Trump Administration Alters Health Equity Approach
The Centers for Medicare & Medicaid Services (CMS) has withdrawn guidance on health equity initiatives for Medicaid and Children’s Health Insurance Program (CHIP) through Section 1115 waivers. Previously released bulletins from winter 2023 and 2024 outlined opportunities to address health-related social needs (HRSNs), but a new memo dated March 4 indicates CMS will now evaluate state waiver applications on a rolling basis to determine compliance with federal requirements.
Political Divide Over Social Determinants
This policy shift highlights the stark contrast between the Trump and Biden administrations’ approaches to health equity. While the Biden administration positioned access for all as central to its health policy, the Trump administration has systematically dismantled diversity, equity, and inclusion initiatives, extending to policies viewed through a health equity lens.
Senator Ron Wyden (D-Oregon) criticized the move, stating: “This action marks the first step in the Republican plan to dismantle Medicaid, brick-by-brick. There is powerful evidence that the key to keeping Americans healthy and out of the hospital starts with addressing the underlying causes of their health challenges, like food and housing insecurity.”
Impact on Service Coverage
Under the Biden administration, CMS-approved coverage included vital support services such as:
- Housing assistance
- Utility support
- Case management services
- Sobering centers
- Medically tailored meals
- Home accessibility modifications
The December 2024 CMS guidance emphasized that unaddressed health-related social needs “can drive lapses in coverage and access to care, higher downstream medical costs, worse health outcomes, and perpetuation of health inequities, particularly for children and adults at high risk for poor health outcomes.”
Budget Implications
The policy change aligns with a House budget proposal that includes approximately $880 billion in cuts to Medicaid. While Republican lawmakers frame these reductions as targeting waste, fraud, and abuse, Democratic legislators and progressive policy analysts argue these cuts extend beyond addressing inefficiencies and could substantially undermine the program’s effectiveness.
Expert Reactions
Dr. Andrey Ostrovsky, former chief medical officer for the Medicaid program at CMS (2016-2017), expressed concern on LinkedIn: “This is a demonstration that the Trump administration does not understand and/or care about the drivers of poor health. Failing to finance HRSNs or SDOHs with Medicaid will disproportionately harm patients and taxpayers in Republican states.”
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