The Alliance for Health Policy http://www.allhealthpolicy.org with support from the Commonwealth Fund https://www.commonwealthfund.org, on October 19th held a Capitol Hill briefing to discuss flexibility and innovation in Medicaid. A panel discussing Medicaid issues along with several leaders from State Medicaid programs, noted the recent changes involving Medicaid programs.
As announced in a letter sent to State Medicaid Directors last January, CMS supports state efforts to test incentives that make participation in the work force or other community engagement a requirement for continued Medicaid eligibility. Also, there is coverage for some adult beneficiaries in demonstration projects authorized under Section 1115 of the Social Security Act.
Moderator Sarah J. Dash, MPH, President and CEO, Alliance for Health Policy introduced the panelists and moderated the discussion on how states are responding to specific changes regarding the 115 Medicaid Waivers.
Rachel Nuzum MPH, Vice President, Federal and State Health Policy Initiative for The Commonwealth Fund said it is important to look at the waiver program’s objectives. She points out there is considerable variation in how Medicaid operates in the states which is producing a varied landscape.
Calder Lynch MSHA, Senior Counselor to the Administrator for CMS https://www.cms.gov detailed how the new policy authorized under Section 1115 is designed to assist states in their efforts to improve Medicaid enrolled health and well-being for all beneficiaries.
This may be achieved through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis not related to any disability that may be present.
He further explained how Section 1115 takes into account helping individuals with Substance Use Disorders (SUD) or other health conditions that provide barriers to meet work and community engagement requirements. States are required to help eligible individuals with opioid addiction and other SUDs by providing access to appropriate Medicaid coverage and treatments.
According to Thomas Barker, JD, Partner, Co-Chair, Healthcare Practice, Foley Hoag, LLP, https://www.foleyhoag.com, the Trump Administration has broadly announced the need for increased flexibility in waivers which needs to cross political boundaries. He also pointed out, “At this time, CMS is more aggressive in approving community engagement waivers despite obvious litigation risks”.
In presenting Medicaid issues from the State viewpoint, Cynthia Beane MSW, LCSW, Commissioner West Virginia Bureau for Medical Services https://dhhr.wv.gov reports, “One in four adults over 65, three in five low income individuals, and one in two children on Medicaid produces a large footprint in West Virginia.”
She explained how the Bureau of Medical Services received State Plan approval from CMS to establish the Neonatal Abstinence Syndrome (NAS) Treatment Center. The Center’s goal is to reduce or prevent symptoms of withdrawal in newborns who have prenatally been exposed to addictive drugs using both pharmacological and non-pharmacological interventions.
According to Beane, “The approval for NAS services in the State will enable newborn babies after discharged from the Neonatal Intensive Care Unit (NICU) or hospital, to continue weening from an opioid substance in a safe environment.”
She also mentioned how the West Virginia Medicaid Health Homes Program created by CMS, is focused on improving health outcomes and cost savings, The Health Homes integrate care for enrollees by increasing self-management skills to achieve optimal physical and cognitive health.
The Program coordinates physical and behavioral health and provides long term services to include social services along with providing support for chronic health conditions for Medicaid beneficiaries.
One operational Health Home is designated for bipolar disorder with risk of hepatitis. This home began with a pilot project conducted in six counties but expanded statewide in 2017. Another health home has been established to help individuals with diabetes, and obesity with risk of depression. This pilot project is currently serving 14 counties.
As reported by Cindy Gillespie, Director, Arkansas Department of Human Services https://humanservices.arkansas.gov, “Arkansas is shifting to a client-centered approach to deliver services across population which has resulted in a robust spectrum of services available and utilized.”
In March 2018, the 1115 Waiver Demonstration was amended to be titled “Arkansas Works 2.0”. Specifically, the work and community engagement requirement was initiated for able-bodied enrollees under 50 years of age without dependents in a Qualified Health Plan. However, there is a request to reduce the income eligibility limit from 138 percent FPL to 100 percent, which means FPL is still pending.
One of the key elements of the demonstration is to use proactive outreach tools to communicate and to provide educational information to all beneficiaries in the first ten days of becoming subject to the work and community engagement requirement. Also, the use of the internet and social media, enables enrollees to receive outreach from their insurance carrier and broker/agents.
Leonardo Cuello J.D., Director, Health Policy, National Health Law Program (NHeLP), http://www.healthlaw.org is critical of how Section 1115 is working in several states such as in the case of Kentucky and Arkansas. With legal issues being discussed in these states, he wonders whether other states will need to further address legal issues related to Section 1115.