Massachusetts wants to amend its Medicaid waiver; Medicaid expansion saves Montana $30M

Medicaid
Though other states have asked to implement partial Medicaid expansion, their applications have all been denied under the Obama administration. (Getty/juststock)

Seeking to control costs, Massachusetts is asking the federal government to let it move to a partial Medicaid expansion and reduce the number medicines covered by MassHealth.

The commonwealth has already had a five-year section 1115 waiver demonstration program approved by the Centers for Medicare & Medicaid Services, which will allow it to shift the majority of its managed care-eligible members into accountable care organizations. But it now wants to amend its demonstration to get even more flexibility.

In a letter sent to CMS Administrator Seema Verma earlier this month, Massachusetts officials say they need that flexibility in order to make MassHealth more sustainable. Right now, they note, it makes up 40% of the commonwealth’s budget. 

Thus, the amendment request seeks to move nondisabled adults with incomes above 100% of the federal poverty level (FPL) out of MassHealth and into subsidized commercial plans through the state’s exchange. Regular Medicaid expansion includes individuals up to 138% of FPL.

Though other states have asked to implement partial Medicaid expansion similar to what Massachusetts is requesting, their applications have all been denied under the Obama administration.

Massachusetts also wants to change MassHealth’s policy of providing coverage for all prescription treatments and instead move to a formulary system modeled off of commercial health plans. 

“Adopting a closed formulary with at least a single drug per therapeutic class would enable MassHealth to negotiate more favorable rebate agreements with manufacturers,” the commonwealth’s officials argue.

In other Medicaid-related news on the state level:

Montana has saved $30M due to Medicaid expansion

An official from Montana’s Department of Public Health and Human Services told a legislative oversight committee last week that the state’s decision to expand Medicaid has saved it $30 million since the program started in January 2016.

“Our current budget crisis would be worse today in the absence of Medicaid expansion,” the official said, according to the Associated Press. 

She also noted that the program covers nearly 84,000 residents and has paid for $574 million in healthcare services since it began. 

Arkansas’ Medicaid spending rises

Arkansas’ Department of Human Services says spending on the state’s expanded Medicaid program increased 24% for the fiscal year that ended June 30, reaching $1.9 billion and surpassing projections by more than $200 million.

Higher-than-expected enrollment was the driving factor behind the spending uptick, though the state’s share of the overall cost still ended up being $5 million less than it projected, according to Arkansas Online. Spending on Arkansas’ traditional Medicaid program increased 4.3%, the largest uptick since 2012.