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.
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, […]
New Mexico: Some Good Waiver News for a Change
Those of us who follow Medicaid waiver activity around the country can feel that we’re being constantly assaulted by bad news. So here’s some good news to brighten your day: instead of proposing burdensome requirements that limit access to Medicaid enrollment and services, New Mexico is planning to improve its section 1115 waiver – known […]
Medicaid Work Requirements: Another Win for Beneficiaries, Another Loss for CMS
CMS Administrator Seema Verma is visibly proud of her agency’s Medicaid and CHIP scorecard, which she claims has ushered in “a new era of accountability and transparency in Medicaid”. The scorecard includes measures of, among other things, federal administrative accountability; one of those measures reports the percentage of Section 1115 demonstration applications that CMS approved […]