Trump administration officials have said they plan to send billions of dollars in federal aid to states as part of a plan to expand Medicaid under the Affordable Care Act.
But a senior administration official said Wednesday that the administration will not give the states direct authority to impose new Medicaid requirements on states.
Instead, they will be able to establish their own rules that will have to be approved by Congress.
“We’re going to provide them the tools and the tools they need to meet their own unique requirements,” said the official, who spoke on the condition of anonymity to discuss the matter publicly.
“That’s the way the system works.”
States are expected to seek waivers from federal rules that mandate coverage for pre-existing conditions, as well as other provisions.
But the administration’s new guidance makes clear that states can not impose restrictions on coverage of pre-existing conditions, including preexisting conditions that were not covered under the law, as long as they do not require insurers to cover those conditions.
Under the law’s individual mandate, people must purchase insurance or pay a penalty.
The law’s Medicaid expansion, which the administration has said will bring about a net increase of 12 million people to the country’s nearly 46 million Medicaid enrollees, is aimed at expanding access to health coverage to those without insurance.
The administration has been trying to convince states that expanding Medicaid will help reduce the number of people without health coverage.
The administration estimates that as many as 40 million Americans are ineligible for coverage, or about 12 percent of the population.
But the administration and governors have been slow to embrace the expansion, and it has not led to significant gains in the number and quality of health coverage available.