Health Reform WK-EDGE Questions about Medicaid go unanswered, but House won’t back down
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Tuesday, January 26, 2016

Questions about Medicaid go unanswered, but House won’t back down

By Sarah E. Baumann, J.D.

The House Energy & Commerce Committee Subcommittee on Health will not let Victoria Wachino, Director of the CMS Center for Medicaid and CHIP Services, off the hook for her failure to respond to questions it posed in July 2015. In a January 13, 2016 letter, the Committee reminded Wachino to answer the questions it tendered to her after her testimony at a hearing discussing the program’s 50-year anniversary (see Medicaid projected to cost $1 trillion in 2025, House concerned, July 10, 2015). In renewing the Committee’s request to answer questions regarding section 1115 demonstration projects, managed care, and other issues, Chairman Joe Pitts (R-Pa) asked her to “swiftly extend the courtesy of answering these important questions.”

Sec. 1115 waivers. Section 2001 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) gave states the option of expanding Medicaid eligibility. Some states wishing to expand eligibility in individually-tailored ways applied for waivers under section 1115 of the Social Security Act (SSA). The Committee proffered numerous questions about the waiver requests, asking CMS to publish the general criteria it uses to evaluate requests, explain whether and how it conducts evaluations of the projects, justify its reasons for not requiring its actuaries to request to the budget neutrality of waivers, indicate whether it would consider creating a “path to permanency” for the waivers, and state whether an expedited process exists for replicating existing waiver models. Questions also addressed the lengthy waiver application process, which is an average of 337 days from application submission to approval, not including prior discussions, and the agency’s history of rejecting requests that include certain job training or work requirements.

Other issues. Representatives asked Wachino to consider allowing more time for stakeholders to respond to proposed managed care regulations, specifically asking about the proposal to require states to provide potential enrollees with at least 14 days of fee-for-service coverage during which they can make an active enrollment choice (see Proposal would overhaul Medicaid managed care, June 1, 2015). The letter included questions about the Medicaid program’s high improper payment rate, which increased from 5.8 to 6.7 percent over the course of a year; program integrity surrounding the provision of personal care services; determinations of Medicaid eligibility made through the marketplace; and transitions to community-based care.

IndustryNews: NewsStory AgencyNews DemonstrationProjectNews FraudNews HealthCareWorkforceNews HealthInsuranceExchangeNews MedicaidExpansionNews ProgramIntegrityNews

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