Verma Outlines ‘Vision’ for Medicaid

CMS chief vows to 'turn the page on Medicaid' and grant states more leeway; pushes work requirements for 'able-bodied' adults; raps Obama Administration's 'soft bigotry of low expectations.'

Centers for Medicare & Medicaid Services Administrator Seema Verma on Tuesday lashed out at the "Washington knows best, one-size-fits all Medicaid policy" and said the Trump administration will push for more state control of their programs.

In her first major speech on Medicaid, delivered at a plenary session at the National Association of Medicaid Directors Fall Conference in Arlington, VA, Verma said the administration's "vision for the future of Medicaid is to reset the federal-state relationship, and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve."

That flexibility for states is expected to include allowing work requirements for "able-bodied" Medicaid enrollees that were brought onto the program under the Affordable Care Act, a topic that Verma touched upon several times in her speech. 

"The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working age, able-bodied adults does not make sense," she said, "but the prior administration fought state led reforms that would've allowed the Medicaid program to evolve to meet the needs of these new individuals, and they did this, even when increased coverage was at stake."

"Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration. Those days are over," she said. "Let me be clear to everyone in this room, we will approve proposals that promote community engagement activities."

Verma referred to "able-bodied" or "non-disabled" adults, individuals and enrollees seven times in her speech, while making the case for work requirements. Her speech included no specifics on what percentage of Medicaid enrollees were considered "able-bodied."

Critics have called claims that healthy adults are bilking the program a red herring, and studies have shown that the numbers of "able-bodied" adults who are on Medicaid are relatively low, and can be explained by other factors, such as leaving the workforce to act as a caregiver.

Verma said Medicaid spending grew from $33 billion in 1985 to $558 billion in 2016, and consumes 29% of total state spending, which she said is unsustainable. To rein in spending growth, she said CMS would restore flexibility, accountability and integrity.

That flexibility would center around 1115 demonstrations, state plan amendments, and 1915 waiver processes, and CMS will allow states to:

• Request approval for certain 1115 demonstrations for up to 10 years;
   
• More easily pursue "fast track" federal review, which makes it easier for states to continue their successful demonstration programs;
   
• Spend time administering innovative demonstrations by reducing certain 1115 reporting requirements;
   
• Expedite state plan amendments and 1915 waiver efforts through a streamlined process and by participating in a new "within 15-day" initial review call with CMS officials.

"We are making innovation easier. If we approve an idea in one state, and another state wants to do the same thing, we will expedite those approvals," Verma said. "However, we won't approve every idea, the law will be our guideposts, and we will also ensure that proposals will not result in additional costs for taxpayers."

As for improving accountability, Verma said CMS is in the process of developing Medicaid and Children's Health Insurance Program scorecards to track and publishing state and federal Medicaid outcomes.

"The Scorecard will allow us to demonstrate your progress to the nation and allow others the opportunity to learn from your successes," Verma said. "This Scorecard isn’t just for States, but for CMS as well, because good partners hold each other accountable."