Trump budget will include big cuts to Medicaid, maybe work rules

The detailed budget that the Trump administration will release Tuesday will contain big cuts to Medicaid, reflecting the approach of the health bill that House Republicans sent to the Senate this month, The Washington Post reports.

"Trump’s decision to include the Medicaid cuts is significant because it shows he is rejecting calls from a number of Senate Republicans not to reverse the expansion of Medicaid that President Barack Obama achieved as part of the [Patient Protection and] Affordable Care Act," Damian Paietta writes for the Post. "The House has voted to cut the Medicaid funding, but Senate Republicans have signaled they are likely to start from scratch."

"Trump offered a streamlined version of the budget plan in March, but it dealt only with the 30 percent of government spending that is appropriated each year," Paietta notes. "Tuesday’s budget will be more significant, because it will seek changes to entitlements — programs that are essentially on auto­pilot and don’t need annual authorization from Congress. The people describing the proposals spoke on the condition of anonymity because the budget had not been released publicly and the White House is closely guarding details."

The budget plan "also will call for giving states more flexibility to impose work requirements for people in different kinds of anti-poverty programs," Paietta reports. The story does not mention work requirements for Medicaid, but the opportunity for states to set such rules would not be a surprise, since it is in the House bill, and the proposed Medicaid plan for Kentucky includes them and was drafted by Seema Verna, the director of the Centers for Medicare and Medicaid Services.