Senators warn against placing Medicaid work requirements on tribes

A bipartisan group of senators is warning the Trump administration against placing Medicaid work requirements on tribes in the U.S.

The administration told tribal leaders in January in a letter that it was unable to require states to exempt American Indians and Alaska Natives from Medicaid work requirements because it is “constrained by statute.” 

Such exemptions would be an illegal racial preference, the administration argues. 

{mosads}

The senators, led by Tom Udall (D-N.M.), argue not exempting tribes would violate federal law and court decisions that state tribes are not a racial group but political communities. 

“The views expressed [by the administration] fail to recognize the unique legal status of Indian tribes and their members under federal law, the U.S. Constitution, treaties, and the federal trust relationship,” Udall and the senators wrote in the letter to Health and Human Services (HHS) Secretary Alex Azar. 

Several states have submitted waivers to the Trump administration asking to put work requirements on some Medicaid beneficiaries — mostly low-income, childless adults who gained coverage through ObamaCare’s Medicaid expansion.

But the administration’s view is that the requirements would also apply to tribes in states that have the waivers approved.

Medicaid services 50 percent of patients at some tribally operated health systems, 40 percent of patients at federally operated Indian Health Service facilities and 25 percent of all American Indian and Alaska Natives nationwide, the senators note. 

Work requirements could hamper access to health care for these groups, they wrote. 

According to the letter from the senators, Centers for Medicare and Medicaid Services Administrator Seema Verma told members of the Secretary’s Tribal Advisory Committee that the HHS Office for Civil Rights (OCR) interpreted that an exemption would be considered “race based.”

“Tribal leaders and organizations confirmed to our offices that other department officials have continued to cite OCR’s interpretation in meetings with tribal leaders on several subsequent occasions,” reads the letter from the senators, which was also signed by Democrats Charles Schumer (N.Y.), Maria Cantwell (Wash.), Jeff Merkley (Ore.) Heidi Heitkamp (N.D.), Martin Heinrich (N.M.), Catherine Cortez Masto (Nev.), Elizabeth Warren (Mass.) and Tina Smith (Minn.), as well as Republican Lisa Murkowski (Alaska). 

HHS has provided “little insight” into the “legal and policy foundation” for their beliefs, the senators wrote, citing conversations with tribal leaders and other groups.