Trump Plan, Plus State Budget Mess, Could Make Big Trouble for Medicaid

By Dan Weissmann
In this Monday, July 13, 2015 photo Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act. More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years.
Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home in July of last year. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act. The lack of state budget in Illinois could become a problem for those insured by Medicaid if combined with policy proposed by President-elect Donald Trump. Christian K. Lee / AP Photo
In this Monday, July 13, 2015 photo Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act. More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years.
Earl Charles Williams Sr., 59, sits next to some of the medication he must take for his diabetes in his Chicago home in July of last year. Williams was uninsured for about a year before a county-run clinic helped him sign up for care under the Affordable Care Act. The lack of state budget in Illinois could become a problem for those insured by Medicaid if combined with policy proposed by President-elect Donald Trump. Christian K. Lee / AP Photo

Trump Plan, Plus State Budget Mess, Could Make Big Trouble for Medicaid

By Dan Weissmann
WBEZ brings you fact-based news and information. Sign up for our newsletters to stay up to date on the stories that matter.

A pair of looming developments, in combination, could spell big trouble in Illinois for Medicaid, the government-funded health insurance program for low-income residents.

The first is expected to happen Jan. 1, when a temporary state spending plan expires with nothing to replace it. By itself, this won’t cause any change to Medicaid.

However, it could become a problem if combined with something President-elect Donald Trump has proposed: Turning Medicaid into a “block grant” program, which would give states a lump-sum to spend.

That would be a change from the current structure, in which Medicaid is an entitlement where anyone who qualifies has a right to benefits that are jointly funded by the federal government and states.

Block grants for Medicaid are part of Trump’s healthcare platform, and part of a budget framework proposed by Tom Price, Trump’s pick to head the department of Health and Human Services, which oversees Medicaid.

Currently, even when Illinois has no budget, federal court cases require that the state fund its share of Medicaid. But those cases rely on the program’s current structure.

“These court cases are based on the fact that our clients have a federal right to Medicaid,” said Stephanie Altman, an attorney for the Shriver Center on Poverty Law, which represents Medicaid recipients in one of those cases. “If that entitlement is gone, the cases provide no protection.”

Altman said she has begun researching legal arguments that could keep Medicaid dollars flowing under Trump’s proposal.

However, she says, those arguments would depend on precedents from “old, old cases”—some of them from the 1800s.

Dan Weissmann is a reporter for WBEZ. Follow him at @danweissmann.