The Centers for Medicare and Medicaid Services (CMS) issued questions and answers today which, among other things, clarified that Section 1115 waiver requests that include enrollment caps or similar policies would not be approved going forward. CMS notes that such policies do not “further the objectives of the program.”

Background note here, Section 1115 Secretarial waiver authority was established to allow the Secretary to waive provisions of federal law in order for states to conduct research and demonstration programs that furthers the objective of the program – not to ignore aspects of federal law they found annoying.

I am glad that the Secretary agrees that limiting access to Medicaid coverage does not further the objectives of the program. In the past, states that covered childless adults had far fewer federal resources and avenues available to them, and some – such as Arizona, Indiana, Wisconsin, Utah and others moved forward through these capped approaches. Today with the historically unprecedented federal matching dollars on the table to extend coverage to parents and childless adults below 138% of the federal poverty line, and a national decision to move towards universal coverage, the justification for capping enrollment no longer exists.