Trump officials reject Medicaid lifetime limits in Kansas

The Trump administration announced Monday that it is rejecting Kansas’s request to impose lifetime limits on Medicaid benefits, drawing a line against a new level of conservative changes to the program.

The administration has already approved work requirements in Medicaid, a controversial move in itself, but Monday’s decision indicates that time limits on Medicaid coverage go too far for the Trump administration.

“We have determined that we will not approve Kansas’ recent request to place a lifetime limit on Medicaid benefits for some beneficiaries,” Centers for Medicare and Medicaid Services Administrator (CMS) Seema Verma said Monday in a speech at a meeting of the American Hospital Association.

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“We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them,” she added.

Kansas’s proposal would have limited Medicaid coverage to three years, at which point people would lose access to Medicaid forever.

Verma was going to announce the rejection of Kansas’s request last week, but the announcement was abruptly delayed at the last minute amid internal administration disagreements.

Eliot Fishman, a former Medicaid official in the Obama administration now at the liberal advocacy group Families USA, said the decision to reject the request is a positive development.

“I think it’s major both on its own terms and because it shows that CMS is not just closing its eyes and letting everything through,” Fishman said, noting that there are other major decisions the administration will face on Medicaid as well.

Other decisions facing the administration include whether to allow work requirements in states that have not expanded Medicaid under ObamaCare and whether to allow drug testing for Medicaid enrollees, as Wisconsin is proposing.

Democrats had urged the Trump administration to reject the requests for lifetime limits.

“Lifetime limits or caps on coverage would be an unspeakably cruel attack on Americans struggling to make ends meet,” wrote all of the Democrats on the House Energy and Commerce Committee in a letter to Health and Human Services Secretary Alex Azar in March.

There was also a question as to whether approving lifetime limits would be legal. The Democratic lawmakers had argued in their letter that the current Medicaid law does not allow time limits to be placed on coverage.

Advocates are already suing over the Trump administration’s decision to allow work requirements for Medicaid, and approving lifetime limits would have set off another legal battle.

Verma indicated that she sees a distinction between work requirements, where Medicaid is still theoretically always available to someone as long as they work, and lifetime limits. With lifetime limits, people would be cut off from the program no matter what what once the time ran out.

Verma said last week that people might get job-based coverage but then lose it down the road for some reason and need Medicaid again.

“We’re trying to think about all of the nuances here,” Verma told reporters last week, speaking in general about lifetime limit proposals.

“We understand that people’s circumstances change over time and that they may actually get into a job, and then maybe something happens in a few years.”

Updated at 1:04 p.m.