BY NATHANIEL WEIXEL - 05/22/18
06:03 AM EDT 534
Red states are getting
a reality check from the Trump administration in just how conservative they can
remake their Medicaid programs.
Earlier this month,
the Centers for Medicare and Medicaid Services (CMS) rejected a request from
Kansas to limit Medicaid eligibility to just three years.
CMS
Administrator Seema Verma followed
up on the Kansas decision by saying the administration will not allow any
states to impose lifetime limits on Medicaid.
“We’ve indicated that
we would not approve lifetime limits and I think we’ve made that pretty clear
to states,” Verma said last week at a Washington Post event on health care.
The Trump
administration has made state innovation a priority and has promised to fast-track
Medicaid waivers, especially those that will impose work requirements on
beneficiaries.
Four states have been
granted permission to do so — Arkansas, Kentucky, Indiana and New Hampshire —
and six others have pending waivers.
States have also been
allowed to impose lockout periods if beneficiaries can’t meet the work
requirements and to charge higher premiums than the Obama administration
allowed.
But the decision on
lifetime limits marks the first time the administration completely rejected a
policy favored by conservatives and shows there is no blank check for red
states.
Verma never promised
automatic approvals of conservative ideas, though some might have interpreted
it that way, according to Jeff Myers, president and CEO of the Medicaid Health
Plans of America.
He said it’s becoming
clear that what the Trump administration wants is to construct policies that
will make Medicaid beneficiaries self-sufficient, but that will not take
away their benefits entirely.
Verma has long argued
that promoting self-sufficiency is key to any changes states make to Medicaid.
In explaining the decision to reject lifetime limits, Verma noted that states
only temporarily suspend benefits if work requirements aren’t met.
“An individual may not
comply with a requirement around cost-sharing and they could potentially lose
coverage. But we want to make sure that there’s a pathway back into the program
... if they’re compliant with the requirements,” Verma said last week.
Medicaid experts said
officials in Kansas and other red states were mistaken if they thought they
could get the Trump administration to approve changes just because they happen
to be conservative.
“Contrary to some
states’ expectations, there really is a waiver approval process,” said Joe
Antos, a health policy expert at the American Enterprise Forum, a conservative
think tank.
“Decisions will move
more rapidly than they were ... [but] that doesn’t mean approvals,” he said.
Matt Salo, executive
director of the National Association of Medicaid Directors, said any time
there’s a change in administration, states jockey to see what policies they can
get approved.
“There’s a lot of
pent-up interest in pursuing flexibility and changes that the Obama
administration would not entertain, [but] I don’t think anyone thought it was a
blank check, do whatever you want,” Salo said.
The administration has
yet to make a decision on other conservative wish list policies, such as
Wisconsin’s proposal for drug testing Medicaid recipients, and partial Medicaid
expansion, which would let states expand coverage for only a fraction of the
population and still receive full federal funding under ObamaCare.
Salo said federal
officials want to make sure that any waivers they approve will survive the
inevitable lawsuits that follow.
“People are pretty
savvy ... if you’re just going to approve something that gets torn down in
the courts, you’re wasting everyone’s time,” Salo said. “The granting of a wish
list that gets trounced doesn’t do any good, and even sets the agenda back
somewhat. Everyone’s better off if there’s a real rationale.”
CMS recently declined
to issue a decision on a request by Arkansas to roll back the eligibility
levels for Medicaid beneficiaries. The agency also declined to rule on Kansas’s
request to impose work requirements, which experts have speculated could be an
implicit rejection of the proposals.
Unlike the other four
states that have been approved, Kansas is not a Medicaid expansion state, and
the administration has not approved work requirements in any nonexpansion
states.
Kansas officials
indicated they were still working with federal officials.
“While we will not be
moving forward with lifetime caps, we are pleased that the Administration has
been supportive of our efforts to include a work requirement in the 1115
waiver. This important provision will help improve outcomes and ensure that
Kansans are empowered to achieve self-sufficiency,” Gov. Jeff Colyer (R) said
in a statement.
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