WASHINGTON — Facing mounting pleas from California and other states, the Trump administration moved Friday to allow states to use Medicaid more freely to respond to the coronavirus crisis and expand access to medical services.
President Trump’s emergency declaration may clear the way for states to more quickly enroll low-income Americans in Medicaid so they can get necessary testing or treatment if they are exposed to the virus, as several states have wanted to do since early in the crisis.
His move also could speed efforts by states to bring on new medical providers, set up emergency clinics or begin quarantining and caring for homeless Americans at high risk from the virus.
“The announcement is welcome but woefully overdue,” said Cindy Mann, who oversaw the Medicaid program in the Obama administration and worked with states to help respond to the H1N1 flu crisis in 2009.
Mann noted that states still face a challenge as they will have to negotiate with the federal government to waive Medicaid rules, a potentially lengthy process.
“This will all take time and time is not on our side,” she said.
In previous emergencies, including the 9/11 terrorist attacks, Hurricane Katrina and the H1N1 flu outbreak, both Republican and Democratic administrations loosened Medicaid rules to empower states to meet surging needs.
But until Friday’s declaration by the president, the White House and senior federal health officials hadn’t taken the necessary steps to give states simple pathways to fully leverage the mammoth safety net program to prevent a wider epidemic.
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The City of Santa Monica closed the Santa Monica Pier in an attempt to prevent the further spread of the Coronavirus. Very few people were on the beach in Santa Monica as the epidemic continues. (Carolyn Cole/Los Angeles Times)
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Volunteer Nagma Shakur, 16, left, hugs her “Grannie” as she helps senior shoppers with their carts at the Grocery Outlet Bargain Market in Altadena. (Al Seib/Los Angeles Times)
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People walk up the ramp, exiting the secure area at the Tom Bradley International Terminal at LAX. (Kent Nishimura/Los Angeles Times)
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David Barker, 56, is visiting with his friend living in a tent on skidrow in Los Angeles. Barker, who is not homeless, works in the area. (Francine Orr/Los Angeles Times)
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Dr. Dallas Weaver, 79, and his wife, Janet Weaver, 75, of Huntington Beach, walk on the Huntington pier. (Allen J. Schaben/Los Angeles Times)
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Seniors, including Eileen Oda Leaf, 67, left, and her husband Dave Leaf, 67, right, both wearing protective masks, line up outside Gelson’s Market in Manhattan Beach early on Wednesday, March 18, 2020. (Christina House/Los Angeles Times)
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Roberta Tabor, 66, of Hermosa Beach, has her ID checked by store director Dennis Sullivan at Gelson’s Market in Manhattan Beach on Wednesday. The store is doing a “seniors shopping hour” where seniors 65+ can go grocery shopping before anybody else. (Christina House/Los Angeles Times)
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Seniors shop at Gelson’s Market in Manhattan Beach on Wednesday. The store is doing a “seniors shopping hour” where seniors can go grocery shopping before the store opens to the general public. (Christina House/Los Angeles Times)
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Dr. Mark V. Morocco oversees testing at UCLA Medical Center where people can drive up and get tested if they have the symptoms. Morocco listens to a female patient’s lungs through the car window. (Carolyn Cole/Los Angeles Times)
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HOPICS outreach worker Ralph Gomez tosses a clipboard for a signature to homeless client Davis Soto, right, taking care to stay at least six feet away during outreach in Los Angeles. (Brian van der Brug/Los Angeles Times)
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Medical personnel screen patients outside the emergency room at Loma Linda University Health during the coronavirus pandemic. (Gina Ferazzi/Los Angeles Times)
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A nurse takes the vital signs of a woman in a medical tent outside the hospital on Catalina. (Francine Orr/Francine Orr/Los Angeles Times)
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An employee of the Trader Joe’s store in Monrovia tells customers waiting in line that it would open doors to everyone at 9 a.m., not just seniors, who arrived believing doors would open earlier to older residents, as some of the people were told by employees and it was reported. Some grocery outlets were offering special morning hours of shopping to accommodate older residents. (Al Seib/Los Angeles Times)
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Kevin Ezeh, protected with face mask and gloves, addresses the Los Angeles City Council meeting standing under a tent erected outside City Hall. A television livestreamed video of the meeting and the public offered comments remotely. (Irfan Khan/Los Angeles Times)
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Orange County Undersheriff Bob Peterson listens during a board of supervisors discussion on combating the coronavirus in Santa Ana. (Allen J. Schaben/Los Angeles Times)
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Dr. Mark V. Morocco oversees the testing at UCLA Medical Center. Testing for Covid-19 is going on at UCLA Medical Center, where people can drive up and get tested if they have the symptoms. (Carolyn Cole/Los Angeles Times)
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A large tent is installed for public attendance at Tuesday’s Los Angeles City Council meeting. The public was not allowed in the council chamber. (Irfan Khan/Los Angeles Times)
