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ICYMI: Guthrie Calls for Modernization of Medicaid’s Cumbersome Waiver Process

Aug 22, 2017

#SubHealth Vice Chairman Brett Guthrie (R-KY) took to Morning Consult today to highlight opportunities to modernize Medicaid’s cumbersome waiver process.

Highlighting an example in his own state, Rep. Guthrie wrote, “Under the leadership of Governor Matt Bevin, Kentucky has applied for a waiver to create some flexibility and new policies that are specific to Kentuckians’ needs. The waiver application includes requiring a sliding scale for premiums ranging from $1 to $15 and some work requirements for Medicaid beneficiaries. These reforms would give recipients the opportunity to work themselves off the program - a groundbreaking idea that, if successful, could serve as a template for other states who want to help people better themselves and transition off the program. Unfortunately, it has been two years and the waiver has not been approved.”

Time to Modernize Medicaid’s Broken Waiver Process

By Rep. Brett Guthrie (R-KY)

For all the attention on various ways to improve Medicaid’s finances and sustainability in recent months, another key area of Medicaid policy that deserves focus is improving the state waiver process. With all the recent calls for bipartisanship, this should be an area where Democrats and Republicans can work together to improve the program.

Medicaid is a state-federal partnership and a critically-important safety net for millions of our nation’s most vulnerable patients. The program dates back to the Great Society era, and will cover up to 98 million people and cost taxpayers more than $600 billion this year alone.

CMS’ new administrator, Seema Verma, has a deep background as a Medicaid reformer, and has the unique opportunity to improve the critical program.

Since the creation of Medicaid, the Secretary of Health and Human Services has been allowed to waive longstanding provisions of the Medicaid statute. Today, Medicaid waivers are widespread, with virtually all states using waivers to test pilot programs and demonstration projects or enroll patients in managed care or home and community based services.

In fact, roughly one in three dollars is spent under a 1115 waiver and some seven in 10 enrollees receive their care through a private managed care plan, often through a managed care waiver. In fact, several state Medicaid programs operate almost entirely under a waiver.

Despite the prevalence and normalcy of Medicaid waivers, the process for states obtaining waivers is needlessly long, cumbersome, and uncertain.

Take my home state of Kentucky for instance. Under the leadership of Governor Matt Bevin, Kentucky has applied for a waiver to create some flexibility and new policies that are specific to Kentuckians’ needs. The waiver application includes requiring a sliding scale for premiums ranging from $1 to $15 and some work requirements for Medicaid beneficiaries. These reforms would give recipients the opportunity to work themselves off the program - a groundbreaking idea that, if successful, could serve as a template for other states who want to help people better themselves and transition off the program. Unfortunately, it has been two years and the waiver has not been approved.

An analysis in 2014 found that CMS takes more than six months to approve a waiver—with some waivers waiting more than a year for approval. In recent years, it took CMS as long as two full years to process a state waiver the agency ultimately approved. Unfortunately, the real total timeframe for a state to receive approval is even longer than these tallies suggest, since official waiver requests are often only submitted for approval after significant preliminary conversations and pre-negotiations with CMS staff.

We need to streamline the waiver process and grant states more flexibility to do the important work of caring for their populations. …

This is an area of Medicaid policy that holds bipartisan promise, and I look forward to working together to adopt commonsense reforms to make the waiver process more efficient, predictable, and fair for states. Administrator Verma is taking action to clean up the bloated bureaucracy, but addressing the waiver process will require an act of Congress.

Click HERE to read the column online.

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