HHS Won't Use Medicaid Waivers to Push for Expansion

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By Sara Hansard

March 7 — The HHS won't try to push states to expand Medicaid under the ACA by using waivers as a lever, a top agency official said March 7.

“We're not going to use this as a lever. We've got no interest in making the residents of a state the pawns,” Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, said in a webcast interview with the Association of Health Care Journalists.

As the presidential election looms in November, a question being raised is what the Department of Health and Human Services will do strengthen the Affordable Care Act. Slavitt was asked whether the CMS—part of the HHS—will use Section 1115 waivers as a way to push states to expand Medicaid under the ACA. The waivers, for which states may apply to use federal Medicaid funds in ways that are not otherwise allowed under federal rules, apply to the traditional Medicaid program in existence before the Affordable Care Act was enacted.

Under the ACA and a subsequent U.S. Supreme Court decision, states have the option of expanding Medicaid to cover people with incomes up to 138 percent of the federal poverty level.

Medicaid Expansion `a State's Decision.'

“I really believe that Medicaid expansion is a state's decision,” Slavitt answered. “That's the way the Supreme Court decided.”

He said HHS is having “a lot of promising conversations with a lot of states” about expanding Medicaid under the ACA.

According to the Kaiser Family Foundation, 31 states and the District of Columbia had expanded Medicaid under the ACA.

Could Use Medicaid for Work Training

Slavitt said proposals that require Medicaid beneficiaries to work wouldn't be acceptable. “A work requirement is not what the Medicaid program is about, and it's not part of what we would do,” he said.

However, he added, “We're flexible. If people want to use Medicaid to help get people into job training programs or other things that could help them with employment, we think those are ideas that could work.”

Arkansas Gov. Asa Hutchinson (R), whose state had expanded Medicaid under the ACA during a previous Democratic governor, has proposed changing the program to include a work requirement .

Marketplaces Becoming More Stable

Slavitt also said that going into their third year in 2016, the “$40 billion” ACA marketplaces are “moving out of the start-up stage into a sort of more stable and more predictable stage.” The marketplaces have characteristics attractive to consumers, such as choice, affordability and a good consumer experience, he said.

Health insurers are experimenting with the marketplaces, which have seen a lot of pent-up, new demand from consumers, Slavitt said. “I really see this market turning into very much the way we operate the Medicare Part D market and the Medicare Advantage market,” he said. Part D is the outpatient drug benefit, and MA is Medicare's managed care benefit.

However, Slavitt said rural areas continue to lack competition and plans covering those areas are less affordable than those for more populated areas. The smaller markets need access to “the things that are going to make them healthier over the longer term,” he said.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

For More Information

More information from the Kaiser Family Foundation on Medicaid expansion is at http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

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