Medicaid waivers

Feds Rescind Texas Medicaid Waiver

A federal Medicaid waiver approved for the state of Texas in the waning days of the Trump administration has been rescinded by the Biden administration. The waiver called for spending as much as $100 billion for health care for low-income Texans over the next ten years. Officially, the Centers for Medicare & Medicaid Services revoked the waiver on technical grounds, maintaining that the agency “… erred in exempting the state from the normal public notice process – a critical priority for soliciting stakeholder feedback and ensuring public awareness.” The Washington Post, however, reports that according to two unnamed federal health [...]

admin2021-04-22T06:00:32+00:00April 22, 2021|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid|

CMS Introduces New Approach to Medicaid Block Grants

States would be able to convert part of their Medicaid programs into block grants under a new program introduced by the federal government. The program, which the Centers for Medicare & Medicaid Services calls “Healthy Adult Opportunity,” would encompass services only for adults under the age of 65 who are not eligible for Medicaid because of disability or the need for long-term care, services, and supports and who are not otherwise eligible for the pre-Affordable Care Act Medicaid program. Under the program, states can develop either a total expenses model or per enrollee model for their block grants and would [...]

admin2020-01-31T06:00:43+00:00January 31, 2020|Affordable Care Act, Medicaid|

CMS Speeds Up Medicaid Review Process

The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs. Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests. According to a recent post on the CMS blog (in CMS’s own words), Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs [note: state plan amendments]. Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016. Between calendar year 2016 [...]

admin2019-05-14T06:00:36+00:00May 14, 2019|Centers for Medicare & Medicaid Services, Medicaid|

HHS Talking to States About Medicaid Block Grants

In the absence of legislation to turn Medicaid into a block grant program, the U.S. Department of Health and Human Services is talking to some states about granting waivers that permit them – voluntarily – to turn their individual Medicaid programs into block grants. HHS Secretary Alex Azar acknowledged this last week during a hearing of the Senate Finance Committee. He did not disclose which states, or how many, with which HHS has had such discussions and he also noted that his staff is talking to state officials about waivers to permit them to adopt Medicaid per capita spending limits. [...]

admin2019-03-20T06:00:51+00:00March 20, 2019|Medicaid|

End Run Around Congress for Medicaid Block Grants?

The Trump administration reportedly is considering introducing Medicaid block grants through regulations rather than legislation, according to published reports. Those reports explain that the administration may seek to offer states an opportunity to apply to the federal government to use Medicaid block grants by obtaining section 1115 Medicaid waivers, a commonly used tool for states seeking exemptions from federal legislative or regulatory requirements. As reported by the online publication The Hill, …the Trump administration is now considering issuing guidance to states encouraging them to apply for caps on federal Medicaid spending in exchange for additional flexibility on how they run [...]

admin2019-01-16T06:00:01+00:00January 16, 2019|Centers for Medicare & Medicaid Services, Medicaid|

CMS Reinforces Need for Budget Neutrality in Medicaid Waivers

States that seek federal waivers for permission to employ new approaches to serving their Medicaid population will have to pass more rigorous tests to ensure that those new approaches are budget-neutral, the Centers for Medicare & Medicaid Services has announced. In a detailed letter to state Medicaid directors, CMS outlines some of the current methodologies employed by states to demonstrate the budget neutrality of their waiver requests and details instances in which it will judge those methodologies differently in the future. A news release accompanying the letter explains that ….this letter marks the first time that CMS has formally outlined [...]

admin2018-08-31T06:00:11+00:00August 31, 2018|Medicaid|

GAO: CMS Needs to Do Better Job on Demonstration Evaluations

The federal government needs to do a better job of evaluating Medicaid demonstration programs, according to the U.S. Government Accountability Office. Demonstration programs, on which the federal government spends more than $300 billion a year, exempt states from selected federal Medicaid requirements and regulations so they can test new approaches to providing and paying for care for their Medicaid population. As part of waiving these requirements, the Centers for Medicare & Medicaid Services requires the states to perform or commission evaluations of the effectiveness of those new approaches. According to a new GAO study, however, those reports are not always [...]

admin2018-02-22T06:00:25+00:00February 22, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well. Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including: establishing time limits on how many months or years individuals may be enrolled in Medicaid; locking out for a [...]

admin2018-02-09T06:00:25+00:00February 9, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. to discuss a variety of Medicaid and Children’s Health Insurance Program issues. MACPAC, the non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the administration, and the states, addressed a number of issues during the meeting. Among them it discussed Medicaid managed long-term services and supports (MLTSS) and voted to recommend that states be given the opportunity to seek permission to make Medicaid beneficiary enrollment in managed care plans mandatory through revisions of their state plan amendment rather than by [...]

admin2018-01-30T06:00:58+00:00January 30, 2018|MACPAC, Medicaid, Medicaid long-term services and supports, Medicaid managed care|

A New Use for Section 1115 Medicaid Waivers?

Historically, states have pursued section 1115 Medicaid waivers as a means of expanding Medicaid eligibility. But the Centers for Medicare & Medicaid Services now appears to be looking at granting 1115 waivers to help states reduce their Medicaid populations. According to a new report published by the Commonwealth Fund, CMS is encouraging states – both Medicaid expansion and non-expansion states – to launch demonstration programs designed to reduce enrollment in “means-tested public assistance” programs such as Medicaid. In their efforts to cut spending and reduce Medicaid enrollment, states are expected to seek section 1115 waivers to experiment with means of [...]

admin2018-01-16T06:00:16+00:00January 16, 2018|Centers for Medicare & Medicaid Services, Medicaid|