Nov. 28, 2018
Dive
Brief:
- Virginia
is the latest state to file a waiver application with
CMS to implement a work requirement for its Medicaid program, which it is
expanding starting next year.
- Meanwhile, CMS Administrator Seema Verma said
she will review the work requirement impact in Arkansas after more than
12,000 people lost coverage when that state's work requirement took
effect. That said, Verma insisted CMS remains committed to work
requirement waivers.
- Also, Wisconsin, which already
received CMS approval for a work requirement waiver, is now having second thoughts after
the gubernatorial election. Governor-elect Tony Evers, a Democrat who
knocked off Republican Gov. Scott Walker this month, said he might end the
Medicaid requirement in his state.
Dive
Insight:
Medicaid
expansion, which was part of the Affordable Care Act, is credited with getting
more than 15 million people health insurance.
Expansion
helps improve care access, but that comes with added costs. A recent HHS Office of the Actuary report on
Medicaid projected the program's expenditures will grow at an average annual
rate of 5.7% over the next decade, faster than the gross domestic product. The
report warned that Medicaid's expenditure growth could strain federal and state
budgets.
Fitch Ratings also said this year that
rising Medicaid costs may force state and local communities to cut spending and
costs or make changes in other programs, such as education, transportation,
public safety, housing and environment.
States,
in turn, are exploring cost-cutting solutions. One way to cut costs is to
require Medicaid recipients to work. Those who don't get jobs, or fail to tally
enough educational or community engagement hours, lose coverage. Many of
those who get a job will be eligible for other types of insurance, including
employer-sponsored plans. Supporters of work requirements argue it gets more
people into employment and cuts the size of Medicaid.
CMS
approved waivers for Arkansas, Indiana, Kentucky, New Hampshire and Wisconsin.
There are 10 other states with pending waivers. A court rejected Kentucky's
plan, which caused the state to submit a similar Plan B to CMS. The agency approved that
option, too, but the new plan will likely wind up in court again.
While
Medicaid work requirements are seen as a way to contain growth, the flip side
is that people lose health insurance and often access to care as well.
Medicaid
expansion is connected to better health outcomes. A recent Government Accountability Office study found
that expansion improves care access and leads to better health results. Plus, a
new report by Georgetown University's Health
Policy Institute and the University of North Carolina's NC
Rural Health Project found that expansion has especially helped low-income
adults in small towns and rural areas.
However,
an analysis by
consulting firm Avalere Health found that pent-up healthcare needs lead to more
claims costs after Medicaid expansion.
Nevertheless,
more states are at least exploring the idea of expansion,
including red states like Missouri, Mississippi and Oklahoma. Earlier this
month, voters in Utah, Nebraska and Idaho approved
Medicaid expansion.
Plus,
Maine, whose voters approved a similar proposal two years ago, is expected to
finally expand Medicaid next year once Republican Gov. Paul LePage leaves
office. A recent court decision demanded
Maine expand Medicaid despite the governor's objections. LePage requested a stay on the ruling and
will likely run out the clock on his term before the state can expand coverage
to another 70,000 people.
Despite
Medicaid expansion, the number of Americans in the federal/state program is actually
on the decline. A recent report from A2 Strategy Group
found that Medicaid covered 1.1 million fewer people this year compared to a
year ago. It's the first year since the ACA that Medicaid enrollment declined.
That's likely connected to an improved economy and people finding health
insurance elsewhere.
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