March 23, 2016
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ACP makes Medicaid expansion waiver recommendations to 'best suit patients'

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The ACP has released a position paper that reviews and makes recommendations on Medicaid expansion waivers to offer patients better coverage.

The paper, Medicaid Expansion: Premium Assistance and Other Options, offered recommendations about information dissemination, program structure and waiver coverage.

"The Affordable Care Act expanded Medicaid eligibility to all individuals with incomes up to 138% of the federal poverty level or about $16,242 for a single adult or $33,465 for a family of four (in 2015)," according to the paper, developed by the Health and Public Policy Committee of the ACP. "The expansion would predominantly benefit childless adults, a population historically barred from Medicaid regardless of income level, and low-income parents."

The paper noted that following a Supreme Court ruling, Medicaid expansion is now optional for states.

"Several states have sought to expand Medicaid coverage in a manner that is more palatable to the conservative ideological leanings of their legislators and residents," the paper stated. "Using the Medicaid waiver process, which permits Medicaid programs to seek approval from the federal government to increase cost-sharing and impose premiums, trim benefits, use Medicaid funds to purchase private insurance, and require or encourage enrollees to participate in wellness or health behavior initiatives."

ACP recommended that:

  • Medicaid programs develop and distribute information that clearly informs enrollees regarding health insurance concepts and other relevant information that is accessible for those with disabilities or limited English literacy;
  • Medicaid expansion waivers cover "the essential health benefit package, non-emergency transportation, Early and Periodic Screening and Diagnostic and Treatment benefits, mental health parity and other Alternative Benefit Plan benefits," at a minimum;
  • Premiums and cost-sharing be structured so that it encourages enrollees to seek high-value services and care, rather than discourage enrollment, encourage dis-enrollment, or delay treatment;
  • Work-related activities not be a condition of Medicaid eligibility; and
  • Wellness programs should utilize positive incentive-based programs that encourage healthy behavior instead of punitive approaches.

"Since waivers are temporary, it is important that state Medicaid programs, patient advocacy organizations, physician and other health care professional groups, and other closely monitor the effects of waiver experiments to better understand the effect of premiums on poor and/or chronically ill patients; provider accessibility and participation; whether Marketplace-based plans are preferable to existing Medicaid managed care arrangements; and the effect of these waivers on administrative complexities, enrollee satisfaction, and overall cost," the paper concluded.