By Leslie Small
It's now been more than
seven months since news emerged that the Trump administration wants to use
waivers to bring block grants to Medicaid. The administration has since moved
closer to doing so, as a document titled "State Medicaid Director Letter:
Medicaid Value and Accountability Demonstration Opportunity" has been on
the Office of Management and Budget’s website since June 6.
What's more, some states
have made moves that suggest they would try to cap their Medicaid funding if
given the green light by CMS. Tennessee is drawing up a waiver request that
would move TennCare from an open-ended entitlement program to one with fixed
federal payments, in exchange for more flexibility. And Utah recently submitted
a waiver proposal that would apply per capita caps to its Medicaid program,
giving the state a fixed amount of federal money per enrollee.
"We would expect to
see that if they do approve some kind of block grant waiver somewhere, the
administration is likely to give that state possibly some pretty favorable
financial terms [that] would not be in place for all states," says Joan
Alker, executive director of the Georgetown University Center for Children and
Families.
That, she says, would
help the administration make the case to Congress to apply Medicaid funding
caps to the whole country. "But it would be a sham experiment because
congressional proposals are all about significant cuts," Alker adds.
According to Alex
Shekhdar, founder of Sycamore Creek Healthcare Advisors, "there would
absolutely be legal challenges" if Medicaid block grant or per capita cap
waivers move from concept to reality. Looming over both funding-cap waivers and
Medicaid work requirements waivers, he says, "is a conversation about what
kind of administrative authority the HHS secretary has."
From Health Plan Weekly
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