Medicaid waiver requests: Speeding enrollment and rescuing hospitals

Some Medicaid exemptions are easier to get than others, recent news suggests. The straightforward process of receiving fast-track enrollment waivers contrasts with an ongoing tug-of-war between Albany, N.Y., and Washington, D.C., over a requested exemption Governor Andrew Cuomo (D-N.Y.) says would rescue ailing hospitals. Specifically:

Amid reports of soaring Medicaid enrollment requests, managing beneficiary on-boarding bombardment may be easier for insurers who receive a "fast track waiver" from the Centers for Medicare & Medicaid Services, according to a new report from the Robert Wood Johnson Foundation. The report gives directions for securing a CMS waiver along with examples of how to operationalize it from four states already doing so--Arkansas, Illinois, Oregon and West Virginia.

States may apply for the waiver by writing a short letter to CMS by December 2015 addressing six points outlined in the report, including the need and duration of the waiver, and fast-track enrollee signatures. CMS confirms waiver eligibility approval in writing.

Once allowed to streamline enrollment, "states have significant flexibility to tailor the fast track strategy to their circumstances and needs," the report states.

The report outlines strategies to implement and boost the effectiveness of fast-track enrollments. For example, states should re-check for Medicaid membership to prevent duplicate enrollments, according to the report.

The news from New York is more complicated: The federal government has yet to decide on the state's request for an exemption to Medicaid rules that would let New York re-invest $10 billion in state health programs, helping relieve financial crisis in New York City's hospital system, according to The Washington Post.

Public hospitals poised for financial collapse in New York serve 5 million Medicaid participants, the Post noted.   

The state's waiver request has been pending for over a year, fueling speculation that Cuomo might pull out of Medicaid expansion if the waiver isn't granted; but this could cost the state and its providers billions, as FierceHealthFinance previously reported.            

HHS spokeswoman Joanne Peters said her department is working with New York to make its waiver request comply with Medicaid law, the Post reported.  

For more:
- here's the RWJF report (.pdf)
- read the Washington Post article

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