Last fall, Mississippi submitted a Section 1115 Medicaid Demonstration Wavier seeking to establish a Medicaid work requirement that would make it harder for thousands of Mississippians to enroll in coverage and access needed healthcare. Even CMS recognized the serious consequences the waiver could have in a state like Mississippi that did not expand Medicaid. In an attempt to expedite approval for the state’s waiver, Mississippi recently submitted a revised application that provides an additional 12 months of benefits. While this sound like a positive change, it does NOT solve the issues with the initial waiver. CMS Administrator Seema Verma recently stated that any non-expansion state seeking to impose work requirements would need to develop a plan to address the “subsidy cliff” individuals will experience if they attempt to meet a work requirement. The “subsidy cliff” refers to a situation that many will find themselves in, earning too much to qualify for Medicaid but not enough to qualify for financial assistance on the Affordable Care Act’s health insurance marketplaces. Out of concern for this subsidy cliff, CMS rejected the state of Kansas’s Medicaid Section 1115 waiver application seeking to impose work requirements, since the state has not expanded Medicaid. Mississippi’s revised waiver application attempts to address the subsidy cliff by including an additional 12 months of Medicaid.
July 2, 2018, The New York Times, Aaron E. Carroll- The Medicaid logjam appears to be breaking. When the Affordable Care Act first invited states to make more low-income people eligible for Medicaid, pretty much all the blue states said yes, but many red ones said no. Now, the Maine Legislature seems poised to overcome Gov. Paul LePage’s opposition to expanding the program. Just weeks ago, Virginia voted to expand Medicaid as well. They would join 32 states that have already expanded the program, and three others actively considering it. But many are still arguing about whether the expansion actually provides adequate care for more Americans. Some believe it really doesn’t improve access to health care. Others believe that even if it does, it doesn’t improve the quality of that care.
July 1, 2018, The Washington Post, Amy Goldstein- The first Sunday after his inauguration, New Jersey Gov. Phil Murphy signed an executive order directing state agencies to report everything they could do to ramp up the visibility of the Affordable Care Act and persuade more people to buy health coverage under the law. Four months later, the Democratic governor signed into law a requirement that makes New Jersey the first state in a dozen years to compel most residents to carry insurance. As bureaucrats in Trenton scramble to set the mandate in motion, New Jersey’s decisions are at the forefront of a nascent movement with states stepping out on their own to counteract Washington’s efforts to erode the ACA. New Jersey’s insurance provision and a similar one that the D.C. Council adopted last week are timed to begin in January, when a federal penalty is scheduled to disappear for Americans who violate the mandate built into the health-care law. A requirement that Vermont just approved is supposed to take effect in 2020, once officials settle on its specifics.
June 29, 2018, Modern Healthcare, Harris Meyer- “There’s no sweeping pronouncement that you can never have a work requirement,” said Sara Rosenbaum, a professor of health law and policy at George Washington University, who opposes the Kentucky waiver. “But the court is very clear that when the Secretary exercises Section 1115 authority, the secretary must show with evidence how the demonstration will advance the core purpose of Medicaid, which is to insure people.” But James Blumstein, a Vanderbilt University law professor, found Boasberg’s opinion unpersuasive. “I thought the point of an experiment is to find out what happens,” he said. “But the court worries that the agency has not considered the outcomes, which is something that occurs once the experiment develops the evidence.” Despite the caveats, Friday’s ruling was cheered by ACA supporters, who see Medicaid work requirements as political camouflage for the Trump administration and GOP state leaders to slash the number of people receiving Medicaid and roll back the ACA’s coverage expansion. “Striking down Medicaid work requirements on the legal merits is a big roadblock in the way of instituting such requirements, not only in Kentucky but in any red states that are thinking of moving forward,” the University of Michigan’s Bagley said.
June 28, 2018, Washington Examiner, Robert King- Between 1.4 million to 4 million people could lose their healthcare benefits if all states implemented Medicaid work requirements, according to a Thursday estimate from the research firm Kaiser Family Foundation. The estimate comes as more states are aiming to install work rules for certain Medicaid beneficiaries. The analysis looked at several scenarios if all states installed work requirements and found that most people who would lose coverage would do so because they wouldn’t fill out the paperwork. In January, the Trump administration allowed for states to apply for waivers to impose work requirements for able-bodied Medicaid beneficiaries.
June 29, 2018, The Hill, Peter Sullivan- The Trump administration is considering cutting funding for ObamaCare outreach groups that help people enroll in coverage, sources say. An initial proposal by the administration would have cut the funding for the groups, known as “navigators,” from $36 million last year to $10 million this year. Sources say that proposal now could be walked back, and it is possible funding could remain the same as last year, but it is unclear where the final number will end up. Democrats are sure to seize on any cut to the program as further evidence that President Trump is “sabotaging” the health-care law, a key argument they are making ahead of the midterm elections. Democrats are sure to seize on any cut to the program as further evidence that President Trump is “sabotaging” the health-care law, a key argument they are making ahead of the midterm elections.