MedPage Today

By: Shannon Firth

The GOP Congress was not able to repeal and replace the Affordable Care Act, and states such as Kentucky, Arizona, Arkansas, and Maine, have decided to continue with their waiver proposals to change their Medicaid programs in their states. However, it is still not certain if these changes will aid or not the future of Medicaid.

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Joan Alker, executive director of the Center for Children and Families (CCF) and a research professor at the Georgetown University McCourt School of Public Policy here, argued that the view of block grants and waiver approaches increasing state flexibility is “flawed.”

Alker said that she anticipated that in the coming months, red states, particularly those whose legislatures opposed expansion from the start, will aim to limit the number of people covered by Medicaid or the services they receive, through explicit or implicit strategies, using waivers.

Similarly, examples of strategies for limiting what states cover could include higher cost-sharing and premiums, Alker noted, pointing out that research has shown that adding premiums would inevitably reduce the number of people who get coverage.

“Simply because we limit people access to care does not mean their healthcare needs go away,” she said. She called such strategies short-sighted because they can lead low-income individuals, including those with chronic conditions, to skip out on healthcare services. They may then land in the emergency department, which is one of the most expensive places to receive care.

Alker drew attention to Indiana’s Medicaid expansion, which requires enrollees to pay premiums and includes lock-out periods for those who fail to pay on time. There is also Kentucky’s proposed expansion waiver that includes lock-out periods, premiums, and work requirements, a provision rejected under the Obama administration.

The panel agreed that the decision on Kentucky’s waiver, likely the first waiver decision of the Trump administration, would lay the blueprint for other red states to follow.

“Fundamentally, I don’t think these programs meet their stated objectives,” she said.

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