As CMS Administrator Verma Announces Obama-Era Medicaid Policy Reversals, States Signal Support for Medicaid Expansion

Tuesday was a big day for Medicaid policy, with both a rollback of Obama Era policy reversals and a movement toward more states adopting Obamacare’s Medicaid Expansion.

CMS’ Conservative Shift

At the fall 2017 Conference of the National Association of Medicaid Directors (NAMD), the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma laid out a new vision for Medicaid, with several new policies aimed at promoting innovative Medicaid reforms, reducing burdens, increasing efficiency, and promoting transparency and accountability. Most notably, one new policy will allow for the approval of work requirements in Medicaid waiver applications. Six states currently have pending waiver applications that include work requirements, which can now expect approval. This is a significant departure from the Obama administration’s guidance on work requirements, which strongly disapproved of such policies.

The new vision also includes:

  • Web Site Content on Section 1115 Demonstrations – CMS updated to provide states with “a clearer indication of how their reform strategies might align with a core objective of the Medicaid program.” CMS states the update signals CMS’ willingness to work with state officials’ flexibility to continue provide quality services, support upward mobility and independence, and advance innovative and delivery payment models.
  • Streamline and Improve 1115 Demonstration, State Plan Amendments, and 1915 Waiver Processes – CMS released several new policies that aim to improve federal and state program management, including:
    • Request approval for certain 1115 demos for up to 10 years
    • More easily pursue fast-track federal review
    • Reduction of certain 1115 reporting requirements
    • Expedite the state plan amendment (SPA) and 1915 waiver process through a streamlined process and a new “within 15 day” initial review call with CMS officials
  • Creation of First-Ever Medicaid and Children’s Health Insurance Program (CHIP) Scorecards: CMS is in the early stages of developing scorecards that aim to provide greater transparency and accountability of the Medicaid program by tracking and publishing state and federal Medicaid outcomes. We currently don’t have any more information on these scorecards but will report as it becomes available.

Maine Medicaid Expansion Vote

In a seemingly contradictory movement, Maine strongly voted in support of the expansion of Medicaid in Tuesday’s referendum. This win is estimated to give 80,000 residents access to healthcare coverage and make Maine the first state to expand Medicaid by ballot. The win is already seeing some roadblocks with Governor LePage, who voted to veto Medicaid expansion five times prior to this vote, saying he will not implement the expansion until the state legislature comes up with the funds for the state’s share of the costs. This amount is estimated to be $54 million in 2020, according to the Maine Office of Fiscal and Program Review. Despite this, the success of the referendum vote will likely further fuel advocates in states such as Idaho and Utah, where the issue could come up on the ballot in 2018.

Virginia also now sees a glimmer of hope for Medicaid expansion with the election of Democrat Ralph Northam for governor, as well as significant gains in the House of Delegates, which has been overwhelmingly controlled by Republicans for a century. Expansion in Medicaid could cover about 400,000 residents. More importantly, exit polls showed healthcare was a determining factor in the race, with four out of ten citing it as a top issue.

These policy developments show Medicaid is poised for a big battle in 2018 and could make it a significant issue in the midterm elections.




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