The Centers for Medicare & Medicaid Services (CMS) has pulled information on health equity for the Medicaid and Children’s Health Insurance Program (CHIP) through Section 1115 waivers.
These bulletins, released in winter 2023 (PDF) and 2024 (PDF), gave guidance on the “opportunities available” under Medicaid and CHIP to covers services to close the gaps on health-related social needs (HRSNs), a new memo (PDF) released by the CMS said March 4.
Now, CMS is declaring it will only consider state waiver applications on a rolling basis and then determine whether the applications meet federal requirements.
It is the latest signal that the Trump administration views social determinants of health (SDOH) and the idea of health equity radically different than the Biden administration, which viewed access for all as a cornerstone of its health policy agenda. The Trump administration has taken a systematic approach at terminating diversity, equity and inclusive initiatives, which increasingly expands into banning policy through a health equity lens.
“This action marks the first step in the Republican plan to dismantle Medicaid, brick-by-brick,” said Sen. Ron Wyden, D-Oregonm in a statement. “There is powerful evidence that the key to keeping Americans healthy and out of the hospital starts with addressing the underlying causes of their health challenges, like food and housing insecurity. These waivers are fiscally responsible and allow states including Oregon to pioneer innovative approaches that keep families healthy. Secretary Kennedy appeared to understand this during his confirmation hearings, but once again he has turned his back on Americans in service of the ideological crusade against Medicaid.”
“This is a demonstration that the Trump administration does not understand and/or care about the drivers of poor health,” said Andrey Ostrovsky, M.D., former chief medical officer for the Medicaid program at the CMS from September 2016 to December 2017, in a post on LinkedIn. “Failing to finance HRSNs or SDOHs with Medicaid will disproportionately harm patients and taxpayers in Republican states.”
Previous coverage services as dictated by the CMS under Biden included housing support, utility assistance, case management services, sobering centers, medically tailored meals and home accessibility modifications like handrails and wheelchair accessibility ramps.
"These needs, when unmet, can drive lapses in coverage and access to care, higher downstream medical costs, worse health outcomes, and perpetuation of health inequities, particularly for children and adults at high risk for poor health outcomes, and individuals in historically underserved communities," guidance from the CMS said in December 2024.
A recently advanced House budget also includes up to $880 billion in critical cuts to the Medicaid program, as Congress tries to crack down on waste, fraud and abuse in the program. Democratic lawmakers and left-leaning think tanks believe the depth of the reform exceeds far beyond just waste and abuse to significantly damage the program.