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February 8, 2018

Trump admin weighing states' requests to implement Medicaid coverage limits

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    The Trump administration is considering whether to allow states to impose lifetime limits on Medicaid coverage for adults.

    New: 12 imperatives for designing a sustainable Medicaid strategy

    According to McClatchy DC, at least five states—Arizona, Kansas, Maine, Utah, and Wisconsin—have submitted waiver requests to CMS that seek to implement lifetime coverage limits for Medicaid. Arizona and Utah have proposed five-year eligibility caps on Medicaid coverage, Wisconsin has proposed a four-year limit, Kansas has proposed a three-year limit, and Maine has proposed limiting individuals' Medicaid eligibility to three months of coverage within a three-year period if the individuals do not meet proposed work requirements.

    Approving such limits "would be a first for Medicaid" and would mark a major shift in policy, positioning Medicaid more as a temporary assistance program than a government-run health program, McClatchy reports. While the administration has not indicated how it will act on the lifetime limit waivers, CMS in recent weeks has approved more conservative proposals for implementing states' Medicaid programs, such as waivers that allow Indiana and Kentucky to tie Medicaid coverage to work requirements for certain beneficiaries.

    Advocates express concerns

    Advocates say allowing states to impose lifetime limits on Medicaid coverage would increase states' administrative burdens, because states would have to track beneficiaries' eligibility statuses.

    In addition, advocates say imposing coverage limits could jeopardize coverage for U.S. residents with low incomes whose employers do not offer health coverage. Some industry experts said such individuals could be removed from Medicaid if they reach the eligibility limit.

    Leonardo Cuello, director of health policy at the National Health Law Center, predicted that "this would happen to thousands upon thousands of people across the country" if lifetime limits on Medicaid coverage were implemented throughout the United States.

    Further, some experts said the waivers, if approved, could face legal challenges because the waivers would not meet federal requirements that Medicaid demonstrations further the Medicaid program's objectives of improving access to health coverage and providers and bolstering health outcomes. Suzanne Wikle, a senior policy analyst at the Center for Law and Social Policy, said, "All of these policies that we are seeing are inconsistent with the objectives of Medicaid. They don't seem to seem to have a legal basis and, as such, our stance is that they should not be approved."

    Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities, estimated that there is a "50-50 chance" the administration will approve states' requests for Medicaid coverage limits, adding, "I wouldn't be too terribly surprised to see it approved."

    HHS said it could not comment on the pending waiver applications, McClatchy reports (Pugh, McClatchy DC/Lexington Herald Leader, 2/6; Baker, "Vitals," Axios, 2/7).

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