The Wall Street Journal

By: Stephanie Armour

Republican-led states are stepping up their efforts with the Trump administration to pursue work requirements and other changes to Medicaid, in the face of legal challenges and Democratic opposition.

Tennessee Republicans want permission to revamp Medicaid in exchange for a fixed amount from the federal government. Utah is testing whether it can get approval for a partial Medicaid expansion with capped payments from the federal government. And Kentucky lawmakers have weighed drug-testing recipients with criminal or substance-abuse histories, among other steps.

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Republicans pursued a revamping of Medicaid in their failed 2017 effort to repeal Obamacare. With that option closed, the Trump administration has signaled it wants to give states more authority, spurring the new initiatives critics say improperly circumvent Congress and amount to an attack on the poor.

“It’s clear that block-granting Medicaid is the Holy Grail,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “It failed through legislation so they are trying through the administration.”