The Trump administration today announced rules for Medicaid that should clear the way for the deep cuts Gov. Asa Hutchinson wants to make in the Medicaid expansion program in Arkansas.

Hutchinson proposes to reduce income eligibility from 138 to 100 percent of the federal poverty level and impose work requirements. This is expected to knock at least 60,000 people off the program. But the state has delayed startup waiting for federal waivers. The change today should help.


On Tuesday morning, the Department of Health and Human Services (HHS) unveiled new criteria for evaluating pitches from states to tweak their Medicaid programs, a significant departure from the Obama administration’s approach to such requests.

Whereas in the past states had to prove that proposed changes would “increase and strengthen” health coverage of their low-income population, that requirement is gone, replaced with language that welcomes proposals for work requirements, drug tests and other hurdles that experts predict would reduce the Medicaid rolls by hundreds of thousands of people.

In a statement distributed to reporters Tuesday morning, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma called the goal of covering more people a “hollow victory of numbers,” and instead called for changes that “reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability.”

This is real simple. The rule changes at state and federal level are meant to reduce participation and reduce government cost. Those who lose coverage might view that as a “hollow victory” where they live.

Note that legal challenges are expected to major changes in coverage under the Affordable Care Act by federal rule and state waiver, as opposed to congressional changes.


Health law experts previously told TPM that there could be legal challenges if CMS moves forward with approving state Medicaid waivers for work requirements, on the basis that the policy is “not consistent with goals of Medicaid,” and imposes an undue burden on low-income people struggling to find employment.

A 2017 study by the Kaiser Family Foundation found that only 27 percent of Medicaid recipients are adults without disabilities, and 60 percent of that group are already working. Most of those not employed are either caring for a family member full-time, have a criminal record, live in an area without job opportunities, or face other “major impediments” to employment.