Indiana develops plan for potential Medicaid template, reform at national level
Seema Verma, a health policy consultant and architect of Indiana’s HIP 2.0 Medicaid plan, was tapped by President-elect Donald Trump to lead the Centers for Medicare and Medicaid Services (CMS).
Verma’s plan, however -- which requires able-bodied recipients to work and locks out those that fail to pay premiums -- was significantly watered down by CMS.
States are barred from using work requirements to deny Medicaid, while the penalties for nonpayment necessitate that recipients are moved to a different level with fewer benefits.
Verma’s original plan could serve as the blueprint for Medicaid reform under the new administration, some speculate.
Josh Archambault, senior fellow at the Foundation for Government Accountability, believes “no amount of window dressing” can disguise the fact that HIP 2.0 has made Medicaid more expensive.
Much of what Indiana asked for as it negotiated expanding Medicaid was removed, and even the watered down penalties are not being enforced, Archambault told Patient Daily.
On the other hand, Archambault said it is possible that Verma’s original plan will be the template for states that want to roll back their expansions, or for those that did not expand in the first place.
Many states want to continue what is in place following the Obamacare expansion, but it is not clear if the same level of federal funding will be available under the new administration.
Archambault and his think tank’s position is more fundamental and far-reaching than the reforms contained in Verma’s original plan for Indiana.
“How do people see it -- as a health insurance or a welfare program?” Archambault said. “It is a welfare program.”
While it should be a safety net for the most needy, he said adding the expansion likely denies speedy access for the most needy.
“It should be focused, living up to the commitment,” Archambault said. “Instead, they are spending more money expanding rather than looking after those in real need.”
Overall, he believes the financing of Medicaid going forward will be decided early in 2017, followed by state flexibility toward the end of the year.
The history of Medicaid expansion in Indiana is checkered. The state did not immediately sign up but -- to prevent losing out on billions in federal funds -- eventually came up with a plan and request for a waiver.
That plan, which included lockouts for nonpayment of premiums into health care accounts, was subject to a patient access audit by CMS, which then told Indiana it could not yank coverage. Indiana described the audit as biased.
Recipients are now placed on a basic plan with fewer benefits if they do not pay their monthly premiums.
Verma said the plan she designed was “the most significant departure from traditional Medicaid ever approved,” according to a report in the Indianapolis Star, which speculated that the health policy consultant may use it as a template for national reform.
“Pence and Trump have made a big deal about giving the states more flexibility and autonomy in managing their Medicaid programs, and she would appear to be the perfect person, given her expertise, to manage that rollout of more state flexibility,” Robert Laszewski, president at Health Policy and Strategy Associates, a consulting firm in Virginia, told the newspaper.
“Those who are concerned about the health and well-being of Americans who rely on Medicaid and Medicare should brace themselves for tumultuous times ahead,” Joan Alker, executive director at Georgetown University for Children and Families, said.
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