HHS chief: No decision yet on lifetime limits for Medicaid

Under fire from Democrats, Health and Human Services Secretary Alex Azar on Thursday said the department has not yet taken a position on whether it will allow states to put lifetime caps on how long people can be enrolled Medicaid.

At least five states have asked the Department of Health and Human Services (HHS) to approve proposals that would put a cap on how long beneficiaries of Medicaid — the health insurance program for low-income and disabled Americans — can receive coverage.   

Lifetime limits would be the second substantial change in Medicaid policy under the Trump administration.

Recently, HHS issued guidance for states on designing work requirements in their Medicaid programs, marking a conservative shift for the program.

Azar was asked at a House Energy and Commerce Committee subcommittee hearing on the department’s budget whether HHS will approve waivers for lifetime limits. In response, he noted that the department has not put out such guidance for lifetime limits.

“I really cannot, here, give you an answer on resolving a waiver I have not seen,” Azar said in response to a question from Rep. Eliot Engel (D-N.Y.). “We will take that very seriously.”

“We have not stated an invitation or a state Medicaid director approach around that type of issue, and so I really need to work with our teams to see what the issues are, what the legal constraints even are. I don’t even know the legal frameworks with regard to any issue of lifetime caps and how that would interact with our waiver or demonstration authorities.”

Earlier in the hearing, Azar said that “we do not have a view that is supportive of it or against it — we need to look at it.”

Opponents of lifetime limits say it’s a tactic meant to shift people off the program. They fear the move would help shift the Medicaid program from being a health care safety net to being a welfare program.

Conservatives have long said that steps like lifetime limits are needed to help curtail the cost of programs like Medicare, Medicaid and Social Security.