CMS blocks Idaho's plans to bypass ACA rules; Dems call Medicaid lifetime caps 'unspeakably cruel'

Affordable Care Act highlighted
CMS has blocked Idaho's plans to offer insurance coverage that is not ACA compliant. (Image: Getty/Ellenmck)

The Centers for Medicare & Medicaid Services spiked Idaho officials' plans to offer insurance that doesn't comply with the Affordable Care Act, saying such a move would be illegal.

CMS Administrator Seema Verma wrote in a letter (PDF) to Idaho Gov. C. L. "Butch" Otter and the state's insurance director Dean Cameron that though the agency wants to offer states more flexibility in how they offer insurance, Idaho's proposed "state-based plans" are against the law. 

"We sincerely appreciate your dedication to the people of Idaho and your efforts to address the damage cause by the PPACA," Verma wrote. "However, the PPACA remains the law and we have a duty to uphold and enforce the law." 


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Idaho unveiled its plans in late January, and did not seek approval from the federal government before announcing it would allow insurers in the state to allow plans that don't comply with coverage requirements in the ACA.  

A bill to codify the plan was spiked in the state's legislature, but at the time state officials said they believed the Department of Health and Human Services was "sympathetic" to their cause. 

RELATED: Special Report—8 ways to fix the Affordable Care Act 

The plans, Verma said, would not meet the essential health benefits outlined in the law and would potentially allow insurers to discriminate against people of certain ages or with pre-existing conditions. 

Though the state-based plans can't be offered as full-time coverage, Verma wrote that "with certain modifications" the plans could be made available as short-term options. HHS recently proposed a rule that would expand the enrollment period for these plans to 12 months from the three months laid out in the ACA. 

Verma said she looks forward to continuing to work with state officials on ways to lower insurance costs in the state, including on its 1332 and 1115 waiver applications.

Democrats: Allowing Medicaid lifetime coverage limits would be 'unspeakably cruel' 

House Democrats wrote to HHS Secretary Alex Azar urging him to reject state requests to impose lifetime Medicaid coverage limits. 

Democrats on the House Energy and Commerce Committee wrote (PDF) that the lifetime caps could harm patients, and that HHS doesn't have the power to approve them, anyway. 

"Lifetime limits or caps on coverage would be an unspeakably cruel attack on Americans struggling to make ends meet," the lawmakers wrote. "We ask that you swiftly make clear that any such proposals will be rejected." 

RELATED: Trump administration mulls lifetime Medicaid coverage caps 

At least five states have applied for waivers that would allow them to impose these caps: Arizona, Kansas, Utah, Maine and Wisconsin. Pregnant women, children and the disable would be exempted from the caps under the state proposals, instead imposing the limits on "able-bodied" Medicaid recipients. 

These caps would fit with Verma's plans to "turn the page" on Medicaid, which focuses on allowing states to test programs that could lift beneficiaries out of poverty.

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