An increasing number of states are making harmful changes to their Medicaid programs using “Section 1115 waivers.” Families USA is tracking state Medicaid waivers that restrict access to quality, affordable health care for low-income families and adults. This new grid offers an overview of the status of each state’s waiver proposal, the restrictive elements of the waiver proposal, and CMS’s decision on each element. Families USA will be updating the grid regularly to reflect new waiver proposals, and CMS decisions on each element of the proposal.
By weakening the standards around what benefits health plans must cover and other changes, the latest policy from the Trump Administration will threaten the quality and affordability of health coverage.
The impact of a proposed Trump administration rule extends well beyond the directly targeted individuals and families whose health will be at risk. A community’s overall health depends on the health of all of its members. The impact of this proposed rule will spill over to others in many ways. Without insurance, families may delay care or forego it altogether. This means there will be more children in school, and adults in the workplace, without needed preventive services and untreated illnesses. More people delaying care until the last possible moment will strain emergency resources. Hospitals’ and clinics’ uncompensated care burdens will increase.
Funding CSR Payments in the Health Insurance Stabilization Package Could Harm Low- and Middle-Income Consumers
Families USA strongly supports bipartisan efforts to give consumers affordable health insurance in the individual market. A successful stabilization bill would enhance affordability and access by raising advance premium tax credits (APTCs), funding reinsurance, financing outreach and enrollment assistance, and stopping proposed regulations that would let short-term plans and association health plans (AHPs) substantially undermine the individual market.
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.
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.
The Trump Administration wants to turn back the clock on protections for health care consumers established by the Affordable Care Act. This latest act of sabotage on the health law came in the form of a proposed rule released by the Department of Health and Human Services. The proposed rule would make it legal to sell “short-term insurance” plans for long periods of time that do not comply with the ACA’s consumer protections.
To protect their residents, some states are considering using their own income tax systems to replace the federal government’s enforcement of the individual mandate. But another approach under consideration in Maryland would both prevent the harm forecast by CBO while taking new steps to insure families who would otherwise remain without coverage.
Not only would Maryland’s approach increase coverage, newly insured young and healthy residents would improve the overall risk pool, stabilizing markets and lowering premiums for numerous insured residents who buy individual coverage.
Idaho state officials sought to create “state-based plans” for health insurance that would set a precedent for individual market insurance plans that could deny coverage for preexisting conditions. The Idaho health insurance guidelines would put older and sicker residents at a disadvantage.