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President-elect Donald Trump’s economic advisers and congressional Republicans have begun preliminary discussions about making significant changes to Medicaid, food stamps and other federal safety net programs to offset the enormous cost of extending Trump’s 2017 tax cuts next year. Among the options under discussion by GOP lawmakers and aides are new work requirements and spending caps for the programs, according to seven people familiar with the talks, many of whom spoke on the condition of anonymity because they were not authorized to speak publicly. Those conversations have included some economic officials on Trump’s transition team, the people said. (Bogage, Stein and Diamond, 11/18)

States are racing to have their Medicaid requests approved before the Trump administration takes power. The new administration is expected to have a very different view of Medicaid than the Biden administration, and GOP lawmakers in Congress are eyeing major changes. Some states want waivers that will impact their states’ budgets, but others seek to allow Medicaid to pay for social services, a Biden administration innovation that links health to social well-being. (Leonard and Cirruzzo, 11/18)

The clock is ticking as New York awaits word from the Centers for Medicare & Medicaid Services on the fate of a lucrative tax meant to fund Medicaid reimbursement rate increases for health care institutions. And it’s not the only policy proposal that state officials hope the Biden administration will green-light in the weeks before handing over the reins to President-elect Donald Trump, whose administration is certain to have a very different view of Medicaid spending. (Kaufman, 11/18)

When Trump takes office in January, he promises to take a combative position with China over its role in the fentanyl crisis, ditching the Biden administration’s efforts at diplomacy and compromise. On the campaign trail, Trump vowed “to tariff the hell out of” China unless it helps to stop the flow of illicit drugs into the U.S. The threat raises the stakes for China to shut down a supply chain that is enabling the underground production of fentanyl and other narcotics. But it also risks backfiring for the U.S. if China’s leader Xi Jinping concludes he can’t be seen as caving to pressure from Washington. (Spegele, 11/19)

Mexican drug cartels are mixing weaker batches of illicit fentanyl, a likely reason behind the nearly 15 percent drop in overdose deaths in the last year, according to DEA Administrator Anne Milgram. Milgram claimed credit before a gathering Friday of family members of those who have died from fentanyl poisoning from counterfeit pills or overdoses, citing pressure the Drug Enforcement Administration is putting on the cartels by targeting their criminal networks — from their chemical supply chains in China to their money-laundering operations. (Paun, Reader, Payne and Schumaker, 11/18)