CMS draws line on reforms by rejecting lifetime limits in Medicaid
Kansas’s proposal to impose a three-year lifetime limit on Medicaid benefits has been formally rejected by CMS, with Administrator Seema Verma, MPH, saying the agency has to ensure the program “remains a safety net for those that need it most.”
“We have determined that we will not approve Kansas’ recent request to place a lifetime limit on Medicaid benefits for some beneficiaries,” Verma said at the annual meeting of the American Hospital Association. “We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them.”
CMS had reportedly been set to make that announcement several days earlier, but internal disagreements delayed it at the last minute.
Kansas had proposed beneficiaries of its KanCare Medicaid program be permanently barred from receiving benefits after three years. Kansas Gov. Jeff Coyler confirmed to the Topeka Capital-Journal that the state received a brief letter rejected the lifetime cap proposal, which was welcome news to Sheldon Weisgrau, executive director of the group Alliance for a Healthy Kansas, which has been advocating for the state to expand Medicaid eligibility.
“Patients can now be assured that an arbitrary bureaucratic time limit would not end their health care coverage in the middle of a critical course of treatment,” he said in a statement. “Patients’ needs change throughout their lives and the programs they depend on should have the flexibility to meet these changing needs.”
Since President Donald Trump took office and Verma took charge at CMS, the agency has been largely supportive of conservative-leaning changes in health policy. Outside of Medicaid, this has involved slashing funds for advertising the Affordable Care Act’s exchanges, criticizing the law and moving to expand the availability of insurance plans which don’t meet the ACA’s standards.
Within Medicaid, CMS has been guiding states on how to be approved for implementing work requirements for their beneficiaries, giving the OK to Kentucky, Indiana, Arkansas and most recently New Hampshire to mandate that able-bodied Medicaid recipients get a job, attend training or volunteer in order to avoid having their coverage cut off.
Those changes have been met with resistance from Democrats and liberal-leaning advocacy groups, including lawsuits, as well as criticism from healthcare organizations. The rejection of the Kansas plan was seen as a positive by one of those advocates, Families USA.
“CMS should apply this precedent to all state requests to impose time limits on any group of people who get health coverage through Medicaid—including adults who are covered through Medicaid expansion,” said the group’s senior director of health policy, Eliot Fishman. “Time limits in Medicaid are bad law and bad policy, harming people who rely on the program for life-saving health care.”
While encouraging the implementation of work requirements, CMS and HHS have rejected other conservative-minded approaches to health policy, most notably saying no to Idaho’s proposal to allow “state-based” insurance plans which don’t comply with the ACA’s insurance rejection. It did so in an almost apologetic tone, however, which Idaho officials argued wasn’t really a rejection.
How far CMS will allow Republican-led states to go in Medicaid reforms remains an open question. Four other states with Republican governors—Arizona, Maine, Utah and Wisconsin—have proposed lifetime limits on Medicaid benefits.
A proposal in Michigan may provide the best litmus test for what Verma’s CMS will allow states to do. The state’s Republican-led Senate has backed a plan for not only implementing work requirements in its Healthy Michigan Medicaid program, but also a looser limit on benefits than the Kansas proposal. For beneficiaries making between 100 percent and 133 percent of the federal poverty level, they would be kicked off the plan after receiving benefits for four years.
According to the Detroit News, Michigan Gov. Rick Synder has opposed the work requirements. In an effort to force Synder to negotiate on the proposal, the Senate included in its version of the state budget a penalty which would suspend salaries for the director of Michigan’s HHS and other state health officials unless a Medicaid waiver, including work requirements, is submitted to and approved by CMS.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.