AAFP, Chapters Caution HHS on Changing Medicaid Eligibility

February 22, 2018 03:42 pm News Staff

States that want the flexibility to change their Medicaid programs should be careful to not harm patients by reducing access or erecting unnecessary barriers to care, the AAFP and state chapters are telling HHS.

[person holding medicaid sign with pen and stethoscope]

CMS told state Medicaid directors(www.medicaid.gov) on Jan. 11 that the agency will consider demonstration projects that predicate Medicaid eligibility on meeting requirements for employment or other community engagement among nonelderly, nonpregnant beneficiaries who may be eligible for Medicaid for a reason other than disability. Several states are pursuing such projects, which are authorized by Section 1115 of the Social Security Act.

The AAFP is assisting chapters that want to communicate with HHS or their state governments about these Medicaid waiver applications.

Separately, the AAFP and five other physician organizations issued a set of principles(5 page PDF) for designing, evaluating, reviewing and approving Medicaid demonstration projects. These principles -- adopted by the AAFP, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association, and American Psychiatric Association -- emphasize that Medicaid was created to allow low-income individuals to obtain affordable health care.  

Story Highlights
  • CMS has told states that the agency will consider demonstration projects that predicate Medicaid eligibility on meeting requirements for employment or other community engagement.
  • The AAFP is assisting chapters that want to communicate with HHS or their state government about these Medicaid waiver applications.
  • Kansas withdrew its application for such a project after the AAFP warned HHS about consequences of the proposal.

"CMS should ensure that waivers and other proposed changes to Medicaid do not impose punitive requirements that individuals be employed, be actively seeking a job, or be enrolled in a job training or job recruitment program and/or impose mandatory drug testing as a condition of eligibility," the organizations said.

The joint statement also calls on CMS to ensure that Medicaid payments to physicians are at least equal to the Medicare rate for comparable services.

Kansas had applied for permission to require employment and/or job training for continued Medicaid eligibility, but the state withdrew the application after the AAFP sent HHS a Jan. 24 letter(2 page PDF) warning of the consequences.

"Several states have recently submitted Medicaid Section 1115 waivers that will harm Medicaid beneficiaries if approved," the letter stated. "They will restrict access by conditioning the receipt of care on meeting standards antithetical to the objectives of the Medicaid program and will ultimately harm health."

The Arizona AFP recently asked HHS to deny an application from that state that would impose a work requirement on adult beneficiaries without children who earn no more than 138 percent of the federal poverty level and would limit lifetime benefits to five years of coverage.

If the proposal is approved, about 400,000 Arizonans would lose benefits.

"Imposing work requirements and lifetime limits on coverage is prima facie illegal and, perhaps more importantly, interferes with access to critical preventative and primary care services," the Arizona AFP wrote to HHS. "For people who face major obstacles to employment, requirements such as limiting their eligibility for health coverage will not help overcome these obstacles."

The letter also pointed out the new administrative burden that family physicians would face under the proposal, which would require them to verify Medicaid status and collect payment if a patient's eligibility changes during the course of care.

"It is clear that the state has not considered the implications of what this will mean for the practices of family doctors," the chapter told HHS.

CMS has approved waivers from Kentucky and Indiana that include work or community engagement requirements. In Kentucky, adults with no disability must complete 80 hours of employment, education, job training or community service to be eligible for Medicaid. Indiana requires adults to complete 20 hours of community engagement a week for eight months each year to maintain eligibility.

CMS is considering waiver applications with work requirements from Arkansas, Maine, Mississippi, New Hampshire, Utah and Wisconsin.

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