CMS Provides Guidance to States on ACA’s Stability Protection Provisions

By Jocelyn Guyer

Today, CMS issued a letter and a frequently asked questions document that outlines how the Administration will work with states to implement the Affordable Care Act’s stability protections.  As readers of Say Ahhh! know, a number of Republican Governors have been pressuring HHS to relax these stability protection or “maintenance of effort” provisions so that they can reduce Medicaid and CHIP expenditures by covering fewer people.  The guidance issued today is good news for families seeking to gain solid footing after tough economic times.

The Administration’s action protects coverage for children and families by drawing on already-established rules from nearly identical “maintenance-of-effort” provisions included in the American Recovery and Reinvestment Act.  It advises states against attempts to cut children and others off coverage by slashing eligibility or by using “backdoor” strategies to create roadblocks to coverage through red-tape and paperwork requirements.

The stability protections or maintenance-of-effort provisions included in the Affordable Care Act require states to maintain the eligibility rules that were in place when the law took effect on March 23, 2010.  The stability protections cover adults until 2014 and children through 2019.  ARRA also included stability protections in exchange for increased federal matching funds to help states meet their obligations during the Recession.

The letter issued by CMS today indicates that they will follow rules already established to implement the stability protections included in the Recovery Act unless otherwise noted.  These rules preclude states from: 

  •  Eliminating Medicaid for an entire category of people covered at state option;
  •  Lowering the income threshold for Medicaid coverage, making fewer people eligible;
  • Eliminating a state’s CHIP program or scaling back income eligibility thresholds to make fewer children eligible
  • Imposing a new asset test in Medicaid or CHIP;
  •  Imposing new requirements for families to renew their coverage more frequently; or
  •  Imposing a new requirement for families to conduct a face-to-face interview instead of allowing mail-in or on-line applications.

 

In a few instances, the guidance addresses new issues that arise out of difference between the Recovery Act’s provisions and those included in the Affordable Care Act.

  • Option to scale back coverage of adults above 133 percent of the federal poverty level.  Congress explicitly gave states with budget deficits this option in the Affordable Care Act, which applies only to adults who are not pregnant or disabled.  
  • Does not require states to renew expiring waivers.  States that have expanded Medicaid to people using 1115 waivers are not obligated to renew these waivers .  CMS already had articulated this policy in a letter to Arizona earlier this month.
  • Allowing premium increases consistent with inflation.  In a divergence from the Recovery Act rules, states can increase premiums in Medicaid and CHIP to reflect inflation.  In explaining the divergence, CMS noted that the stability protections included in the Affordable Care Act are in place for a considerably longer period of time.

 

 

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