State of Play:  The Centers for Medicare and Medicaid Services (CMS) has developed a toolkit to facilitate expedited application and approval of state waiver requests in order to respond quickly to states’ needs and provide them flexibility to address the COVID-19 pandemic.  As of April 2, CMS had approved 41 state Medicaid 1135 waivers.  CMS issued its letter to state Medicaid directors outlining the flexibilities included in the Healthy Adult Opportunity (HAO), a demonstration initiative allowing states to apply for section 1115 demonstration waivers under either an aggregate or per-capita cap financing model.  Oklahoma and Tennessee have both submitted 1115 waivers for block grants.  The U.S. District Court for the District of Columbia has struck down Michigan’s work requirements, requiring able-bodied beneficiaries to seek work or participate in other qualifying activities, leaving Utah the only state that has work requirements, which are not yet being enforced.  CMS has granted thirteen 1115 waivers to states to help respond to the national emergency related to the coronavirus.

HLC Position:   Medicaid serves as an important and viable safety net for low-income individuals and families without access to either employer-sponsored insurance or the individual insurance market.  Increasing efficiency in the program is important, but such changes should maintain access to the healthcare safety net for our country’s most vulnerable citizens.  Drawing from private-sector progress in moving to pay for value, the Medicaid program should encourage the thoughtful use of federal waivers to encourage actuarially sound Medicaid expansion in those remaining states that have not yet expanded their eligibility requirements.  Waivers should be used to encourage innovation that emphasizes value-based care and care coordination while allowing private sector entities to play an integral role in providing patients more empowerment over their own care.  HLC also supports incentivizing healthy behaviors and care management for Medicaid enrollees. 

HLC Recent Activity:

  • On June 30, HLC signed a coalition letter encouraging Congress to strengthen Medicaid in future COVID-19 packages.
  • On April 17, HLC shared its COVID-19 key legislative priorities list with Senate and House leadership for consideration in future legislative packages to address the COVID-19 pandemic.
  • On March 19, HLC contacted the National Association of Medicaid Directors to determine ways to assist with 1135 waivers to address the COVID-19 pandemic and asked CMS to issue guidance.
  • On January 17, HLC responded to CMS’s proposed Medicaid fiscal accountability rule.