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In the January 11, 2018, letter published by the Centers for Medicare & Medicaid Services (CMS) giving the green light for states to pursue adding work requirements to their Section 1115 waiver programs, the Trump administration, through CMS, has looked to push the envelope as to how far they can modify the Medicaid program as we know it. Changes have not only included typical proposed structural changes, such as turning Medicaid into a block grant program, but new proposals are aimed at the very heart of what Medicaid means—and these proposed changes are being led by the states.
As 2018 and Year 2 of the chaotic Trump Administration kick off, trying to predict what will happen in Medicare, Medicaid, and the Affordable Care Act is as challenging as ever. It’s a midterm election year with terrible headwinds for the GOP, so the legislative calendar is abbreviated, and partisan rancor will peak. That makes it less likely Republicans will get to do much damage but also more likely they will try to serve up red meat for their base, like a return to “repeal and replace.” Congressional leaders, fresh off their billionaire bailout tax bill, are already talking about taking up “reform” (aka cuts) of Medicare and Medicaid and other social welfare programs. The only thing that is certain is 2018 will be another battleground year for government health programs.
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.
Supporters of the Affordable Care Act (ACA) won another huge battle against TrumpCare this week, but the war rages on. The threat will continue to loom until Trump is removed from office, Democrats retake the House or Senate, or the Senate provides him a win with a bipartisan market stabilization bill in the wake of the stinging defeat of Graham-Cassidy, his third failure to repeal the ACA.
Congress is in recess, and, for now, the Affordable Care Act (ACA) fight is on hold, at least legislatively. This is not so, however, for states and the Centers for Medicare & Medicaid Services (CMS). While the rejection of ACA repeal proposals under which Medicaid would face significant cuts was seen as a major win for the program and the underserved communities, the fight goes on as states look to make changes through 1115 waivers and wait for the outcome of the Children’s Health Insurance Program (CHIP) funding reauthorization. Discussed below is some of the recent impactful waiver activity.
I am continually amazed by how many health plans in Medicare Advantage (MA) and Medicaid still cling to restrictive, “Dr. No”’90’s-style managed care practices like pre-authorizations, referrals, and concurrent review. With massive policy changes looming in Medicaid, and the influence of Star Ratings in MA greater than ever, health plans may soon have a gun to their heads: evolve medical management from restrictive to supportive, or die.
The reintroduction of the bipartisan “Stabilize Medicaid and CHIP Coverage Act of 2017” in the House (Green, D-Texas, and Barton, R-Texas) and the Senate (Brown, D-Ohio) provides 12 months of continuous eligibility to Medicaid and Children’s Health Insurance Program (CHIP) enrollees, mitigating the effect of what is known as “churn” for enrollees and health plans. “Churn” affects millions of enrollees who are disenrolled from Medicaid or CHIP due to changes in income or paperwork, despite being otherwise eligible.