The Trump administration has unveiled a plan to “turn the page" on the Medicaid program, an effort that will include revamping the waiver process, encouraging work requirements for beneficiaries and creating quality scorecards.
Centers for Medicare & Medicaid Services Administrator Seema Verma outlined the plan on Tuesday at the National Association of Medicaid Directors’ fall conference in Arlington, Virginia.
“Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve,” said Verma, who helped design Indiana’s right-leaning Medicaid expansion program before taking the helm at CMS.
Verma’s vision for retooling Medicaid includes an effort “streamline and improve” provisions that allow states—with the federal government’s approval—to test and implement changes to their Medicaid programs.
For one, CMS’ newly released policies will allow states to request approval for certain section 1115 waiver demonstrations for up to 10 years. Currently, such waivers are generally approved for an initial five-year period and must be renewed to continue operations past that period, according to the Kaiser Family Foundation.
The agency also aims to reduce certain 1115 reporting requirements and let states more easily pursue a “fast-track” federal review that allows them to continue their Medicaid demonstration projects.
Similarly, CMS outlined changes meant to streamline the processes surrounding state plan amendments and 1915 waivers. SPAs allow states to change their Medicaid program policies or operational approaches, while 1915 waivers let states develop home and community-based services for individuals who receive long-term care services and supports.
As part of that effort, CMS staff has already begun conducting introductory calls with states within 15 days of receiving a new SPA or section 1915 waiver submission.
A broader view of waivers
In addition to these changes in process, CMS debuted a new webpage that outlines its “new, broader view of Section 1115 demonstrations.”
The new site makes it clear that the federal government is eager to work with states on requests for greater flexibility—particularly efforts to “engage with their working-age, able-bodied citizens on Medicaid through demonstrations that will help them rise out of poverty.”
That language echoes a letter that Verma and erstwhile Health and Human Services Secretary Tom Price issued to state leaders in March, which indicated that the Trump administration was eager to review and approve state-led innovations that promote “training, employment and independence” among Medicaid beneficiaries.
“CMS believes that meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being, and health of Americans,” Verma said on Tuesday, according to CMS’ release.
States are already heeding the administration’s call, as New Hampshire submitted an application in late October that would allow it to impose a work requirement on its Medicaid beneficiaries. The Obama administration had denied the state’s request to do so.
Verma also said that CMS is beginning to develop scorecards that will track and publish state and federal Medicaid outcomes, calling it a “historic opportunity” to demonstrate that taxpayer dollars are being spent appropriately.
“We will not just accept the hollow victory of numbers covered [in the program], but will dig deeper and demand more of ourselves and of you,” Verma said.
Indeed, the Trump administration has been critical of the expansion of Medicaid eligibility under the ACA, arguing that allowing able-bodied adults into the program erodes its core mission.
As part of their legislative efforts to repeal the federal healthcare law, Republicans have not only tried to roll back Medicaid expansion, but also change how the Medicaid program is financed—which would have significantly cut federal funding.