Since the Trump Administration took office, several states have asked the Centers for Medicare and Medicaid Services (CMS) for approval to waive Medicaid requirements or add new ones through requests known as Medicaid Section 1115 waivers. View our timeline below of the different stages that occur before these requests get to CMS.
Today, Medicaid faces unique threats, and these threats are happening largely below the radar screen. So far, we have succeeded in averting multiple attempts to erode Medicaid as we know it through federal legislation, but efforts to undermine coverage continue through legally questionable regulatory actions and destructive Medicaid waivers. These Medicaid waivers have the potential to have a profound impact on children, families, and their oral health coverage.
On March 5, 2018, CMS approved Arkansas’ request to add a work requirement to its Medicaid program. Equally important, it did not approve the state’s request to roll back Medicaid eligibility to a partial Medicaid expansion. Both tell us a lot about what’s behind CMS’s approach to Medicaid waivers, and what states can expect to have, and not have, approved. View factsheet here.
CMS has approved work requirements (sometimes spun as “community engagement” requirements) in three states: Arkansas, Kentucky, and Indiana. Eight additional states have similar requests pending, and CMS appears likely to approve those requests, as well. Litigation challenging the authority of the executive branch to approve work requirements—rules that are contained nowhere in Medicaid law—have also begun.
Medicaid Work Requirements Aren’t About Work, They’re About Taking Health Care Away From Low-Income Americans
There is overwhelming evidence that the Administration’s actions, working with several conservative governors, are about taking coverage away from people rather than about supporting employment.
Recently, the state of Wisconsin submitted an application to the federal government seeking Medicaid waiver authority to make drug testing a condition of eligibility for the state’s adult Medicaid program--BadgerCare. This request breaks dangerous new ground; drug testing has never been allowed as part of the application process in the Medicaid program. That’s because it is illegal, it will make it harder for everyone applying for Medicaid, and it will hurt rather than help those with substance use disorders.
With this decision, CMS is making it clear that policies that make it harder for the lowest-income people in the program to get health care are inconsistent with the goals of Medicaid. The decision also defined some boundaries regarding what is and is not appropriate for approval through the Medicaid waiver process.
Last month, Kentucky asked the federal government for approval to make significant and troubling changes to its highly successful Medicaid expansion program. To justify its request, the state asserted that these changes would help “break the cycle of poverty.” However, the results would likely be the opposite.
The fact is, by providing health insurance and helping people in the program avoid medical debt, Medicaid coverage can actually improve the financial health of its enrollees. Two recent reports, one in April and one in June, offer new evidence supporting that link.
How States Can Fund Community Health Workers through Medicaid to Improve People’s Health, Decrease Costs, and Reduce Disparities
This brief discusses the value of community health workers (CHWs) in improving care while reducing disparities for vulnerable populations. It also walks advocates through how they can get sustainable funding for CHWs in their state.