Most Vulnerable Over Lottery Winners Act”; “Close Annuity Loopholes in Medicaid Act”; and the “Verify Eligibility Coverage Act.”

This all sounds fairly innocuous, right? I mean, with a title like “Strengthening Medicaid and Prioritizing the Most Vulnerable," clearly the intent would be on how to make Medicaid stronger, right?


The focus of this hearing was all about exclusion, continuing the troubling drumbeat we are hearing from Republican leaders about strategies for capping Medicaid or moving to state block grants to "prioritize the most vulnerable" as the title of the hearing euphemistically suggested.

Of the three bills under discussion at this hearing, the one that I found most troubling was the "Verify Eligibility Coverage Act." Here is the description of the bill from the official memo announcing the hearing:

  • Focusing Medicaid subsidies on U.S. citizens and legal immigrants. In certain cases, federal law requires states to subsidize Medicaid-based coverage for those who have not yet documented that they legally reside in the United States. To the degree that such individuals are not legally present in the U.S., the law forces States to spend scarce resources on those who are not eligible for Medicaid at the expense of those who are. Federal law should require proper documentation to enroll in Medicaid.

Let's dig a bit deeper to understand the underlying meaning of the statement above.

Under current law, states are obligated to provide applicants who attest to being U.S. citizens or to having satisfactory immigration status and are determined otherwise eligible for Medicaid, a reasonable opportunity period (ROP) to provide documentation that would verify their citizenship or eligible immigration status. During this ROP, states are required to enroll applicants in Medicaid and are eligible to receive federal matching funding for their care. This bill proposes eliminating federal funding during the ROP.

The memo prepared by the Committee on Energy and Commerce Democratic Staff describes the process well:

  • Medicaid-eligible individuals must be U.S. citizens or have an eligible immigration status. Moreover, their citizenship or immigration status must be verified. When completing applications, U.S. citizens attest under penalty of perjury that they are citizens. In practical terms, the vast majority of Medicaid applicants provide their Social Security number (SSN) and it is used along with other personal information to complete a data match with Social Security Administration (SSA) records to verify U.S. citizenship. The majority of applicants are successfully verified using this process. In some instances, however, individuals must send in paper documentation to verify that they are U.S. citizens. If applicants have satisfied all other eligibility requirements—except for verification of citizenship—then the Medicaid agency will provide Medicaid coverage to the applicant during a state-defined time period that is referred to as a reasonable opportunity period (ROP). States set a timeframe in which consumers can submit their documents and for workers to review the documents to verify citizenship. During this time, states receive the federal matching portion of reimbursement for Medicaid coverage provided during the ROP. The draft legislation removes federal financial participation (the federal portion of the Medicaid matching payment) from states during the ROP for those individuals having a citizenship status that is not immediately verifiable. 

For those of you who work with immigrant families, you know the chilling effect this would have. I contacted Sheila Pires, Human Service Collaborative, one of the nation's foremost experts on Medicaid EPSDT, and asked her what this trend toward exclusion and the unrelenting desire to move to block granting Medicaid meant for children. Her quote should be a wake-up call for all:

"As Congress considers various proposals to 'update Medicaid,' it is critical that the Early Periodic Screening, Diagnostic and Treatment provisions in Medicaid remain intact. Over 30 million children and youth rely on Medicaid EPSDT to access comprehensive and preventive health and behavioral health care, and the courts consistently have reaffirmed the importance of EPSDT to ensuring that children and youth have access to appropriate preventive, dental, behavioral health, developmental and specialty care. Congress also is considering various proposals to block grant Medicaid. The history of block grants over time has meant significant cuts in funding for the states. Such a fundamental change in the Medicaid program would make it virtually inevitable that states will not be able to meet the comprehensive mandate of EPSDT."  ~ Sheila Pires, Human Service Collaborative ~ 

The most damaging part of this bill is the removal of federal funding during the reasonable opportunity period, leaving vulnerable families and children dangling in the wind. The proposal in this bill is just another assault on the fundamental essence of who we are as a welcoming nation. This law proposes a hard line approach of not even giving an individual the chance to pull together the necessary information needed to qualify for Medicaid.

Hearings like the “Strengthening Medicaid and Prioritizing the Most Vulnerable” that took place this past week are nothing more than thinly veiled attempts to erode the most important safety net for children and families this country offers.

Stay vigilant, stay informed, and speak out.

  • Key documents, legislative text, and video can be found here.
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