Medicaid Waiver-less Managed Care Options Recommended

January 2018 – A panel that advises Congress on Medicaid issues wants to make it easier for states to place beneficiaries into managed care without first seeking a waiver from the CMS. The Medicaid and CHIP Payment and Access Commission (MACPAC), asked congress Friday to amend federal statute to permit states to enroll their Medicaid beneficiaries in managed care plans without the need for seeking separate section 1915(b) or 1115 waivers from the federal government.

The unanimous vote of the panel (12-0, with 2 absentions), will be included in MACPAC’s March report to Congress.  Last month, the commission asked Congress to extend waiver periods and to streamline their application process.

Those who abstained raised the concern that such a plan change may not afford the same level of regulatory oversight, or public input as the waiver process.

MACPAC is seeking the statutory change in order to reduce the administrative burden on states. There is a 90-day review process for state plan amendments, while there is not a set review time for waivers. Also, a state only has to give a budget estimate for plan amendment costs, while waivers have to either be cost-effective or budget-neutral.

A former staffer at the agency who used to review waivers, states that if Congress were to sign off on this change, a number of individuals would be pleased from the individual states to CMS (Centers for Medicaid Services). That former staffer, Camille Dobson, stated that many agency staff felt they were spending too much time evaluating waiver cost-effectiveness rather than considering the substance and benefits of the requests.  “The hoops states have to jump through for waivers doesn’t add any value from either a CMS or state perspective,” she said.

As reported in Modern Heathlines, January 28, 2018.