Medicaid Waivers

Pending Medicaid waiver proposals (updated)
Kentucky Waiver – Open for Public Comment Again – due Aug. 18
As reported in the July 3 Washington Update (under “Courts”), a federal court vacated the Department of Health and Human Services (HHS) approval of a Kentucky Medicaid waiver proposal to impose work requirements on Medicaid beneficiaries. The court’s ruling was based on the failure of the Centers for Medicare and Medicaid Services (CMS) to consider the evidence provided in numerous public comments that the waiver would lead to loss of coverage. The court included excerpts from organizations’ comments as an appendix to its opinion, demonstrating the importance of public comments in establishing a record that must be considered by the agency in making waiver decisions.

On July 18 CMS announced that it would provide another 30-day public comment period for the Kentucky waiver. The comment period ends on August 18. Rather than following the usual process for submitting comments through Regulations.gov, CMS is taking comments through Medicaid.gov.

Mississippi Waiver – Open for Public Comment Again – due Aug. 18
Mississippi has also requested a waiver to establish work or community engagement requirements for Medicaid beneficiaries. Under that proposal, those who are employed the required number of hours and get paid minimum wage will then make too much to qualify for Medicaid. (Those who meet non-paying community engagement requirements would still be eligible.) In light of an amendment to the waiver proposal, CMS is providing another comment period for the Mississippi proposal as well. Comments are due on August 18.

NEW: New Hampshire – Federal Comments Accepted through Sept. 2
New Hampshire seeks to: 1) provide beneficiaries’ healthcare through the State’s managed care delivery system rather than the current Premium Assistance Program; 2) eliminate retroactive coverage to Medicaid beneficiaries; 3) require documentation of citizenship and residency to determine Medicaid eligibility; and 4) apply an asset test to the Medicaid expansion population.

• Pending Application
• Submit comments

Other States’ waivers and waiver proposals – comments
Waiver proposals from several other states are also open for public comment:

• Utah’s Primary Care Network (due August 11)
• Delaware’s Diamond State Health Plan SUD Amendment (due August 12)
• Delaware’s Diamond State Health Plan Extension (due August 12)
• Rhode Island’s Global Waiver Renewal (due August 17)
• Maine’s Demonstration for Individuals with HIV/AIDS (due August 18)
• Maryland’s Health Choice (due August 18)

State-Level Comment Periods
Several states are currently taking comments on their waiver proposals to establish Medicaid work requirements. Alabama is providing a second comment period.

• Healthy Michigan– comments are due August 12.
• Alabama Medicaid Workforce Initiative– comments are due August 30. (See second paragraph of Public Notice for submission details.)
  • July 31, 2018, revised application
  • • Waiver proposal.
    • Analysis of impact on parents and children from the Georgetown Center on Children and Families.Oklahoma Soonercare– comments are due September 3.

Resources on Medicaid Work Requirements (updated)

NEW Putting Medicaid to Work – recording of July 17 webinar sponsored by the USC Annenberg’s Center for Health Journalism and the National Institute for Health Care Management (NIHCM) Foundation 

The National Disability Navigator Resource Collaborative (NDNRC) has compiled a bank of news and resources relating to Medicaid work-requirement waivers: Summary of Posts and Resources on Medicaid Work Requirements.

A blog post from the Georgetown Center on Children and Families (CCF) – A Disturbing Trend of Hiding the Coverage Losses is Emerging in Medicaid Waivers (7/17/18) – addresses the lack of information on budget neutrality in state waiver applications, which may be helpful for advocates commenting on their state’s waiver proposals. Waivers are supposed to be budget-neutral.

OTHER Medicaid News, information and Resources

• In Weary Post-Storm Puerto Rico, Medicaid Cutbacks Bode New Ills (Kaiser Health News, 8/6/18). 
• Meet the Group Funding the Fight to Expand Medicaid in Red States (The Hill, 8/2/281)

WORTH REPEATING: State-Specific Information

The American Academy of Pediatrics (AAP), working with other organizations, has developed a number of state-specific fact sheets:

• State Medicaid and CHIP Snapshots, 2018: Underscores importance of Medicaid and CHIP in providing coverage for children help them grow up healthy and thrive (in partnership with Georgetown University Policy Institute Center for Children and Families)
• Children’s Coverage Snapshot Fact Sheets: Uses data on the ACA, Medicaid and CHIP to highlight how all three programs have worked together to ensure children’s access to health coverage (in partnership with Georgetown University Policy Institute Center for Children and Families)
• CHIP Fact Sheets: Outlines how each state’s CHIP program works for children (in partnership with the Georgetown University Policy Institute Center for Children and Families)
• Medicaid Fact Sheets: Explains the importance of Medicaid for children in each state (in partnership with the Children’s Hospital Association)
• NEW EPSDT State Profiles: Provides detailed information each state Medicaid program’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit and how this compares to AAP/Bright Futures guidelines and recommendations (supported by the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration). See Using Your State EPSDT Profile.