The CMS gave the OK for a one-year extension of Kansas’ Medicaid program, KanCare, that allows the state to cover most of its Medicaid population in a managed care plan.
The move will also allow Kansas to continue its safety net care pool, which helps cover uncompensated care, and delivery system reform incentive payments.
Also Monday, Minnesota Gov. Mark Dayton sent a letter saying his state would move ahead with its waiver, which uses a reinsurance program to control premium increases. He continues to disagree with the HHS about funding for the program, however.
KanCare started in 2013 and covers more than 420,000 Kansans. Amerigroup of Kansas, Sunflower Health Plan and UnitedHealthcare Community Plan of Kansas offer the services. President Barack Obama's administration had rejected the waiver based on worries about Kansas’ oversight of the managed care program. Though the CMS reversed its decision, the agency asked that Kansas officials address those concerns.
The managed care program was slated to end at the end of the year, but now Kansas will continue for at least another year to provide Medicaid with a managed care program rather than move it back to fee-for-service.
Kansas is one of a handful of states that have applied for 1332 state innovation grant waivers this year to help with stabilizing the Affordable Care Act (ACA) exchanges. The CMS has recently promoted using innovation waivers to create state-operated reinsurance programs or high-risk pools, saying they "may be an opportunity for states to lower premiums for consumers, improve market stability and increase consumer choice.”
That's particularly a concern in the wake of the administration's decision to end cost-sharing reduction (CSR) payment to insurers.
The CMS also approved a 1332 waiver to establish a reinsurance program for Alaska in July. Minnesota's state innovation waiver will provide $139 million to the state in 2018 and a total of $1 billion between 2018 and 2022. Dayton criticized the waiver process as being “nightmarish," in addition to his disagreement with a federal law interpretation that will reduce funding for the state’s Basic Health Plan.
Iowa has proposed a stopgap measure to help stabilize its ACA exchanges. The waiver would replace premium tax credits with flat premium subsidies based on age and income, eliminate CSRs and create a reinsurance program. Though the CMS hasn't announced its decision yet, President Donald Trump reportedly told CMS Administrator Seema Verma that he opposes the plan.
Meanwhile, Oklahoma withdrew its waiver request when it wasn't approved quickly enough for the state. Oklahoma’s proposal would also create a reinsurance program and change the ACA requirement that payers can charge older people only three times more than younger people. The state’s top health official sent a letter to Trump Administration officials in September citing frustration with the slowness of CMS' decision-making process and requesting a “timely waiver approval.”