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Shoppers queue up ahead of the Los Feliz Costco opening for business on Tuesday, March 17, 2020 in Los Angeles. (Kent Nishimura/Los Angeles Times)
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Muhammad Faruq, an Uber driver, picks his ride Sotero Reyes, left, and Cristian Eguia, visitors from Houston, all in protective masks, from downtown Los Angeles. (Irfan Khan/Los Angeles Times)
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Volunteer Rachel Figueroa, serves a free lunch to go to Destiny Mendez, with her mother, Estefany, at the Dream Center in Los Angeles. LAUSD students can get free breakfast, lunch and dinner at the Dream Center, Monday through Friday. (Mel Melcon/Los Angeles Times)
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Emma Bradley, left, and her husband, Samuel Bradley, of Palmdale are walking up the ramp to catch the Metrolink in Union Sation in Los Angeles. (Francine Orr/Los Angeles Times)
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Medical personnel surround a car that is going through a coronavirus drive-thru test clinic at the San Mateo County Event Center. Drive-thru test clinics for COVID-19 are popping up across the country as more tests become available. (Justin Sullivan/Getty Images)
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From left, Josh Akamine, of Oahu, Hawaii; Madison Shine of Oahu; Matthew Valencia of Los Altos and Dani Ikeda visit L.A. Live in downtown Los Angeles. (Mel Melcon/Los Angeles Times)
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Normally bustling Grand Central Market in downtown L.A. is open only for take out. (Irfan Khan/Los Angeles Times)
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L.A. has banned restaurants from offering seating at places such as Grand Central Market. (Irfan Khan/Los Angeles Times)
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Carlos Perez, a worker at Wolfgang Puck Bar & Grill at L.A. Live in downtown Los Angeles sits in the empty restaurant. (Mel Melcon/Los Angeles Times)
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A line at the Martin B. Retting gun store in Culver City on Sunday extends out the door and around the corner in 2020. (Francine Orr / The Times)
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A guest wears a mask in front of the Sleeping Beauty Castle at Disneyland on Thursday. (Allen J. Schaben / Los Angeles Times)
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Students hug as they are let out of school at Hamilton High School in Los Angeles, Calif., on March 13, 2020. The school has 2,623 students who live in 94 different zip codes, some of whom travel upwards of 30 miles to school on 24 different school bus routes. 221 school staff live in 88 zip codes. Los Angeles Unified School District Superintendent Austin Beutner announced that schools will be closed due to the coronavirus. (Gary Coronado / Los Angeles Times) (Gary Coronado/Los Angeles Times)
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Blake Anderson, left, a freshman, walks with his father Oree Anderson, as school is let out at Hamilton High School in Los Angeles. LAUSD announced that schools will be closed due to the Coronavirus. (Gary Coronado/Los Angeles Times)
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Students leave John C. Fremont High School in Los Angeles at the end of the school day on Friday, Mar. 13, 2020. LAUSD announced it will shut down beginning Monday. (Luis Sinco/Los Angeles Times )
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Alexandria Casserly crosses the street while looking for toilet paper in downtown Los Angeles. (Gabriella Angotti-Jones / Los Angeles Times)
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A crew member stands on the stern of a cruise ship docked at the Port of Los Angeles. (Luis Sinco/Los Angeles Times)
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Two children look at movie posters in the lobby of the Arclight theater Thursday in Manhattan Beach. (Jay L. Clendenin / Los Angeles Times)
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Disneyland guests wearing ponchos pass the Marketplace inside Star Wars: Galaxy’s Edge on Thursday. Disneyland and California Adventure will temporarily close in response to the coronavirus pandemic. (Allen J. Schaben / Los Angeles Times)
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People shop at the Del Amo Fashion Center in Torrance. (Luis Sinco/Los Angeles Times)
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Disneyland guests take photos in front of the Millennium Falcon: Smugglers Run at Star Wars: Galaxy’s Edge. (Allen J. Schaben / Los Angeles Times)
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Airline workers take precautions at Tom Bradley International Terminal in Los Angeles on Thursday. (Christina House / Los Angeles Times)
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An airport worker cleans a railing at Tom Bradley International Terminal. (Christina House / Los Angeles Times)
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Two people arrive at Knott’s Berry Farm on Thursday in Buena Park. (Gina Ferazzi / Los Angeles Times)
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Cab drivers wait for riders at the Long Beach Airport. (Luis Sinco/Los Angeles Times)
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The Del Amo Fashion Center in Torrance. (Luis Sinco/Los Angeles Times)
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A woman claims her luggage at he Long Beach Airport. (Luis Sinco/Los Angeles Times)
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The Del Amo Fashion Center in Torrance. (Luis Sinco/Los Angeles Times)
One reason federal health officials took so long to act appeared to be Trump’s reluctance to declare a national emergency, which would have conflicted with his repeated efforts to downplay the seriousness of the epidemic.
