Featured in Health Business Daily, Dec. 5, 2017

Through Demo Waivers, States Seek Work Requirements, Financial Buy-ins for Medicaid Enrollees

Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care. Subscribe today!

November 16, 2017Volume 23Issue 22

Below are highlights of the seven Section 1115 demonstration proposals that are pending at CMS and seek to impose work and other “community engagement” requirements on certain Medicaid recipients. View all pending waivers at http://tinyurl.com/yczuqx2f.

Arkansas: In an amendment pending since June 30, proposed modifications include limiting eligibility for Arkansas Works to those living at 100% or lower than the federal poverty line and implementing work requirements for all members aged 19-49. Beneficiaries would have to be at work, pursue state-approved education or job training or provide documentation of at least 80 hours per month of job searching. Arkansas Works offers subsidized premiums on private health insurance provided by a participating employer or purchased on the state exchange. Arkansas does not have a managed Medicaid structure.

Indiana: Through an amendment pending since July 20, Indiana seeks to modify its Medicaid expansion program, the Healthy Indiana Plan 2.0, by making the Gateway to Work program a requirement for all able-bodied adults receiving benefits through HIP who are not working or in school at least 20 hours per week. The demonstration also would scale that program relative to how long an individual has received HIP benefits and define income tiers for HIP members and their spouses so that contributions of their monthly income to a Personal Wellness and Responsibility account would vary. CMS accepted comments on the proposal through Aug. 31.

Kentucky: The state in July submitted a revised version of its August 2016 proposal to replace its expanded Medicaid delivery system, kynect, with the Kentucky HEALTH demonstration. It would, among other things, require work or educational activities of at least 20 hours per week as a condition of eligibility, disenroll people from the program if changes in employment or income are not reported in a timely manner, and allow Medicaid managed care plans to implement a Health Savings Account-like feature. The public comment period closed on Aug. 2.

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Maine: Through an amendment pending since Aug. 2, the state intends to revamp its MaineCare Medicaid program by requiring that potential Medicaid beneficiaries aged 19-24 work or pursue education at least 20 hours per week, perform community service for at least 24 hours per month, demonstrate proof of job search or participate in job readiness programs. Maine does not have a managed Medicaid structure, nor has it expanded Medicaid, despite multiple attempts by the state legislature that have been vetoed by Gov. Paul LePage (R). And although voters on Nov. 7 approved a referendum to expand MaineCare, LePage said his administration would not implement expansion unless it is fully funded by the state legislature. CMS accepted comments through Sept. 16.

New Hampshire: Through an amendment pending since Nov. 2, New Hampshire is seeking to add a work requirement to its Premium Assistance Program, which supports certain adults who are newly eligible to purchase individual coverage through the Marketplace. If approved, able-bodied newly eligible adults would have to engage in up to 30 hours per week of one or a combination of specific employment and training activities, depending on the length of time covered under the premium assistance demonstration. A similar request was rejected by the Obama administration.

Utah: Through an amendment pending since Aug. 16, the state seeks to impose an enrollment cap for subgroups of its childless adult population, coverage term limits for certain eligible individuals without dependent children, and a work requirement that involves participating in training and/or job search activities unless the individual meets a federal Supplemental Nutrition Assistance Program exemption.

Wisconsin: Through a pending amendment to its BadgerCare Demonstration Reform Project, the state seeks to establish, among other things: monthly premiums, with lower payments in place for members engaged in healthy behaviors; drug screening as a condition of eligibility, and a 48-month maximum limit on Medicaid enrollment if members do not meet certain employment requirements, after which they will not be eligible again for six months. CMS accepted comments through July 15.

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