By Carolyn Bick
NORTHWEST ASIAN WEEKLY
“I come without answers,” Charissa Fotinos admitted. “I come with a lot of uncertainty at both what the Medicaid program will experience from the current state budget negotiations and how those reductions and changes and potential staffing reductions will be translated to us as an agency.”
Fotinos, the state’s Medicaid director under the Washington State Health Care Authority, was speaking to a virtual roomful of attendees at the state Department of Health’s (DOH) monthly community collaborative meeting on April 9. The month’s meeting brought a mix of people concerned about the future of Medicaid, as changes under the current administration and Congress could significantly impact the program meant for low-and no-income individuals to access health care.
The proposed cuts would require the state to either increase spending by $2 billion, in order to continue to cover everything, or to reduce coverage. Given the current state budget situation, as well the uncertainty surrounding the availability of federal funds, the former is not feasible. Trump most recently decided to withhold federal emergency disaster relief funds from Washington and other states.
Those in favor of the cuts spearheaded by Trump claim—as with every other program they are targeting—that doing so will cut federal costs and allegedly wasteful spending. (The recently released budget resolution would also make Trump’s 2017 tax cuts permanent, which could stand to balloon the U.S.’s debt.)
While Fotinos could not tell any of the anxious faces in the room how Medicaid would change, she could tell them for certain that “there will be changes and that we will have fewer funds to do less work.”
The situation, as Fotinos described it, sounds a lot like triage.
“We have made proposals with a priority of continuing to support services where they are most needed … communities who have traditionally not had equal footing in society or in any way.”
These communities, she said, include BIPOC communities, as well as those in rural or frontier areas, and small community providers that need assistance.
According to an informational presentation Fotinos shared in the meeting chat with attendees, most of Washington is what is known as a Health Professional Shortage Area (HPSA), and that the rural communities they serve rely on Medicaid to pay for services. The same is true for Tribal community health services, many of whose community members rely on Medicaid coverage in some capacity.
Siniva Driggers is a prominent community caregiver in the Pacific Islander community, and belongs to the Samoan Nurses Organization of Washington . She has been in the community “for a very long time,” she told DOH panelists and attendees, and is growing increasingly desperate for community caregiving assistance.
For instance, she said, she serves communities of elders who live in Tacoma’s Eastside and throughout King County. But most of the senior centers in Tacoma are now closed, she said, and elders don’t know where to go, because those centers also offered them meal programs.
“I’m feeling the heat of that, because all those people that used to go to those programs are flooding in and [have] overwhelmed the program I have,” Driggers said. “And they said they don’t have money and they want me to feed them.”
Driggers said that one of the issues she is concerned about has to do with transportation to the few remaining food programs like hers. Alongside nutrition and housing assistance, non-emergency medical transportation (NEMT) covered under Medicaid is also on Trump’s intended cut list. Many who need Medicaid don’t have reliable access to transportation, and the elders Driggers serve use this currently covered service to go to her program, as well as for other reasons.
There are areas of Medicaid that, legally, Washington can’t cut, Fotinos said. These are dubbed “mandatory benefits,” and include things like transport to medical care and physician services. But things like pharmacy services, dental care, and the NEMT program that Driggers is concerned about are considered optional, and therefore seen as expendable by those who support the cuts to Medicaid.
There’s also the lingering question of who will be eligible for Medicaid. Trump is tying Medicaid coverage to a proposed work requirement. If implemented, this policy would require Medicaid recipients to meet certain employment criteria to retain coverage. This could put many at risk— particularly those with health conditions that prevent them from working, including many elders and people with disabilities. As of 2024, this would mean that almost 280,000 Washingtonians who rely on Medicaid would lose coverage.
Fotinos addressed this, saying that the work requirement was one of the many aspects of the cuts to Medicaid she had heard about, but that had not yet been decided.
“There are no details, but there will be some sort of work requirements if what the House side of the federal government wants stays in place,” Fortinos said.
Ultimately, she said, Medicaid is “really complex,” and there are several ways the government can take funding from the program. But neither she nor others in the field—nor the people who need Medicaid—will know what will happen until either the summer or autumn of this year. If the federal government doesn’t figure out what to do, she said, the country will go into default on its debt.