Texas health officials are evaluating whether to accept a block grant from the Trump administration to expand the state's Medicaid program to more low-income adults.
The grants place fewer restrictions around how states can spend federal money. Republicans argue they give states more flexibility than traditional federal programs. Health advocates argue block grants often lead to cuts because states can be more strict about who is eligible and what services they provide.
The Trump administration sent letters to states Thursday notifying Medicaid directors about a “new opportunity for states to potentially achieve new levels of flexibility in the administration and design of their Medicaid programs while providing federal taxpayers with greater budget certainty.”
Under the Affordable Care Act, also known as Obamacare, states were given the ability to expand their Medicaid programs to include more low-income adults, including those under 65 who aren't disabled or pregnant. Republican-led Texas is among a small number of states that has not expanded coverage under the federal health care law.
The proposal presents an opportunity for the state to expand Medicaid with fewer federal regulations.
Christine Mann, chief press officer for the Texas Health and Human Services Commission, said the agency is “currently evaluating this new opportunity.”
Anne Dunkelberg, associate director of the Center for Public Policy Priorities, said block grants are not an ideal way for the state to expand Medicaid because there are fewer ways to ensure coverage is comprehensive and affordable.
“It’s a bad fit,” she said. “It would never be a choice I would suggest for the Medicaid program – even for a small part of it.”
Dunkelberg said more than 1 million uninsured adults in Texas could potentially gain some sort of coverage if Texas leaders pursue this option, though. She said that could include a lot of uninsured parents and young people currently left out of Obamacare.
“If it takes something like this to bring our governor and lieutenant governor to the table,” she said, “then we would certainly be happy to hear that discussion get started.”
If Texas seeks a block grant, Dunkelberg said, it should be sure to provide comprehensive and affordable coverage that doesn’t create a lot of bureaucratic red tape that stops many people from accessing care they're eligible for.
Conservative groups have already said they don’t think the Trump administration’s proposal is a good fit for Texas, anyway.
Elizabeth O’Connor, a legislative fellow and health care policy analyst at the Texas Public Policy Foundation, said it “wouldn’t be a great idea right now for Texas” to expand its Medicaid program.
She said there are already problems with Texas’ Medicaid program, so "expanding the population, even through a block grant, could crowd out those that we are trying to protect with Medicaid.”
Dunkelberg said the proposal will likely be challenged in the courts, slowing implementation for some time. Overall, though, she said the state has better options if it wants to expand coverage to more people in Texas.
“This is not a great way to fund Medicaid,” she said. “We would hold our noses and support it because it is important enough for 1.5 million uninsured Texas adults to get coverage, though.”