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.
More States Moving to Extend Medicaid Postpartum Coverage Option Under ARP, Why Are Georgia and Missouri Limiting Its Reach?
Extending postpartum coverage continues to be a hot topic in state legislatures, in Congress, and in the Biden Administration. As my colleagues shared in a blog last week, CMS recently approved Section 1115 demonstration waivers in Georgia and Missouri that extend postpartum benefits to at least some pregnant people. While a step forward, the approvals […]
Georgia and Missouri Postpartum Medicaid Waiver Approvals Promote Limited Coverage
As Say Ahh readers know, there have been bursts of Section 1115 demonstration activity since the start of the year. April was no different, bringing another flurry of actions from CMS. This time, however, there were some new demonstration approvals that promote coverage, albeit in a more limited way than we would have liked to […]
Medicaid Wars: Litigation Risk (Episode III)
It turns out that unwinding illegal Medicaid policies is complicated. There’s this thing called “litigation risk”. Executive Branch agencies have to make reasoned decisions and stay within their statutory guardrails; if they don’t the federal courts may rein them in. As it happens, litigation risk goes both ways. The Unwinding began with the issuance of […]
Advancing Postpartum Coverage in Medicaid: Waiver or SPA?
The recently enacted American Rescue Plan Act has many new opportunities and important provisions that we are still absorbing and unpacking. One key change, as readers of SayAhh! know, is the new state option to provide 12 months of postpartum Medicaid and CHIP coverage to women after the end of their pregnancy, well beyond the […]
Some States’ Letters to CMS on Medicaid Work Requirements Double Down
Last month, CMS began taking steps to get rid of Medicaid section 1115 work requirement waivers as my colleague Joan Alker has written about. The Biden Administration sent letters to states with approved work requirements that “preliminarily” disapproved the policy on the basis of the COVID-19 pandemic and uncertainty of its aftermath on health and […]
Medicaid Wars: Rescind and Withdraw (Episode II)
The Biden Administration has a long list of bad Medicaid policies to unwind. As chronicled in Episode I, the groundwork for the unwinding was laid in a Presidential Executive Order, “Strengthening Medicaid and the Affordable Care Act,” issued on January 28. Among other things, the E.O. directs the Secretary of HHS to review section 1115 demonstrations and […]