The Center for Medicare and Medicaid Services (CMS) named Chris Traylor to lead federal Medicaid policy as acting director of the Center for Medicaid and CHIP Services, last week. Traylor, who was previously deputy administrator for strategic initiatives, takes over from Mary Mayhew, who left last week after three months on the job to run Florida's healthcare department.
Traylor retired from the Texas Health and Human Services in 2016 as the Executive Commissioner where he negotiated an extension of Texas’ 1115 waiver to help cover healthcare providers' unpaid bills of Medicaid-eligible and uninsured patients. Traylor then worked as a consultant before joining the CMS in July 2018.
During his 26-year public service career, TACH&H has worked with Mr. Traylor in several capacities such as when he led Texas' Department of Aging and Disability Services and when he served as the state's Medicaid director for more than three years.
Mr. Traylor will be in charge at a time when the Trump administration is quietly devising a plan to bypass Congress to let states receive block grants for Medicaid, a longstanding Republican goal, according to POLITICO. Instead of the traditional open-ended entitlement, states would get spending limits, along with more flexibility to run the low-income health program.
Aware of the political sensitivity, the administration has been deliberating and refining the plan for weeks, hoping to advance an idea that Republicans since the Reagan era have unsuccessfully championed in Congress against stiff opposition from Democrats and patient advocates. During the Obamacare repeal debate in 2017, Republican proposals to cap federal Medicaid spending helped galvanize public opposition, with projections showing millions would be forced off coverage. In addition to potential legal obstacles presented by moving forward without Congress, the effort could face strong opposition from newly empowered House Democrats who've vowed to investigate the administration's health care moves.
The administration's plan remains a work in progress, and sources told POLITICO that the scope is still unclear. It's not yet known whether CMS would encourage states to seek strict block grants or softer spending caps, or if new limits could apply to all Medicaid populations — including nursing home patients — or just a smaller subset like working-age adults.
It is known that Mr. Traylor has been in support of block grants, so it is no surprise that a spokesperson for CMS indicated support for the concept of block grants. However, the administration’s plans may ultimately be limited by Medicaid statute, which requires the federal government to match state costs. It remains to be seen if the federal government can still try to stem costs by approving program caps.
TAHC&H will be watching this issue very closely, especially since the Texas legislature is now in session. Stay tuned to our “Gavel To Gavel” reporting each week for regular updates on the Texas Legislative Session.