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Tuesday, November 3, 2015

As More States Expand Medicaid with Waivers, a New Tool Aids Advocates

Andrea Callow

Associate Director of Medicaid Initiatives

A majority of states are taking advantage of federal funds and expanding their Medicaid programs under the Affordable Care Act (ACA). Several states have done so using Section 1115 waivers to modify aspects of their Medicaid program, like benefits, premiums, and cost-sharing. While these waivers were intended to give states flexibility, state changes to the Medicaid program can make it harder for consumers to maintain coverage and get access to care. Our new Medicaid Expansion Waiver Center outlines what’s in state expansion waivers and gives state advocates resources for challenging potential harmful proposals.

Montana, Michigan, and Arizona submit waiver requests

While states can extend coverage without a waiver, 7 of the 31 states that expanded Medicaid (including the District of Columbia) have asked CMS to waive some program requirements. Montana is the latest state to expand Medicaid through an 1115 waiver (which received federal approval on November 2). Additionally, Michigan recently sought to amend its existing 1115 Medicaid expansion waiver, significantly changing the successful Healthy Michigan Program. And Arizona, whose entire Medicaid program is run through an 1115 waiver, is seeking an amendment that would dramatically change its expansion. 

As more states decide to expand Medicaid, we expect to see more waivers and waiver amendments. States are using the flexibility of 1115 waivers to expand Medicaid in a way that fits the state’s particular needs. However, a lot of the proposals we’re seeing contain troubling elements that make care less affordable and accessible. 

New waiver center shares latest information on state Medicaid expansion waivers and helpful advocacy tools 

Our new waiver center contains state-specific updates and talking points that will equip advocates to:

  • Keep abreast of what’s happening with expansion waivers in different states 
  • Get involved in the waiver process early and remain involved through comment periods and implementation
  • Develop strategies to either eliminate or ameliorate some of the harmful elements states are proposing 
  • Craft arguments for challenging or limiting program elements that curb consumer protections, make Medicaid harder for enrollees to use, or make the program less efficient

Advocates and others can use these arguments both during the legislative process and through state and federal comment periods, if their state is submitting a waiver.

Medicaid expansion is most effective when enrollees don’t face barriers to getting care

Many states are using these waivers to expand Medicaid with significant program changes. In the requests associated with recent Medicaid expansions, states have been asking CMS for waivers that diminish protections for consumers. These protections—which include limits on cost-sharing and premiums and provide for benefits like non-emergency medical transportation—are critical to ensuring that enrollees can maintain Medicaid and get care.  

The best way to expand Medicaid is through an approach that: 

  • Keeps consumer protections in place, like limits on cost-sharing and premiums 
  • Is structured to ensure that enrollees can get care and keep coverage 
  • Avoids administrative complexity of Health Savings Accounts and the associated added costs

Unfortunately, however, waivers that seek to dilute enrollee protections are and will continue to be part of Medicaid expansion programs. We hope that the Medicaid Expansion Waiver Center will help advocates and lawmakers navigate the waiver landscape now and in the future. 

Note: This tool looks only at state waiver requests that CMS has considered. As states incorporate new elements into expansion waiver requests to CMS we will update the site accordingly.