Verma Rebuffs Kansas Request for Lifetime Medicaid Limits

The three-year coverage limit Kansas had sought for some Medicaid beneficiaries could threaten the program's 'safety net' status, the CMS head warned.

Centers for Medicare & Medicaid Services Administrator Seema Verma said Kansas will not be allowed to impose a lifetime limit on Medicaid benefits for some beneficiaries as it had requested.

The state, which was among at least five states—including Arizona, Utah, Maine, and Wisconsin—seeking a waiver for permission to impose such a cap, had pushed the idea of a three-year coverage limit. But that could undermine Medicaid's "safety net" status, Verma said Monday.

"We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them," Verma said in her prepared remarks for a speech before the American Hospital Association annual membership meeting.

• For the first time in U.S. history, Verma noted, the federal government is allowing states to establish Medicaid work requirements, which the Trump administration prefers to call "community engagement requirements," for beneficiaries deemed to be able-bodied.
   
• Three states had been granted waivers for their Medicaid work requirements as of Monday morning—Kentucky, Indiana, and Arkansas—with a fourth expected to be announced within the week, Verma said in her speech.
   
• The fourth state to receive a waiver for Medicaid work requirements was revealed Monday afternoon to be New Hampshire.
   
• At least six additional states have waiver applications pending.
   
• Each of the states that have secured waivers for work requirements thus far expanded Medicaid coverage under the Affordable Care Act, and the work requirements would apply only to those beneficiaries in this category, as Kaiser Health News reported.
   
• Verma notified Jon Hamdorf, acting Medicaid director for Kansas, of the decision in a letter Monday: "While we continue to review the state's proposal, we have determined that we will not approve this formulation of the state's request to impose a lifetime limit on Medicaid benefits for individuals who are eligible for Medicaid."

Additionally, Native American leaders have argued the Trump administration would be reversing longstanding protections if it denies the tribes' request for an exemption from the Medicaid work requirements. The administration argues granting such an exemption would constitute illegal race-based preference.

Verma addressed this concern in her speech, suggesting that the task of protecting native groups should be the states' responsibility.

"We believe we can give states flexibility and discretion to implement the community engagement requirements with respect to local tribal members," she said. "We look forward to working with states and tribes to try to help them achieve their goals and determine how to best apply community engagement to serve their populations."

Despite praising CMS for its decision on Kansas' request, some advocacy groups argued the administration's position on tribal healthcare contradicts federal law.

"Tribes have their own governments and health systems that, by statute and treaty, have a direct government-to-government relationship with the United States. States are legally forbidden to impose Medicaid premiums or any other Medicaid cost-sharing on American Indians and Alaska Natives enrolled in Medicaid," said Eliot Fishman, senior director of health policy for Families USA, in a statement calling state efforts to impose Medicaid work requirements "foolish and self-destructive."

"If states can’t impose premiums or cost-sharing on tribal governments," he added, "they can’t impose waivers that take coverage away entirely."

Editor's note: This story was updated on Tuesday, May 8, to include additional information.