The Medicaid program could face significant challenges under the Trump administration, according to Dan Tsai, the deputy administrator and director of the Center for Medicaid and Children’s Health Insurance Program (CHIP) Services. He expressed these concerns during a leadership update call from the Center for Medicare & Medicaid Services (CMS) on Wednesday.

“Medicaid is so important across the country,” Tsai said. “Over one in five Americans get their health care coverage through us. We are leaving the program stronger today than where we started four years ago, but that progress is at risk.”

Tsai specifically opposed the introduction of work requirements or block grants for the program, arguing that they would create excessive bureaucratic hurdles.

“They are just plain bad policy not backed up by facts and evidence. And the cost will be people’s lives and health across the country,” he said.

The Trump administration has indicated that these requirements and grants may be introduced during President Trump’s next term.

Tsai’s concerns follow President Trump’s appointment of Dr. Mehmet Oz to lead CMS and Robert F. Kennedy Jr. to head the Department of Health and Human Services.

During the call, CMS leadership highlighted the agency’s accomplishments over the last four years. These included recovering from the disruptions caused by the COVID-19 pandemic, supporting the resumption of regular Medicaid and CHIP renewals after a three-year hiatus, and implementing provisions of the American Rescue Plan, the Inflation Reduction Act, the Affordable Care Act and other legislation.

Agency leaders reported that, despite these challenges, CMS has successfully increased health coverage to a historic high. By the end of 2024, approximately 45 million Americans are expected to have coverage under the Affordable Care Act, including Marketplace plans, Medicaid expansion, and basic health plans. This represents an increase of 14.1 million people since 2021, amounting to a 46% rise. 

Most consumers qualify for $0 premiums or save an average of $800 annually on premiums, Dr. Ellen Montz, director of the Center for Consumer Information and Insurance Oversight, said.

Investment in home- and community-based services and value-based care

Over the past four years, CMS has implemented a series of initiatives aimed at strengthening and improving access to home- and community-based services (HCBS). These actions allow states to address existing HCBS structural issues, such as supporting the direct care workforce, expanding critical service capacities, meeting the needs of individuals on HCBS waiting lists and supporting family caregivers.

Thanks to the American Rescue Plan, states reportedly plan to invest $37.1 billion in initiatives to enhance, expand or strengthen HCBS. Most of this funding will go toward recruiting and retaining direct care workers, which includes increasing wages, establishing career development pathways and creating registries to connect individuals receiving HCBS with providers.

Alternative payment models reward providers for delivering patient-centered, high-quality and affordable care. In 2021, CMS set a goal for all individuals with traditional Medicare and most with Medicaid to be in an accountable care relationship with their health care provider by 2030. CMS leaders reported that as of 2024, approximately 13.7 million people with traditional Medicare are aligned with an accountable care organization, representing a 3% increase from 2023.

Additionally, CMS Administrator Chiquita Brooks-LaSure announced that this would be her final stakeholder call as administrator for the Biden-Harris administration.

“We always describe our accomplishments in broad terms; our efforts together impact over 160 million people, and it’s a significant responsibility,” she said. “Thanks to your dedication, we have achieved record-high enrollment across the three M’s. This is a tremendous achievement of which we should all be proud. It is our mission to enhance the care received by individuals in our programs – care that our neighbors and families depend on.”