CMS Shines Light on the Secret Lives of Medicaid Waivers

Just as Yelp has saved us from many a bad meal, the new Medicaid “Idea Factory” has the potential to protect us from bad health policy decisions.  The idea behind the “Idea Factory” is to infuse more transparency into the process and elicit greater public input into important health policy decisions.  In my view, nowhere is greater public scrutiny needed more than in the secret lives of Medicaid waivers.

As part of this move toward greater government transparency, CMS has started posting all Medicaid waiver proposals on a new site—  With enough clicks, you can get from the homepage to the Idea Factory, where anyone can view and comment on waiver applications. (Click on Waivers, sort the list to Pending, click on any state’s waiver, then click the link next to Submit Public Comments.) Unfortunately, amendments to waivers and other important information were not included in the initial phase of the site.

The good news is that CMS wants our input on how to improve the site and they have made it as easy as reviewing a business on Yelp.  Each viewer can submit a suggestion or vote for other comments, not just on waivers applications but on the site itself.  Each registered e-mail address gets 10 votes per topic.

In the hopes that my fellow waiver watchers will Yelp up my comment, I have submitted one suggesting that amendments to waivers and other important information be included on the site.  It’s based on comments CCF sent along with 28 other national organizations.

Here’s what I submitted on behalf of waiver watchers everywhere:

As a long-time “waiver watcher”, I commend you on your efforts to create greater transparency and more meaningful public input on Medicaid waivers.  As you know, waivers and amendments to waivers often have a significant impact on the health and well-being of children, families and other individuals.  These decisions should be subjected to full public scrutiny – not hidden behind closed doors.  You have made an important first step toward the goal of opening the door on what can be an opaque process.  It’s important to note that many consequential changes to Medicaid occur through amendments to waivers.  In some case, the changes can even be greater than was effected through the underlying waiver itself. To move closer to that laudable goal of a more transparent decision-making process, we “waiver watchers” strongly recommend that waiver amendments be subjected to the same public notice and comment requirements as initial applications.  We also recommend that useful information, such as the question and answer dialogue between the state and federal government, be posted as it is written rather than after the waiver has been approved.  On behalf of Georgetown University’s Center for Children and Families and 25 national groups that support these changes, I want to thank you for the opportunity to comment on the great job you have done so far and for the opportunity to provide our recommendations for improvements.

For a full description of the new waiver process, please look at the brief I co-authored for the Kaiser Commission on Medicaid on the new requirements.

And thank you for joining me in shining the light on the secret lives of Medicaid waivers.

Joan Alker
Joan Alker is the Executive Director of the Center for Children and Families