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State officials and health care advocates worry that many Marylanders on Medicaid could lose coverage under a recent proposal from congressional Republicans that aims to cut billions in federal dollars by tightening program eligibility and other administrative hurdles.
While state officials are still determining the full scope of the GOP proposal unveiled Sunday night, they anticipate that a 鈥渟ignificant鈥� portion of Maryland鈥檚 1.55 million Medicaid recipients could lose coverage under the current proposal.
鈥淣o matter how you slice it, we鈥檙e going to see the most vulnerable in our communities lose health coverage,鈥� said U.S. Rep. Sarah Elfreth (D-3rd).
In an attempt to find $880 billion in federal savings over the next decade, the House Committee on Energy and Commerce released language for a budget reconciliation bill that would make hefty changes to the Medicaid eligibility process when people enroll or reenroll in the program.
Ryan Moran, the Maryland Department of Health deputy secretary who focuses on Medicaid, said the proposal gives the department a clearer idea of how the Trump administration plans to cut federal funding to Medicaid 鈥� but many questions remain on the total impact to Maryland鈥檚 Medicaid population.
鈥淭his has been something that 鈥� has long been discussed since the election of the Trump administration,鈥� Moran said. 鈥淣ow that 鈥� there is text to actually react to, that is the work that we will be going through over the next couple days to understand in more detail.鈥�
Medicaid is a health care program that is jointly funded by state and federal dollars to help lower-income households and certain other populations receive health coverage. About 25% of Marylanders receive health care through Medicaid.
There are several components to the proposal that could affect Maryland鈥檚 Medicaid operations, such as language to restrict federal Medicaid dollars from going to certain abortion providers or gender-affirming care for youths. The proposal also would restrict a state鈥檚 ability to tax health care providers to help fund the state鈥檚 share of Medicaid.
In addition, the proposal would cut federal funding from states that use their own money to help provide health care coverage for undocumented residents. Moran said that the department is evaluating how that language could affect some of Maryland鈥檚 Medicaid programs that undocumented individuals could benefit from.
As for Medicaid recipients, the budget reconciliation proposal calls for work requirements for people to stay enrolled in the program. The proposal exempts students, family caregivers, people with disabilities and some other cases.
The budget reconciliation proposal also requires that recipients prove eligibility for Medicaid every six months, as opposed to the current annual redetermination process.
These two factors combined, plus other tightened eligibility requirements, would likely mean that many Marylanders would have to jump through hoops to get health care coverage through Medicaid, and some will likely fall through the cracks.
鈥淯ltimately, what ends up happening is that individuals don鈥檛 go through the red tape to actually enroll in coverage,鈥� Moran said. 鈥淪o, it really does lead to a loss of coverage for individuals 鈥� who would otherwise be eligible.
鈥淚t鈥檚 making it harder for people to enroll. Fewer people do enroll, and that has dramatic, significant impacts on the health care ecosystem,鈥� he said. 鈥淏ut it does, in the end, provide the federal savings that you were looking for 鈥� by having fewer enrollments into the program.鈥�
The proposed budget would also require significant state resources to conduct the increased eligibility checks for the 1.55 million Marylanders on Medicaid, which will likely 鈥減ut a burden on Maryland鈥檚 system,鈥� said Gene Ransom, CEO for MedChi, the Maryland State Medical Society.
Sen. Pamela Beidle (D-Anne Arundel), who chairs the Senate Finance Committee, added that there could be additional downstream effects 鈥� such as additional strain on the state鈥檚 already extended emergency room wait times, which are some of the highest in the nation. With more uninsured people, she said, there will be more Marylanders receiving health care in emergency rooms.
鈥淓mergency rooms will be more crowded than they already are,鈥� Beidle said.
While the state works through the details of Sunday鈥檚 proposals, Moran noted that it is still early in the legislative process and there could be changes down the line 鈥� for better or worse for the state.
鈥淭his is the first take鈥� Moran said. 鈥淭his is the start of a process that we will be watching over the course of the next few months. Just because things are included as proposals today, that doesn鈥檛 mean there couldn鈥檛 be other changes or amendments.鈥�
