One of the consequences of the election, I believe, is that given the significant number of opponents of health care reform who were elected as Governors and/or Insurance Commissioners, we are going to see more “waiver” proposals. Even before the election, Senator Orrin Hatch (R-UT) was talking up the prospect of seeking legislation to allow the state of Utah to receive a waiver for its exchange. (Watch for an upcoming blog on this topic – let’s just say for now that there are serious limitations to Utah’s exchange model!) So there may be attempts on the legislative front to make it easier and quicker to get waivers from provisions of the Affordable Care Act (ACA) as well as more waiver proposals heading to CMS as 2014 draws closer.
As I have blogged about in the past, under current law, states can only use existing waiver processes (i.e. Section 1115 Medicaid and CHIP demonstration requests) to modify certain Medicaid and CHIP provisions of ACA between now and 2017 when a new, broader waiver authority authorized by Section 1332 of ACA comes into effect.
Given that we may see renewed waiver activity ahead, and that some of these waivers may propose changes that limit benefits and/or eligibility for people who depend on Medicaid and CHIP, it is more important than ever to have a strong public notice and comment process in place. Some of the most troubling waivers have been rushed through in the past with little opportunity for scrutiny and comment.
Fortunately, we are right in the middle of the public comment period for proposed regulations about the Section 1115 Medicaid and CHIP waiver process. Georgetown CCF and our partners at the Center on Budget and Policy Priorities, along with a long and diverse list of national consumer and provider groups, have developed comments on the proposed regulations. We urge state and national groups to sign-on to these comments (no individual signers please) before our deadline Friday, November 12th. Also, please feel free to use sections of these comments to help develop your own.
A strong public notice and comment process for Section 1115 demonstrations will be an important tool in the days ahead.