CMS rejected Kansas’ plan to place a three-year lifetime limit for its residents to receive Medicaid benefits. In a speech to the American Hospital Association on Monday, CMS Director Seema Verma announced the denial and said CMS hopes to let states exempt Native Americans from Medicaid work requirements.
Also, New Hampshire became the fourth state to receive the OK to create a work requirement for Medicaid recipients. The Granite State's requirement of 100 hours per month spent on "community engagement activities" exceeds the 80-hour requirements in Kentucky, Indiana and Arkansas.
In announcing Kansas' waiver rejection, Verma said CMS “is determined to make sure that the Medicaid program remains a safety net for those that need it most.”
We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them.— Administrator Seema Verma (@SeemaCMS) May 7, 2018
Verma and the Trump administration have largely supported state waivers as long as they don't attempt to bypass the Affordable Care Act. Despite the CMS administrator's opposition to the ACA, Verma has said she still has to enforce the law and won’t approve plans that attempt to avoid ACA regulations.
In that vein, CMS rejected an Idaho plan in March that would have allowed insurers to offer plans that don't include the ACA's essential health benefits or protections for people with pre-existing conditions. At that time, Verma told the state it could still achieve many of its goals through short-term catastrophic plans, which the Trump administration plans to expand in 2019.
Meanwhile, the New Hampshire plan was criticized for going even farther than previous work requirements. New Hampshire Gov. Chris Sununu said work requirements help empower people and get them out of poverty, while “also allowing states to control the costs of their Medicaid programs.”
But many experts say these policies are misguided and ineffective. A recent Health Affairs analysis found that if work requirements were applied to Medicaid nationwide, 11 million enrollees would be at risk of losing coverage.
Rosemarie Day, president of Day Health Strategies and former chief operating officer for Massachusetts’ Medicaid program, recently told Healthcare Dive that work requirements are difficult and costly to administer.
“Requiring people to work for their healthcare also creates a real Catch-22," she said. "If a person loses their health coverage for not working, but they weren't able to work due to an undiagnosed physical or mental health issue, then they will be prevented from solving the problem that is preventing them from working. It would take an extremely benevolent (and costly) administrative process to disentangle these issues.”
In other Medicaid news, Utah may become the next Medicaid expansion battleground. The state verified that Utah Decides Healthcare collected 141,600 signatures, which was more than the 113,143 needed to get a Medicaid expansion referendum on the ballot this fall. The lieutenant governor still needs to certify the initiative.
Also, Maine’s Medicaid expansion program remains stalled. Maine voters became the first to approve Medicaid expansion at the ballot box last fall. Since then, Gov. Paul LePage has refused to present a plan for Maine to become the 34th Medicaid expansion state.
LePage, a Republican in his final term as governor, said he won’t forward a plan unless the legislature finds between $45 million and $55 million to fund expansion without raising taxes or dipping into reserves. The state’s health department recently missed an HHS deadline for its Medicaid expansion proposal.
Now, one of the organizations involved in the Maine referendum, Maine Equal Justice Partners, is suing the LePage administration in hopes to force the governor to expand the program. In the latest twist, Maine Attorney General Janet Mills, a Democrat, said her office will not represent LePage in the lawsuit.