Transcript Medicaid Waivers, the MMA & States

Medicaid Waivers, the MMA & States
Alan Weil
Executive Director
National Academy for State Health Policy
Briefing sponsored by
The Alliance for Health Reform
&
The Kaiser Commission on Medicaid and the Uninsured
April 4, 2005
Three Types of Waivers
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Section 1915(b): statewideness,
comparability, freedom of choice
Section 1915(c): home and communitybased services (HCBS)
Section 1115: research and demonstration
Waivers and Budget Neutrality
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The requirement that a waiver not increase the
cost to the federal government is a matter of
long-standing practice, not law.
Sources of savings to offset increases in
spending include managed care, reprogramming
of disproportionate share hospital (DSH) funds,
reallocating unspent SCHIP funds, and scaling
back benefits
The Important Role of Waivers
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Central to the advent and spread of
managed care for Medicaid enrollees
Have completely redefined the scope of
long-term care services within Medicaid
Enabled expansions to otherwise ineligible
populations (e.g., childless adults)
Allow for creative approaches (e.g.,
Oregon priority-setting)
State Viewpoint on Waivers
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Long-standing NGA policy supports allowing
replication without going through waiver process
Governors regularly object to having to come to
Washington “on bended knee” for permission to
run their programs as they see fit
Efforts to create enforceable timelines in waiver
process have not succeeded
States and the MMA
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States as employers
States as administrators of Medicare
means testing
States as funders of Medicare (clawback)
States as administrators of Medicaid
Medicaid and the MMA
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On January 1, 2006, 6 million “dual
eligibles” who have received their
prescription drugs through the Medicaid
program will no longer be eligible for
Medicaid drug coverage and will receive
their prescription drugs through the new
Medicare Part D benefit.
States Have Concerns
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Timeline for assignment to Medicare plans
is rapid
Some enrollees may not be able to
navigate the new system
States will not obtain any information
about the drug utilization of enrollees
Risks are substantial