Waivers
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Letter Regarding Healthy Michigan Plan Section 1115 Demonstration Extension Application
The Georgetown University Center for Children and Families and the Center on Budget and Policy Priorities sent this letter to CMS regarding Michigan’s application to extend its “Health Michigan” 1115 waiver. CCF-CBPP_Healthy Michigan Plan Extension Letter
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Comments on Tennessee’s Proposed “Amendment 4” to TennCare III Demonstration
The following organizations joined Georgetown University Center for Children and Families in submitting comments to HHS regarding Tennessee’s proposed “Amendment 4” to its TennCare III Demonstration. ACNM Tennessee Affiliate American College of Obstetricians and Gynecologists (ACOG) American Lung Association Autistic Self Advocacy Network Center for Law and Social Policy Center on Budget and Policy Priorities…
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Oregon Leads the Nation By Covering Children in Medicaid from Birth to Kindergarten – Which State Will Be Next??
The Biden Administration announced today that it will approve Oregon’s request to provide continuous Medicaid coverage to children from birth through age five and for two years for all Oregonians enrolled in Medicaid age six and up. This use of Section 1115 authority is precisely what Medicaid demonstrations are for — as we and colleagues…
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Coalition Recommends HHS Take Steps to Improve Medicaid Waiver Process
Section 1115 Medicaid waivers drive a large and growing share of Medicaid spending. Currently, 46 states and D.C. operate some or all of their Medicaid programs under section 1115 demonstration authority. Many of these waivers promote coverage; others undermine it, and in the process, the Medicaid program. Unfortunately, the federal regulations governing section 1115 waivers…
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Waiver Update: CMS May Have Found a Path Forward in Tennessee
The Biden CMS inherited a real waiver mess in Tennessee, but CMS may have found a path forward. CMS has asked the state to amend the most problematic parts of its section 1115 demonstration known as TennCare III, so that the TennCare program can continue. Just as importantly, to its credit (and unlike some other…
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Vermont’s Section 1115 Demonstration: Medicaid Managed Care Meets Single Payer
Vermont is one of ten states that don’t use risk-based Medicaid managed care. It’s not that Vermont isn’t interested in risk-based managed care. The state is very interested—so long as it is the managed care organization (MCO). The state made its case to CMS in its application to extend its section 1115 demonstration beyond June…
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Texas Medicaid Waiver Trilogy: The Final Installment
The drama over Texas’ Section 1115 Medicaid waiver has come to a somewhat surprising and precipitous close. On April 22nd, 2022 the Biden Administration decided to stop fighting the litigation brought by Texas Attorney General Paxon to reinstate the terms of the Trump Administration’s waiver approval issued on January 15, 2021 (i.e. just a few…
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Now You See It, Now You Don’t: Supreme Court Drops Medicaid Work Requirements Case, But Still Does Damage
If you blinked at just the wrong moment last week, you might have missed that the Supreme Court erased several years of critical Medicaid law with just one 113-word order. Poof! On Monday, April 18th, the Supreme Court issued an order in the cases on appeal reviewing the legality of approvals of work requirements by…
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Texas Medicaid Section 1115 Waiver Drama Trilogy: Part II
Texas Expects to Get, But Not Give, Notice The Biden Administration came to town with clear intentions to review some of the waiver agreements that the Trump Administration had authorized – most notably on work requirements. We and others had urged the Trump Administration to reconsider the January 15th demonstration approval in Texas in light…
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Medicaid Wars: The Unwinding at the One Year Mark (Episode V)
In its first twelve months, the Biden administration has been unwinding the anti-Medicaid actions taken by its predecessor. The unwinding has been slow and methodical, and it is not yet finished. In part, this is because the new management at CMS has necessarily been focused on responding to the COVID-19 pandemic and in part because…
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California’s Medicaid Managed Care Waiver: New Potential for Access and Transparency
One of the most significant Medicaid managed care developments in 2021 happened on December 29, when CMS approved federal funding and waivers for California’s reform initiative, Advancing Innovation in Medi-Cal (CalAIM). The approval involved two sets of waivers, one operating under section 1115 of the Social Security Act, the other under section 1915(b)(4). For good…
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Texas Medicaid Section 1115 Waiver Drama: A Trilogy
The world of Section 1115 Medicaid waivers can be mysterious and weedy, arcane and annoying, boring and, at times, dramatic. And in recent years, the use of Section 1115 authority by the Trump Administration stretched all previously known boundaries and wound up in court on multiple occasions – most famously in the Arkansas work requirements…
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Georgia’s 1332 Waiver Proposal Puts Children and Families at Risk of Losing Coverage
In 2020, Georgia submitted a waiver under Section 1332 of the Affordable Care Act (ACA) to allow the state to exit HealthCare.gov; the Trump Administration approved the request in November of last year. Under this proposal, the 500,000 Georgians who use the federal marketplace every year to enroll in private health plans and Medicaid would…
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Oregon’s 1115 Medicaid Waiver Request is a Mixed Bag
State seeks to become the first to provide continuous coverage to all children enrolled in Medicaid until age six while continuing to restrict children’s access to health care by continuing to deny them the EPSDT benefit package provided to children in all other states. After months of engaging stakeholders, Oregon has posted its draft…
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Retroactive Coverage Should Not Be Waived in Florida or Anywhere Else: Florida’s Own Evaluation Makes That Clear
We recently submitted public comments on Florida’s amendment to its Section 1115 waiver which has a medley of requests for the federal government to consider. On the plus side, the state is seeking to extend postpartum coverage from 60 days to 12 months (although it is unclear why they need a waiver). But on the…
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Retroactive Coverage Waivers: Coverage Lost and Nothing Learned
If you took cooking classes for more than two decades but still couldn’t boil water, wouldn’t you reconsider your lesson plan? Using section 1115 demonstrations, the Department of Health and Human Services (HHS) can grant states waivers of federal Medicaid requirements, if and only if, the waivers enable the states to conduct health coverage experiments…
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Medicaid Wars: The Unwinding (and Litigation) Continues (Episode IV)
It’s been seven months and change since the Biden Administration took office. What it found waiting for it on January 20 was not just a crisis of democracy and a global pandemic and a surge of unaccompanied children at the border, but also a large pile of policy intended to undercut the Administration’s ability to…
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Federal Government Accepting Public Comments on Tennessee Medicaid Block Grant Waiver Restricting Access to Prescription Drugs
The Centers for Medicare and Medicaid Services (CMS) have reopened a 30-day public comment period for Tennessee’s controversial section 1115 waiver, which the Trump Administration approved in January 2021. While the waiver’s radical centerpiece converting the state’s federal Medicaid funding into a block grant has rightfully received the most attention, the waiver would also allow…
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Biden Administration Takes Further Action to End Barriers to Medicaid Coverage
Nearly six months ago, the Biden Administration initiated efforts to withdraw work reporting requirements in the eleven states with approved section 1115 Medicaid waivers. Now, the resolution many have been waiting for is almost entirely complete. On August 10, Ohio, South Carolina, and Utah all received letters from CMS formally withdrawing their work requirement waivers.…
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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…
