Waivers
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COVID-19 Medicaid Waiver Soup Explained
Over the past month there has been an explosion of Medicaid waiver activity relating to the COVID-19 pandemic. This activity is not to be confused with the implosion of the Medicaid section 1115 work requirements waivers, which would undermine coverage. Instead, the COVID-related waivers are designed to help state Medicaid programs respond to the pandemic,…
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Pandemic Induced Pragmatism: The State of Medicaid Waiver Policy
Amongst other ways in which life has dramatically changed in the last month, Section 1115 Medicaid waiver terrain has experienced a tectonic shift. For those of us who have been responding to massive numbers of public comment periods over the past two-plus years, only one waiver opened for public comment that we are commenting on…
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Approved 1135 Waivers and State Plan Amendments for COVID-19
Introduction Section 1135 of the Social Security Act allows the Health and Human Services Secretary to waive or modify certain Medicare, Medicaid, and CHIP requirements during a national emergency. The purpose of this authority is to ensure that during an emergency sufficient health care services are available to Medicare, Medicaid, and CHIP `beneficiaries. As of March 13,…
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Indiana’s Own Medicaid Waiver Evaluation Shows Evidence of Coverage Losses
Indiana’s Healthy Indiana Plan (HIP) demonstration, which has been approved in its current form since January 2015, has its extension application up for federal comment. If approved as is, the demonstration would be allowed to continue ten for years! The current HIP demonstration includes work requirements, a tiered benefit structure based on payment of monthly…
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Florida House Bill Targeting Parents on Medicaid Would Cause Huge Coverage Losses
Florida’s legislature is at it again, despite a recent strong Appeals Court ruling that Medicaid work requirements are not permitted by the statute. A bill to impose the harshest Medicaid work reporting requirements in the country on very poor parents – mostly women – is moving through Florida’s House of Representatives. An identical bill passed…
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HIDING THE BALL: The Trump Administration’s Section 1115 Medicaid Waiver Policy has Entered a New and Dangerous Phase
Section 1115 Medicaid waivers have been the tool of choice for the Trump Administration and CMS Administrator Verma’s efforts to mold Medicaid to their wishes since Congress failed to do so in 2017. Unfortunately, their wishes include allowing states to erect barriers to coverage (such as work requirements, raising costs for beneficiaries) and a recent…
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Appeals Court Strikes Decisively at the Heart of Administrator Verma’s Medicaid Agenda
In a decision which warmed my heart on a cold Valentine’s Day here in Washington, the federal Court of Appeals issued an unanimous opinion striking down the Arkansas work requirements waiver. In doing so, it upheld district court Judge Boasberg’s decision vacating the Arkansas’ Section 1115 waiver (including most famously Medicaid work requirements) because it…
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Statement by Joan Alker on Medicaid Block Grant/Per Capita Cap Guidance
Following is a statement by Georgetown University Center for Children and Families Executive Director Joan Alker regarding the Trump Administration’s Medicaid block grant/per capita cap guidance announcement: “The misguided, unlawful guidance issued by CMS today encourages states to gamble with the health and well-being of their residents and their budgets by trading in their guarantee…
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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…
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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…
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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…
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“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…
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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…
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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,…
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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…
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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…
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Medicaid Work Requirements: Is Momentum Stalling?
Last week marked the 18-month anniversary of CMS guidance urging states to apply for Section 1115 Medicaid waivers to impose work reporting requirements as a condition of eligibility. One day after issuing the guidance (January 12, 2018) CMS approved the first state, Kentucky, to go forward with work reporting requirements along with numerous other harmful…
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Pending CMS Guidance on Medicaid Block Grants: Executive Overreach Strikes Again
It has been reported that CMS is developing guidance to encourage states to pursue a new “block grant” or “per capita” cap on federal Medicaid funding through Section 1115 waiver requests. And sure enough, this “Dear State Medicaid Director” letter has appeared on the Office of Management and Budget’s website signaling that it is under…
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New Study Finds Arkansas Medicaid Work Requirement Isn’t Working
As readers of SayAhhh! know, we have been closely following the developments in Arkansas – which was the first state to implement a Medicaid work requirement in the second half of 2018 before a federal judge stepped in and put a hold on the state’s Section 1115 waiver. However, prior to the court’s intervention, more…
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In Utah, Another Attempt to Limit Access to Health Care Coverage
Utah revealed the next chapter in its drawn-out Medicaid expansion debate on May 31. Unsurprisingly, it’s yet another attempt to limit access to affordable health care coverage. Rather than heeding the will of the voters and implementing Prop 3 – which would have given 150,000 low-income Utahans access to Medicaid coverage – the state has…
