Archive: Waivers/SPAs

Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

On June 29th, a district court judge blocked Kentucky’s waiver request to require Medicaid enrollees to work or participate in a job-related activity for at least 80 hours per month or lose their health coverage. The court ruled that the Centers for Medicare and Medicaid Services (CMS) had not properly considered whether the initiative would violate Medicaid’s central objective of providing medical assistance to the state’s citizens. The decision could have broad implications for other states hoping to limit Medicaid enrollment through work requirements.

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Katiri Zuluaga

Manager, State Initiatives

Indiana is now the second state to receive approval from the Centers for Medicare and Medicaid Services (CMS) for a waiver request that imposes work requirements on Medicaid beneficiaries to maintain coverage. Indiana’s Section 1115 waiver also enacts a Substance Use Disorder (SUD) Program which will include coverage for residential treatment in Institutions for Mental Disease (IMD) and will increase premiums for beneficiaries who use tobacco and are not engaged in tobacco cessation activities. The National Council for Behavioral Health strongly opposes work requirements and any attempts to restrict access to needed behavioral health services.

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Katiri Zuluaga

Manager, State Initiatives

In a historic first, the Centers for Medicare and Medicaid Services (CMS) approved Kentucky’s Section 1115 waiver request that imposes work requirements on Medicaid beneficiaries to maintain coverage. The National Council for Behavioral Health strongly opposes work requirements and believes that work requirements not only prevent individuals with mental health or substance use disorders from receiving the treatment they need, but are in opposition to the core mission of Medicaid. Nine other states have pending work requirement waivers; however, any approvals will likely be challenged in court delaying their implementation.

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Stephanie Pellitt

Policy and Advocacy Associate

On Thursday, the Trump Administration released guidelines for states to create the first-ever work requirements for Medicaid recipients. The guidance targets “able-bodied adults” with some exemptions. While details are still emerging, the National Council has grave concerns that the policy’s exemptions will not be broad enough to protect all individuals with mental health and substance use disorders. Ten states have asked the federal government for approval to institute Medicaid work requirements. With this new guidance, the Administration is expected to begin approving these requests.

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Katiri Zuluaga

Manager, State Initiatives

Arizona has submitted a Section 1115 Medicaid waiver request that would institute a lifetime cap on Medicaid coverage and impose work requirements on enrollees. If approved by the Centers for Medicare and Medicaid Services (CMS), Arizona’s Medicaid program will have the ability to deny or disenroll eligible individuals who fail to meet criteria to work or take educational courses and limit Medicaid coverage to five years for “able-bodied adults.” Each of these measures could significantly harm individuals with mental health and/or addiction disorders who receive care for these conditions through Medicaid.

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Katiri Zuluaga

Manager, State Initiatives

Last week, the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma gave a speech that further elaborated on new guidelines and priorities for Medicaid waivers. The Administrator’s comments to State Medicaid Directors included encouraging states to submit Section 1115 waivers that include work requirements, using the term “community engagements” to describe work requirements for able-bodied adults.

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Stephanie Pellitt

Policy and Advocacy Associate

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released guidance to streamline approvals of Medicaid waivers and state plan amendments. These tools are used by states to alter Medicaid benefits, eligible populations, and service delivery. While the Administration’s stated goal is to ensure Medicaid’s long-term fiscal sustainability and promote beneficiary independence, advocates should be aware of state proposals that could limit beneficiaries’ participation in the Medicaid program.

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