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CLEVELAND — With a broad overhaul of Obamacare stalled in Washington, one of President Trump’s top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval.

Seema Verma, director of the federal Centers for Medicare and Medicaid Services, is promising to give states an “unprecedented level of flexibility” to design their Medicaid programs as they see fit. In an appearance in Cleveland this week, she pledged to reduce scrutiny of state requests for waivers from federal rules meant to preserve access and quality standards.


“We want to get to the point where we are making the whole waiver process easier,” Verma said during a discussion at the Cleveland Clinic’s annual medical innovation summit. “We’re not going to tell the states what their priorities are. They are going to come and tell us what their priorities are.”

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  • One of the largest cost to any state is the Medicaid budget line that pays to keep frail elders safe and comfortable in nursing homes. Here in CT the state program pays anywhere from $3,000 to $4,000 per month per patient to skilled nursing facilities.

    As a former geriatric care manager I witnessed the “trick” that middle and upper middle class families use to make sure that the taxpayers pay these charges and not the patient. Protected by rules made in the CT Legislature these families use Elder Law attorneys to protect assets from being recovered to support frail elders in their later years. The more frequent method is deeding the home to children 5 years or more before needing Medicaid help.

    What bothers me is that often these children are quite comfortable already, having a paid up mortgage and, maybe a summer place too, and now they have Mom’s house as well while we sustain Mom using our tax dollars. How about closing up this loophole for starters.

    Leave the rest of the CT program alone. It works.

  • “How many ( babies on Medicaid) were delivered to moms who smoked?” Huh? Because if Mom smoked, it’s her fault if something’s wrong, so make that baby pay the price? And if theses people should be getting insurance through the private market, how the hell are they supposed to pay? And why is that extra profit for the insurance companies so important? Also, any time I hear about “flexibility ” I know it’s a code word for “less money will be available and insurance companies will also be freer to rip people off with scrappy policies”.

  • Of course, we know which states will use this super flexibility to cut their rolls, those where Medicaid is most needed. Ms. Verma is short-sighted: yes, the State may save money, but the health of the people will suffer. Also, who will wind up paying for those necessary hospital stays? You and I, through higher insurance premiums.

  • The entire reason someone is on Medicaid, is because they cannot afford private health insurance. It has no bearing if they’re “able-bodied” or not. How does she intend these people find the money to pay for their insurance? Thievery? Prostitution? Seriously – how?

  • Another example of this administration’s penchant for putting someone opposed to the fundamental mission of an agency in charge of the agency. How many health care services could have been provided with the consulting fees she collected from her efforts to weaken a vital program and shame those who need it? People like Ms. Verma are simply soulless. What a constant slap in the face to those who work to advance a basic level of decency.

    • So true, their proposal would be akin to moving from a defined benefit plan to a defined contribution plan. “Out of Medicaid money for the year Nevada? Well, too bad so sad, guess you should get your people to be less sick.” !?!?!? I want to say I can’t believe these people, but I work in state public health and I stopped being shocked at rationing proposals a long time ago. :-/

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