Historically, states have pursued section 1115 Medicaid waivers as a means of expanding Medicaid eligibility.
But the Centers for Medicare & Medicaid Services now appears to be looking at granting 1115 waivers to help states reduce their Medicaid populations.
According to a new report published by the Commonwealth Fund, CMS is encouraging states – both Medicaid expansion and non-expansion states – to launch demonstration programs designed to reduce enrollment in “means-tested public assistance” programs such as Medicaid. In their efforts to cut spending and reduce Medicaid enrollment, states are expected to seek section 1115 waivers to experiment with means of doing so such as:
- establishing monthly premiums for Medicaid recipients
- eliminating retroactive eligibility
- imposing lifetime limits on how long individuals may participate in Medicaid
- excluding people with substance abuse problems
- shifting Medicaid enrollment to a single annual open-enrollment period
- implementing more frequent eligibility determinations
And just last week CMS signaled states that it was now welcoming waiver applications to impose work requirements on some Medicaid recipients.
In a recent section 1115 waiver application, the state of Kentucky, for example, projects that the combination of establishing premiums for Medicaid participation and locking out those who do not make their payments, eliminating retroactive eligibility, and imposing a work requirement would reduce its Medicaid population 14.8 percent in the sixth year such changes were implemented. That waiver was granted last week.
Learn more about how CMS is preparing to use section 1115 Medicaid waivers to enable states to reduce their Medicaid enrollment in the Commonwealth Fund report “State 1115 Proposals to Reduce Medicaid Eligibility: Assessing Their Scope and Projected Impact,” which can be found here.