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GOP-led states diverge on easing Medicaid access during COVID-19

March 19, 2020

Topics: Quote of the Day

By Harris Meyer
Modern Healthcare, March 18, 2020

At least two Republican-led states want to temporarily ease their Medicaid waiver requirements and make it easier for residents to get and keep coverage under Medicaid and the Children’s Health Insurance Program during the coronavirus pandemic.

On Tuesday, Arizona and Iowa sent requests to the CMS so they can make temporary changes to their Medicaid programs, including eliminating premiums and pausing disenrollments.

Meanwhile, two other Republican-led states, Oklahoma and Utah, are pushing ahead with Medicaid waiver changes intended to tighten eligibility for expanded coverage to low-income adults under the Affordable Care Act, including work requirements.

The sharply different directions these states are taking illustrate the pull between pragmatic and ideological pressures in the midst of the COVID-19 outbreak, which experts say requires making testing and treatment as accessible and affordable as possible to limit the spread of the epidemic.

“Work requirements and premiums are precisely the kinds of policies that are dangerous now and divert energy for state government staff, who are under enormous stress,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “They need to focus on facilitating as many people’s access to care as they can.”

The Arizona Health Care Cost Containment System’s request would help them mitigate any disruption in care for their members during the emergency declaration, the agency said in a March 17 letter to CMS Administrator Seema Verma.

Iowa asked to temporarily waive premiums and copays and permit continuous eligibility for adults and children. That runs counter to the Trump administration’s effort to test beneficiaries for eligibility more often to ensure program integrity, which has led to hundreds of thousands of people being disenrolled.

Going in the other direction, the Oklahoma Health Care Authority on Monday published its Medicaid Section 1115 waiver application and announced the start of a 30-day public comment period. The waiver would include a work requirement, premiums and co-pays.

Utah is proceeding with its plan to require Medicaid expansion enrollees report at least 48 job searches in the first 90 days of eligibility, as well as to complete an online job readiness survey.

“At a time when the job market is collapsing, the absurdity of that requirement is even more apparent,” Alker said. “I hope good-faith leaders in Utah will drop that requirement, which is a threat to public health.”

Indiana, another Republican-led state that established premiums and other restrictive conditions on coverage through a Section 1115 waiver, did not respond to requests for comment on its plans in light of the pandemic.

A handful of states have limited Medicaid’s traditional 90-day retroactive eligibility when people seek care. Experts warn that may put a heavy financial burden on hospitals serving lots of uninsured, low-income coronavirus patients.



By Don McCanne, M.D.

You would think that the COVID-19 pandemic would provoke state administrators to look for ways of reducing barriers to health care. Expanding Medicaid coverage for low-income individuals would seem to be a logical step, but it appears that some states are making Medicaid access more difficult by adding a work requirement and adding premiums and copays at a time that the job market has collapsed.

How can they? Are their hearts made of stone?

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About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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