Waivers
Section 1115 of the Social Security Act establishes authority for the Secretary of Health and Human Services (HHS) to waive certain provisions of the Medicaid and CHIP statutes for a state to establish an “experimental, pilot or demonstration” project that promotes the objectives of the program. Such demonstrations are intended to test and learn about new approaches to program design and administration. States have obtained Section 1115 waivers that make broad changes in Medicaid eligibility, benefits, cost sharing, and delivery and payment of care.
South Carolina Becomes First State to Impose Harmful Work Requirements Primarily on Poor Parents
I had held out a little sliver of hope that the Trump Administration would not cross this line but today those hopes were extinguished when CMS Administrator Verma traveled to South Carolina to personally deliver the news to South Carolina Governor McMaster that his state would be the first in the nation to apply a […]
Federal Investigators Discover Improprieties in Medicaid Work Requirement Spending
My father, a professor, used to always say the most interesting part of a paper can often be found in the footnotes. And a recent report from the Government Accountability Office (GAO) on administrative spending in Medicaid Section 1115 work requirement waivers support his claim. I recently read every word of the report, including all […]
Tennessee Medicaid “Block Grant” Proposal: Imagination Gone Wild
The Tennessee Medicaid agency has posted a proposal to convert a portion of its federal funding to a “block grant.” The proposal, which responds to a directive from the Tennessee State Legislature, takes the form of an amendment to the state’s current section 1115 demonstration, which expires at the end of June 2021. The state […]
“Intentional Program Violations” (IPVs): Weaponizing Program Integrity to Undercut Medicaid Expansion
Last November, Utah voters passed an initiative calling for Medicaid expansion. Since then, Utah policymakers have been fighting a convoluted battle against covering low-income adults that has been chronicled by my colleagues Joan Alker, Adam Searing, and Kelly Whitener. The latest chapter in this saga is Utah’s “per capita cap” waiver, which is now before […]
State Flexibility Has Its Limits — Even for the Trump Administration
Like many others, I was out of Washington for the second half of August. That tends to be the period of time when Administrations publicly announce decisions they want buried. And when it comes to Medicaid waivers, the timing may not have been intentional, but what happened in August is worth unearthing to examine more […]
Utah’s Bad Medicaid Bet: Governor and Utah Legislators Relied on Trump Administration Promises that Didn’t Pan Out
What a mess. After repealing the ballot initiative passed by a majority of Utah voters that offered more affordable health coverage through a simple Medicaid expansion, Utah’s Governor and legislature substituted a law that creates a very complex Medicaid plan aimed at only people with incomes under about $12,000 a year. As it turns out, […]
