The Secretary of the U.S. Department of Health and Human Services released a letter to governors this week that is signed by both Secretary Price and Seema Verma, Administrator of the Centers for Medicare and Medicaid Services. The letter outlines their priorities, which largely align with Administrator Verma’s previous work on Medicaid reform efforts in Indiana.
At the beginning of the letter, Secretary Price and Administrator Verma state that the expansion of Medicaid through the Affordable Care Act (ACA) to non-disabled, working-age adults without dependent children was a departure from the historic core and mission of the Medicaid program. In addition, they express a belief that providing a higher federal reimbursement rate for this population has provided state with an incentive to deprioritize the most vulnerable populations. The letter goes on to state that they are committing to “ushering in a new era” for the partnership between states and the federal government that has more flexibility for states.
The letter lists five areas where the agencies plan to collaborate with states.
Improve federal and state program management
The agencies will engage with the states in the State Plan Amendment process in hopes of making the process more transparent, efficient, and less burdensome. Additionally, they aim to “fast-track” approval of waivers and demonstration project extensions.
Support innovative approaches to increase employment and community engagement
The letter reaffirms agency commit to support and complement federal, state, and local programs that have demonstrated success in assisting low-income adult beneficiaries in efforts to rise out of poverty. The agency intends to use existing Section 1115 authority to review and approve work-requirement for able-bodied adults.
Align Medicaid and private insurance policies for non-disabled adults
In this section, the letter encourages greater alignment between the design of Medicaid with common features of commercial health insurance in order to help working age, non-pregnant, non-disabled adults prepare for private coverage. This ranges from consumer-directed healthcare to premium contribution requirements and promoting continuous coverage.
Provide Reasonable Timelines and Process for Home and Community-Based Services Transformation
CMS will work toward providing additional time so that states can comply with the January 6, 2015 Home and Community-Based Services (HCBS) rule. The agency will also be looking for ways to improve engagement with the states on implementation of this rule.
Provide States with More Tools to Address the Opioid Epidemic
The letter expresses commitment to ensuring that states have tools to combat the opioid epidemic and to working with states to improve care for individuals struggling with addiction under Medicaid state plans. HHS and CMS will continue looking at additional opportunities for the states to care for those affected and to develop a more streamlined approach for Section 1115 substance abuse treatment demonstration opportunities.
The full text of the letter from Secretary Price and Administrator Verma is available here.