Red States to Push for Medicaid Waivers in 2020

by Jane Anderson

Conservative states are likely to push hard in 2020 for CMS approval of Medicaid waivers that will allow them to implement policies such as work requirements, while voters in some of the 14 states that have not yet expanded Medicaid could tee up referendums that would require expansion, Medicaid observers say.

"With the clock ticking on the [Trump] administration, they will want to get through as many waivers as possible with conservative principles [such as] work requirements and copayments, and things that discourage folks from staying on the rolls," Jerry Vitti, founder and CEO of Healthcare Financial, Inc., says of red states.

Meanwhile, Medicaid expansion efforts in state legislatures may slow as the country approaches the 2020 election, notes Patricia Boozang, senior managing director at Manatt Health. Several states — such as Idaho, Utah and Nebraska — are in the process of expanding Medicaid in 2020 following successful ballot initiatives in the previous midterm elections.

States also are holding off on implementation of already-approved Medicaid work requirements as litigation surrounding those requirements works through the court system.

"I do think the litigation around work requirements is something that states and the administration are watching really closely," Boozang says. "While we may see additional states seek approval, we may not see any implemented."

Vitti adds: "If the courts say work requirements are fine, you'll see the red states adopt them."

Meanwhile, more than a dozen states are looking at conducting Medicaid managed care contract procurement in 2020, Boozang says. These states include: Georgia, Iowa, Indiana, Kentucky, Michigan, Missouri, Mississippi, Pennsylvania, Tennessee, Virginia, Washington, Wisconsin and West Virginia.

As states move through procurement, Boozang says she expects to see more value-based payment systems implemented, with health plans' help. Plus, states increasingly are turning to Medicaid managed care programs to help them implement policy priorities, such as those surrounding social determinants of health, according to Boozang.

From Health Plan Weekly