CMS’ Verma: States Will Be Allowed to Impose Medicaid Work Requirements

NYAPRS Note: In her remarks to state Medicaid directors this morning, CMS Administrator Seema Verma said that CMS will approve state waiver proposals with "community engagement," such as requiring some enrollees to work or participate in other job-related activities. She also released policy guidance to streamline approvals of Medicaid waivers and state plan amendments, which officials in both parties have criticized as onerous. The agency has revised its website on 1115 waivers to encourage state submissions with different objectives than those promoted by the Obama administration, including strategies to ensure Medicaid's long-term sustainability.

While Administrator Verma is very supportive of Medicaid for those "permanently and totally disabled" (the SSI and SSDI medical determination eligibility test, our challenge will be to get across that a significant number of who are not "permanently and totally" disabled require Medicaid supports and services to reside and function in the community, including work arrangements.

Verma Outlines Vision for Medicaid, Announces Historic Steps Taken to Improve the Program

New Policies Help Ensure States Can Focus More Resources, Time Achieving Positive Health Outcomes for Beneficiaries

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia.

During her first major speech on the subject, Verma noted that when the federal government established Medicaid, it was intended to be a partnership with state governments to care for society's most vulnerable citizens. With the growth of the program over the last several years came increased federal and state spending, which naturally meant increased federal oversight and regulation, said Verma.

"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 Administrator Verma. "We need to ensure that we are building a Medicaid program that is sound and solvent to help all beneficiaries reach their highest potential."

Verma emphasized her commitment to "turn the page in the Medicaid program" by giving states more freedom to design innovative programs that achieve positive results for the people they serve and pledged to remove impediments that get in the way of states achieving this goal. She announced several new policies and initiatives that break down the barriers that prevent state innovation and improvement of Medicaid beneficiary health outcomes:

Web Site Content on Section 1115 Demonstrations: CMS updated Medicaid.gov to give states a clearer indication of how their reform strategies might align with a core objective of the Medicaid program: serving the health and wellness needs of the nation's vulnerable and low-income individuals and families. The revised web site content signals a new, broader view of Section 1115 demonstrations, in which states can focus on evidence-based interventions that drive better health outcomes and quality of life improvements. The update signals CMS's willingness to work with state officials requesting flexibility to continue to provide high quality services to their Medicaid beneficiaries, support upward mobility and independence, and advance innovative delivery system and payment models.

In a significant shift from prior policies, in speaking about the new approach to Section 1115 demonstrations, Verma emphasized the agency's commitment to considering proposals that would give states more flexibility to engage with their working-age, able-bodied citizens on Medicaid through demonstrations that will help them rise out of poverty. As Medicaid has expanded to able-bodied individuals, the needs of this population are even more imperative, she said. During her remarks, the Administrator made it clear that CMS will openly consider proposals that promote community engagement and work activities.

"Every American deserves the dignity and respect of high expectations and as public officials we should deliver programs that instill hope and say to each beneficiary that we believe in their potential," said Administrator Verma. "CMS believes that meaningful work is essential to beneficiaries' economic self-sufficiency, self-esteem, well-being, and health of Americans."

Streamline and Improve 1115 Demonstration, State Plan Amendments, and 1915 Waiver Processes: CMS released several new policies that improve federal and state program management, specifically through improvements in the review, approval process, and monitoring of 1115 Demonstrations and Medicaid and Children's Health Insurance Program (CHIP) state plan amendments (SPA) and 1915 waivers. Taken together, these policies include provisions that will allow states to:

  *   Request approval for certain 1115 demonstrations for up to 10 years;
  *   More easily pursue "fast track" federal review, which makes it easier for states to continue their successful demonstration programs;
  *   Spend time administering innovative demonstrations by reducing certain 1115 reporting requirements;
  *   Expedite SPA and 1915 waiver efforts through a streamlined process and by participating in a new "within 15-day" initial review call with CMS officials.

In addition, the policies will improve how waivers and demonstration projects are monitored and evaluated. Waivers and demonstration projects that are less complex and have been running smoothly will require much less reporting, and waivers and demonstration projects that have a good track record of producing positive results will find an easier path to renewal. In her remarks, the Administrator underscored that these new policies were intended to relieve the regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries.

Creation of First-Ever Medicaid and CHIP Scorecards: CMS is in the early stages of developing Scorecards that will provide greater transparency and accountability of the Medicaid program by tracking and publishing state and federal Medicaid outcomes. In her remarks, Verma said that the Scorecards were a "historic opportunity" to demonstrate to taxpayers that their hard-earned tax dollars were being spent appropriately. In addition, the reporting will provide validation to Medicaid beneficiaries that the $558 billion spent on Medicaid is producing positive results and improved health outcomes.

To close her remarks, Administrator Verma noted that federal and state officials have a higher purpose than "just handing out Medicaid cards and being a financier of healthcare." She stressed that the Administration's new vision for Medicaid, and the new policy changes outlined today represented the results of a promise to Medicaid beneficiaries and to the American people that fund the program.

"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," said Verma. "For those unable to care for themselves, we will create sustainable programs that will always be there to provide the care you need, to provide choices and allow you to live as independently as possible. For those that just need a hand up, we will provide you the opportunity to take charge of your health care and assist and empower you to rise out of poverty and government dependence to create a better life for yourselves and your family."

To view a copy of Administrator Verma's remarks, as prepared for delivery, click here.

To visit the new updated Medicaid 1115 Demonstration Project page click here.

To view the Section 1115 Demonstration Process Improvements Informational Bulletin, click here.

To view the State Plan Amendment and 1915 Waiver Informational Bulletin, click here.

Information on the new CMS Medicaid Scorecards will be publicly released when more information becomes available.


Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgovPress.












________________________________