Under pressure, Trump administration opens door to mobilizing Medicaid to fight coronavirus

Donald Trump, Seema Verma
Seema Verma, head of the government’s Centers for Medicare and Medicaid Services, in a meeting with President Trump in 2017.
(Evan Vucci / Associated Press)

Facing mounting pleas from California and other states, the Trump administration moved Friday to allow states to use Medicaid more freely to respond to the coronavirus crisis and expand access to medical services.

President Trump’s emergency declaration may clear the way for states to more quickly enroll low-income Americans in Medicaid so they can get necessary testing or treatment if they are exposed to the virus, as several states have wanted to do since early in the crisis.

His move also could speed efforts by states to bring on new medical providers, set up emergency clinics or begin quarantining and caring for homeless Americans at high risk from the virus.


“The announcement is welcome but woefully overdue,” said Cindy Mann, who oversaw the Medicaid program in the Obama administration and worked with states to help respond to the H1N1 flu crisis in 2009.

Mann noted that states still face a challenge as they will have to negotiate with the federal government to waive Medicaid rules, a potentially lengthy process.

“This will all take time and time is not on our side,” she said.

In previous emergencies, including the 9/11 terrorist attacks, Hurricane Katrina and the H1N1 flu outbreak, both Republican and Democratic administrations loosened Medicaid rules to empower states to meet surging needs.

But until Friday’s declaration by the president, the White House and senior federal health officials hadn’t taken the necessary steps to give states simple pathways to fully leverage the mammoth safety net program to prevent a wider epidemic.

One reason federal health officials took so long to act appeared to be Trump’s reluctance to declare a national emergency, which would have conflicted with his repeated efforts to downplay the seriousness of the epidemic.


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Another element may be ideological: The administration official who oversees Medicaid, Seema Verma, head of the government’s Centers for Medicare and Medicaid Services, has been a champion of efforts by conservative states to trim the number of people enrolled in Medicaid.

The steps that California, Washington and other states hit hard by the epidemic want to take would likely increase the number of people enrolled in the program.

“Medicaid could be the nation’s biggest public health responder, but it’s such an object of ire in this administration,” said Sara Rosenbaum, a Medicaid expert at George Washington University. “Their ideology is clouding their response to a crisis.”

By finally issuing the order Friday afternoon, the president cleared the way for the Centers for Medicare and Medicaid Services, or CMS, to issue formal waivers to states, loosening Medicaid rules for enrolling people and paying for medical services.

“Waivers are going to be the tool that allows states to quickly and effectively position Medicaid to help address the pandemic crisis,” said Matt Salo, head of the National Assn. of Medicaid Directors.

CMS has indicated the agency “was prepared to exercise that [waiver] authority.”

Medicaid, the half-century-old government safety net program, and the related Children’s Health Insurance Program provide health insurance to more than 70 million low-income Americans, many of whom gained coverage through the 2010 Affordable Care Act.


To control fraud, the program has extensive rules dictating who is eligible and what kinds of medical services can be covered; federal officials can penalize states that don’t scrutinize who receives benefits.

During major disasters, CMS has traditionally loosened these rules.

In 2005, for example, two weeks after Hurricane Katrina struck New Orleans, the administration of President George W. Bush told states that it would grant waivers so they could rapidly enroll people into Medicaid who had been displaced by the storm.

This meant simplified applications for enrollees and no requirement that states verify applicants’ income or other information to grant coverage.

Similarly, in 2009, after President Obama declared a national emergency in response to H1N1, Secretary of Health and Human Services Kathleen Sebelius invited states to seek waivers from Medicaid rules to make it easier for medical providers to quickly treat patients without worrying about their eligibility for government assistance.

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Similar flexibility is needed now, said Jacey Cooper, who directs Medi-Cal, as California’s mammoth Medicaid program is called. Medi-Cal currently covers about 13 million low-income Californians.

Cooper said an emergency declaration would “really help us get services to people who need it.”


California officials were reviewing the president’s order Friday to assess whether it will allow the state to better respond to the coronavirus crisis.

Among other things, Cooper said the state wants to shorten lengthy verification procedures to quickly enroll people. Public health experts fear that gaps in insurance coverage make controlling coronavirus more difficult because patients who don’t have insurance won’t seek medical attention and testing they fear they can’t afford.

California and other states also want to ensure that mobile clinics and other temporary facilities set up to handle a crush of patients can bill Medicaid, which also would require a waiver.

And a number of states with large homeless populations — including California, Washington and New York — are interested in potentially using Medicaid funding to help homeless victims of coronavirus who need not only medical care but also housing and other services.

Those kinds of needs prompted a growing number of states to plead with the federal government for an emergency declaration and more Medicaid flexibility.

On Thursday, the American Medical Assn., the American Hospital Assn. and the American Nurses Assn. also sent a joint letter to Vice President Mike Pence calling for the president to issue a declaration.