Opinion: Throwing stones at Trump over Medicaid? Check our CT backyard

Hartford Courant – Tuesday, February 11, 2025
By Sheldon Toubman

Imagine there was a new law clearly requiring Medicaid coverage of certain drugs and the government said that they were not going to spend any money to implement it because they just didn’t want to and didn’t think anyone could make them. Or imagine some politicians said that, instead of reimbursing Medicaid providers for all services they provide, we should radically change that payment system and just give a fixed amount of money for all services that Medicaid members need and let the providers cut services to fit within that budget regardless of need.

If you thought these were proposals at the national level by the new Trump Administration or by Republicans in Congress, you would be wrong. These are approaches being taken right now by the Lamont Administration and its Department of Social Services.

Gov. Ned Lamont, legislative leaders and Connecticut’s Attorney General should all be lauded for standing up to the Trump Administration in its illegal attempt to impound federal dollars expressly earmarked by Congress for specific services, because they don’t like how the money is being spent or just want to demonstrate raw power. A federal court has already preliminarily sided with the attorney general in his important litigation along with other states to stop this lawlessness. But the ability to call out lawlessness on the national level is undermined if the same behavior is being practiced at home.

In 2023, the state legislature passed, and the governor signed into law, PA 23-94, which unequivocally requires that the Medicaid program administered by DSS cover “prescription drugs approved by the Food and Drug Administration for the treatment of obesity on an outpatient basis,” for all Medicaid members meeting strict statutory criteria, effective on July 1, 2023. These drugs prevent medical complications of obesity, which are often quite costly to the taxpayers. Yet, DSS still has not implemented this legislative mandate, despite there now being eight drugs which have been formally approved by the FDA specifically for weight loss.

On January 16, 2025, DSS issued an official bulletin to all CT Medicaid providers stating that, as of February 3, “the Department will reimburse for new prescriptions for Wegovy through the pharmacy benefit when prescribed to reduce the risk of Major Adverse Cardiac Event,” under certain circumstances. Wegovy is a drug FDA-approved in March 2024 for reducing cardiac risk. But the bulletin goes on to say that “Wegovy will NOT be covered: • [e]xclusively for weight management,” even though Wegovy was also FDA-approved for weight loss in June of 2021. The bulletin thus brazenly proclaims that DSS intends to continue to violate state law.

DSS officials are unabashed in explaining this: the drugs required to be covered by the legislature, in a law signed by the governor, are expensive. This is not unlike the excuse used by the Trump Administration to impound federal dollars required to be spent by Congress.

The Lamont Administration also has strongly opposed proposals to change the way the federal government pays states under Medicaid. Currently, the federal government reimburses a state for every dollar it spends at a percentage rate based on the state’s relative wealth and the specific eligibility category (CT is reimbursed 50 cents per dollar for most Medicaid enrollees). Republicans in the U.S. House have repeatedly proposed to instead pay each state an annual fixed “block grant,” with a reduction of federal dollars intended, and then have the states either make up the difference or, more likely, cut eligibility or services when the block grant runs out.

When a voluntary Medicaid block grant was proposed by the first Trump Administration in 2020 under its “Healthy Adult Opportunity” proposal, Lamont and his then-DSS Commissioner, Deidre Gifford, stated that, “[u]nder this new set-up, states would agree to cap, or block-grant, a portion of the funding in exchange for the ability to limit services and benefits, with the result that some individuals may lose benefits, or coverage altogether.” Their statement called this “an ill-conceived and unnecessary change that could fundamentally degrade a critical public health program.”

Yet, on February 3, the current DSS Commissioner, Andrea Barton Reeves, spoke strongly in favor of a state bill (HB 6836) that would give her authority, under a federal grant called “AHEAD,” to pay a hospital under just such a block grant for all Medicaid enrollees who go to that hospital. There would be one fixed payment to the hospital for the year regardless of the hospital’s actual costs. As with a block grant given to the state, this fixed annual payment would put access to care for a hospital’s patients at severe risk if the hospital’s budget should be exceeded. Hospitals would also be incentivized to reduce care for Medicaid members throughout the year because they could pocket the difference between the fixed annual payment and the cost of services rendered.

The commissioner tried to persuade Public Health Committee members that this block grant approach, which Lamont roundly rejected when proposed by President Trump, was somehow OK on the local level because, like the Trump proposal, it is “voluntary” for the hospitals. But the people who really are affected, low-income Medicaid enrollees, will have no choice but to receive services under this system risking their health, if their hospital chooses it.

The governor deserves credit for calling out the threatening, and in some cases illegal, actions that the new federal administration is taking towards Medicaid. But if the governor wants to have credibility in doing so, he needs to look in his own backyard. Pursuing dangerous Medicaid block grant schemes and allowing flagrant violations of unequivocal state laws looks like throwing stones in a Capitol building made of glass.

Sheldon Toubman is the Litigation Attorney at Disability Rights Connecticut. He has been an advocate for Connecticut Medicaid enrollees for 34 years. 

Access this article at its original source.