Sign up for our daily briefing

Make your busy days simpler with Axios AM/PM. Catch up on what's new and why it matters in just 5 minutes.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Denver news in your inbox

Catch up on the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Des Moines news in your inbox

Catch up on the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Minneapolis-St. Paul news in your inbox

Catch up on the most important stories affecting your hometown with Axios Twin Cities

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tampa Bay news in your inbox

Catch up on the most important stories affecting your hometown with Axios Tampa Bay

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Charlotte news in your inbox

Catch up on the most important stories affecting your hometown with Axios Charlotte

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

CMS administrator Seema Verma. (Photo: Jabin Botsford/The Washington Post via Getty Images)

The Trump administration is considering giving states the ability to receive Medicaid block grants, Politico reported on Friday, a move that has experts unsure of its legality and the political world bracing for its volatility.

The bottom line: While analyses found that block grants under the GOP's repeal and replace legislation would result in millions losing health care coverage, changing the law is vastly different than giving states the option to negotiate waivers that are constrained by federal Medicaid statute.

The big picture: Details will matter, and we don't know much.

  • “It's kind of like the word wall. There’s a lot of definitions of what a block grant might be under a waiver," the Kaiser Family Foundation's Diane Rowland told me.

The basic idea being reported (The Hill has confirmed it as well) is that states would have the option — likely through the existing "1115" waiver program — to trade a cap on federal Medicaid dollars for additional flexibility in how they run the program.

  • There are legal limitations on what can be done through waivers, and some legal experts are more skeptical than others of the plans' legality.
  • "I have no idea what authority they think they have," said Sara Rosenbaum, a law professor at George Washington University, adding that the theory that this could be done via 1115 is "nonsense."

Be smart: Regardless of how the details shake out, this would be vastly different from what the GOP included in its 2017 repeal and replace legislation, beginning with the very fact that it would be optional.

  • Under repeal and replace, "there were states that would have been winners and states that would have been losers. Presumably, no state is going to negotiate a waiver in which it’s a loser," Rowland said.
  • There are also Medicaid laws making clear who must be covered. While Congress has the authority to change laws, waivers must abide by them, limiting the scope of what can be done.
  • "I have no clue the extent of the new flexibilities that might be available. And of course it raises the question, if you can do those with an 1115-driven 'block grant,' why couldn’t you do them now with a regular 1115?" said Matt Salo, executive director of the Association of Medicaid Directors.

And then there's also the question of whether states would even want these waivers.

  • Not only would a waiver have to theoretically be devised to make sense for a state, but a Democratic administration almost certainly wouldn't continue to make block grant waivers available.
  • "In addition to being legally spurious and in direct violation of the purpose of the program, it can and will be un-done at the first stroke of the pen of any administration that has anything but the most ideological read of the Medicaid program," said Andy Slavitt, a former administrator of the Centers for Medicare & Medicaid Services under President Obama.

Go deeper

3 mins ago - Health

CDC extends interval between COVID vaccine doses for exceptional cases

Photo: Joseph Prezioso/AFP via Getty

Patients can space out the two doses of the coronavirus vaccine by up to six weeks if it’s "not feasible" to follow the shorter recommended window, according to updated guidance from the Centers for Disease and Control and Prevention.

Driving the news: With the prospect of vaccine shortages and a low likelihood that supply will expand before April, the latest changes could provide a path to vaccinate more Americans — a top priority for President Biden.

Texas AG sues Biden administration over deportation freeze

Texas Attorney General Ken Paxton speaks to members of the media in 2016. Photo: Alex Wong/Getty Images

Texas Attorney General Ken Paxton is suing the Biden administration in federal district court over its 100-day freeze on deporting unauthorized immigrants, and he's asking for a temporary restraining order.

Between the lines: The freeze went into effect Friday, temporarily halting most immigration enforcement in the U.S. In the lawsuit, Paxton claims the move "violates the U.S. Constitution, federal immigration and administrative law, and a contractual agreement between Texas" and the Department of Homeland Security.

Dan Primack, author of Pro Rata
3 hours ago - Podcasts

Carbon Health's CEO on unsticking the vaccine bottleneck

President Biden has said that getting Americans vaccinated for COVID-19 is his administration’s top priority given an initial rollout plagued by organizational, logistical and technical glitches.

Axios Re:Cap digs into the bottlenecks and how to unclog them with Carbon Health chief executive Eren Bali, whose company recently began helping to manage vaccinations in Los Angeles.