President-elect Donald Trump has made official his controversial nomination of Robert F. Kennedy Jr. as the Secretary of Health and Human Services, but has yet to name who will lead the CMS or its Medicare and Medicaid branches.
It could be well into next year before subagency appointees are announced. Still, the current head of Medicaid has a message for his eventual replacement: Treat the massive insurance program with respect.
The Trump administration is widely expected to look for ways look for ways to shrink the healthcare safety net, and Kennedy’s selection as HHS Secretary on Thursday will do little to assuage those fears given the noted science skeptic’s support for slashing federal agencies.
“Treat the program the way you would want it if you, your kids, your family, your closest friends, relied on the Medicaid and CHIP program,” said Daniel Tsai, the director of the Center for Medicaid and CHIP Services, on Thursday at the HCPLAN Summit in Baltimore.
Tsai was appointed to run Medicaid in June 2021. Since then, the program has grown to cover more than one in five Americans under Biden administration policies looking to increase insurance coverage, especially for vulnerable people.
Trump was quiet on the campaign trail about his plans for Medicaid. However, the Republican politician is widely expected to take a similar tack when it comes to the safety-net program as he did in his first term, when he supported state waivers that capped financing and created eligibility restrictions, including through controversial work requirements.
Trump’s policies resulted in fewer people having Medicaid coverage than would have otherwise, according to experts.
More drastically, the second Trump administration could try to dismantle the Medicaid expansion under the Affordable Care Act, or lower enhanced federal funding for states that cover adults with incomes up to 138% of the poverty line. Trump could also elect not to implement Biden-era regulations meant to advance access to care, or remove policies allowing states to streamline beneficiary renewals, according to health policy think tank KFF.
The president’s healthcare regulators could also resuscitate block grants for Medicaid funding, or pursue other avenues to cap enrollee spending — a recommendation in Project 2025, the conservative Heritage Foundation’s policy blueprint for the administration.
Trump has attempted to distance himself from Project 2025. But should the president-elect align himself with the plan, limiting Medicaid access it proposes could cause almost 19 million Americans to lose coverage, according to the Center for American Progress.
However, many Republicans in Washington argue that Medicaid has become bloated and need steep cuts to reduce government spending. Conservative lawmakers have released budgetary proposals this year including those cuts.
One marked up by the House Budget Committee in March would slash federal Medicaid spending by $2.2 trillion over a decade, including through per-enrollee caps on spending, work requirements and eliminating the Medicaid expansion higher federal match rate.
Debates about the size and scope of Medicaid are valid, according to Tsai. However, erecting additional barriers for healthcare for low-income individuals and families “flies in the face” of running Medicaid “the way you would want it run for yourself,” the Medicaid director added.
“Do to others what you would want done to yourself. I think that true north is the biggest piece I would strongly, strongly urge my successor to keep in mind,” Tsai said.
