The Dallas Morning News

Trump-ok’d plan voided

Requested changes would have helped state avoid expansion


WASHINGTON —The Biden administra­tion on Friday rescinded approval for changes to Texas’ Medicaid program granted by the Trump administra­tion, saying that federal Medicaid officials “materially erred” by speeding approval for the state’s $100 billionplu­s request in January.

Two federal health officials, speaking on the condition of anonymity to discuss private conversati­ons, characteri­zed Friday’s decision as an effort to push Texas toward accepting the Affordable Care Act’s Medicaid expansion. Texas, which has more uninsured than any other state, is one of only 12 that have not expanded the program.

“[W]e are rescinding the approval issued on January 15, 2021,” because it did not go through the full federal rulemaking process, Liz Richter, the acting administra­tor of the Centers for Medicare and Medicaid Services, wrote in a letter to Texas officials obtained by The Washington Post.

Health advocates have called Texas’ waiver an effort to work around the federal Medicaid expansion by setting up alternate funding to help cover the costs of uninsured patients.

Texas Gov. Greg Abbott slammed the Biden administra­tion decision, saying it was

“obstructin­g health care access for vulnerable Texans and taking away crucial resources for rural hospitals in Texas . ... With this action, the Biden administra­tion is deliberate­ly betraying Texans who depend on the resources made possible through the waiver.”

In its final week, the Trump administra­tion told Texas officials that it had approved a 10year extension for its Medicaid plan, which was set to expire in 2022. The waiver provides more than $11 billion in federal funding per year to the state, meaning that the Biden administra­tion’s decision puts billions of dollars in federal funding to Texas at risk.

The approval for Texas’ changes, known as a Medicaid 1115 waiver, was among a flurry of last-minute activities overseen by Trump health officials in the waning days of the administra­tion. Public health advocates and researcher­s decried the moves as inappropri­ate attempts to grant GOP governors’ requests and lock in Trump-era changes. Trump officials said that they were moving to provide stability for health care providers.

“The 10-year extension permits greater financial certainty for the state and its safety net providers that serve Medicaid population­s,” Seema Verma, then-administra­tor for the Centers for Medicare and Medicaid Services, wrote in a Jan. 15 letter to Texas.

Verma also said there was no need for the approval to go through the standard public notice-and-comment process, citing the COVID-19 public health emergency. But the Biden administra­tion concluded the decision was a mistake.

“Upon further review, we have determined that CMS materially erred in granting Texas’s request for an exemption from the normal public notice process,” Richter wrote in her letter Friday.

The new Democrat-led administra­tion has been unwinding a series of actions overseen by Trump officials, including the prior administra­tion’s approval of Medicaid work requiremen­ts.

The Biden administra­tion also has pushed a dozen holdout states to accept the federal Medicaid expansion. Medicaid officials said on a briefing call for state officials last month that if Texas opted in to the federal expansion, the state would get a $3.9 billion funding boost over two years and 2.06 million uninsured people would become eligible for Medicaid coverage, according to a presentati­on obtained by


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