If Elected, How Would Biden Handle Newly Approved Waivers?

by Leslie Small

With the 2020 election drawing ever closer, the Trump administration has been approving states' waiver applications at a brisk pace — greenlighting Georgia's Section 1115 Medicaid waiver on Oct. 15, and another Medicaid waiver from Nebraska on Oct. 20. Further, CMS has said that it's on the cusp of approving Georgia's unique plan to remake its individual insurance market.

"I'm sure that the timing is not a coincidence," Allison Orris, counsel at Manatt Health, says of the waiver approvals. "Waivers by their nature are always political documents," she says.

Both the Georgia and Nebraska 1115 waivers contain work requirements in Medicaid. And Georgia's soon-to-be approved Section 1332 waiver would eliminate the state's use of HealthCare.gov as a centralized enrollment platform.

From a business standpoint, both Georgia and Nebraska's Medicaid demonstrations would have a small — though still positive — impact on the managed care plans currently serving those states, Citi analyst Ralph Giacobbe wrote in recent research notes.

According to The Commonwealth Fund, Medicaid work requirements waivers have now been approved but not implemented in five states, blocked by federal courts in four states and halted by state officials in another two. Arkansas and the Dept. of Justice have asked the Supreme Court to overturn lower court rulings that halted that state's program.

If former Vice President Joe Biden wins the presidency, "I think it will take some thinking on the part of a new administration to decide how they want to move forward with Georgia, with Nebraska," Orris says. Theoretically, it is "certainly possible if the Biden administration wanted to send a signal, they could say, 'waivers are granted at the [HHS] secretary's discretion, we're going to un-grant this waiver.' But I don't think that's how most administrations want to start their relationships with states."

Joan Alker, a research professor and executive director of the Georgetown Center for Children and Families, says a new administration would have the right to rescind those states' waivers, even if it doesn't exercise that option.

"Every administration, of both parties, uses demonstration authority to promote things they want to promote," she says. "But we have not seen such an extraordinarily broad attempt to rewrite Medicaid law and add conditions of eligibility and restrict access" until the current administration, Alker adds.

From Health Plan Weekly