GAO takes stock of Medicaid waiver approval process


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The agencies that evaluate states’ Medicaid innovation waiver programs are working together to develop assessment tools and taking a flexible approach based on states’ needs, according to a new report from the Government Accountability Office.

The report, which outlines the purpose of the 1332 waivers and evaluates the approval process, says that the Department of Health and Human Services and the U.S. Treasury have established several controls their review process “that seek to ensure approved waivers meet the statutory criteria of preserving health coverage and controlling federal costs.”

In order to gain approval, waivers must provide coverage to at least a comparable number of residents and offer benefits at least as comprehensive and affordable as in the absence of the waiver, the report says. This applies not only to the general population, but to particularly vulnerable populations, HHS has previously clarified.

In addition, the waiver cannot increase the federal deficit either during the five-year maximum waiver period or during the 10 years covered by a budget plan submitted by the state. Beneficiaries’ coverage costs and out-of-pocket spending also cannot be higher than in the absence of the waiver program, the GAO report adds.

To ensure these standards are met, HHS and Treasury officials tell the GAO they have been coordinating between and within their departments to help states develop the concepts for their waiver proposals before they submit applications.HHS and the Treasury hadn’t approved any waivers as of May 2016, however, so GAO had no examples of approved applications or of how the departments applied their controls, the report notes.

The federal government, however, is currently in the process of evaluating Kentucky Gov. Matt Bevin’s proposal to require non-disabled Medicaid beneficiaries to obtain jobs in order to receive benefits and ask them to pay small premiums into the program.

A previous issue brief from The Commonwealth Fund noted that another type of Medicaid waiver, known as section 1115, will require robust evaluation, as it has the potential to reduce or eliminate some beneficiaries’ coverage.

- read the GAO report