Another element may be ideological: The administration official who oversees Medicaid, Seema Verma, head of the government’s Centers for Medicare and Medicaid Services, has been a champion of efforts by conservative states to trim the number of people enrolled in Medicaid.
The steps that California, Washington and other states hit hard by the epidemic want to take would likely increase the number of people enrolled in the program.
“Medicaid could be the nation’s biggest public health responder, but it’s such an object of ire in this administration,” said Sara Rosenbaum, a Medicaid expert at George Washington University. “Their ideology is clouding their response to a crisis.”
By finally issuing the order Friday afternoon, the president cleared the way for the Centers for Medicare and Medicaid Services, or CMS, to issue formal waivers to states, loosening Medicaid rules for enrolling people and paying for medical services.
“Waivers are going to be the tool that allows states to quickly and effectively position Medicaid to help address the pandemic crisis,” said Matt Salo, head of the National Assn. of Medicaid Directors.
CMS has indicated the agency “was prepared to exercise that [waiver] authority.”
Medicaid, the half-century-old government safety net program, and the related Children’s Health Insurance Program provide health insurance to more than 70 million low-income Americans, many of whom gained coverage through the 2010 Affordable Care Act.
To control fraud, the program has extensive rules dictating who is eligible and what kinds of medical services can be covered; federal officials can penalize states that don’t scrutinize who receives benefits.
During major disasters, CMS has traditionally loosened these rules.
In 2005, for example, two weeks after Hurricane Katrina struck New Orleans, the administration of President George W. Bush told states that it would grant waivers so they could rapidly enroll people into Medicaid who had been displaced by the storm.
This meant simplified applications for enrollees and no requirement that states verify applicants’ income or other information to grant coverage.
Similarly, in 2009, after President Obama declared a national emergency in response to H1N1, Secretary of Health and Human Services Kathleen Sebelius invited states to seek waivers from Medicaid rules to make it easier for medical providers to quickly treat patients without worrying about their eligibility for government assistance.
Similar flexibility is needed now, said Jacey Cooper, who directs Medi-Cal, as California’s mammoth Medicaid program is called. Medi-Cal currently covers about 13 million low-income Californians.
Cooper said an emergency declaration would “really help us get services to people who need it.”
California officials were reviewing the president’s order Friday to assess whether it will allow the state to better respond to the coronavirus crisis.
Among other things, Cooper said the state wants to shorten lengthy verification procedures to quickly enroll people. Public health experts fear that gaps in insurance coverage make controlling coronavirus more difficult because patients who don’t have insurance won’t seek medical attention and testing they fear they can’t afford.
California and other states also want to ensure that mobile clinics and other temporary facilities set up to handle a crush of patients can bill Medicaid, which also would require a waiver.
And a number of states with large homeless populations — including California, Washington and New York — are interested in potentially using Medicaid funding to help homeless victims of coronavirus who need not only medical care but also housing and other services.
Those kinds of needs prompted a growing number of states to plead with the federal government for an emergency declaration and more Medicaid flexibility.
On Thursday, the American Medical Assn., the American Hospital Assn. and the American Nurses Assn. also sent a joint letter to Vice President Mike Pence calling for the president to issue a declaration.
