President Donald Trump

The Trump administration may look to sidestep the House in a move to rein in spending for skilled nursing’s biggest source of funding.

Politico reported Friday that the White House is working on a plan that would allow states block grants for Medicaid. Such a switch has been a “longstanding conservative dream” of legislators wanting to scale back the payment program.

Trump sent providers reeling shortly after his inauguration when he made a first run at instituting the block grant approach. Healthcare providers and consumers banded together to beat back the contentious effort. It is believed that this time, however, the administration is pursuing plans on a much quieter scale.

Three sources told the website that the administration is now drafting guidelines of the “major Medicaid overhaul,” which would shift from open-ended entitlement to stricter state spending limits and more flexibility in running the payment platform.  

The report noted that Trump could face legal obstacles in trying to circumvent lawmakers, and fierce opposition from new House democrats.

“Hell no,” Sen. Bob Casey (D-PA) tweeted on Friday after the story broke. “If the administration tries to decimate Medicaid through executive action after its scheme was rejected by Congress and the American people, I will fight it with everything I have.”

Politico said the scope of the proposal is still unclear, with uncertainty whether the government would seek stricter blog grants or softer spending caps. It’s also yet to be determined whether reforms would hit all Medicaid populations, including nursing home residents, or a smaller subset. A Centers for Medicare & Medicaid spokesperson declined to comment to Politico.