New Guidance on Medicaid Demonstrations Released as Judge Mulls Legality of Work Requirements

New tools and guidance aim to help states document and assess their Medicaid waiver projects, including those involving work requirements.

As a federal judge heard arguments Thursday in legal proceedings challenging Medicaid work requirements in Kentucky and Arkansas, the Centers for Medicare & Medicaid Services launched new tools to monitor and evaluate such tweaks to the program.

The new CMS tools and guidance establish standard metrics and recommended methods to assess the performance of Section 1115 demonstration waivers, which have been used to authorize Medicaid work requirements and a wide variety of other adjustments to the joint state-federal program

CMS Administrator Seema Verma alluded briefly to the lawsuits in a blog post published alongside Thursday's additional guidance.

"I recognize that not everyone supports our efforts to prioritize local control," Verma wrote. "I've heard the derisive comments from those in the health policy stratosphere that prefer centralized government command and control of health care in America. It's not surprising that many of these same people are now working double time to pull us into the big government abyss of Medicare for All."

"They decry the very notion of linking eligibility for programs like Medicaid with expectations of work and community engagement, despite these being long-standing bedrock values of our society," she added. "They dismiss any possibility that setting and supporting these expectations may actually help families break cycles of generational poverty and improve their health and financial independence more than just handing out a Medicaid card. And they argue vociferously that we overstepped our authority by allowing states to test these theories."

The new resources include the following items CMS highlighted:

• An implementation plan template: This gives states a framework to document their various approaches to implementing work requirements (which the administration calls "community engagement" requirements), and it aims to help states determine what information they should be reporting to CMS quarterly and annually, CMS said.
   
• A monitoring report template: This gives states a framework on how to report information to CMS quarterly and annually, with quantitative metrics, CMS said.
   
• Evaluation design guidance: This draws attention to key questions, hypotheses, measures, and evaluation approaches that states can use to assess their Section 1115 demonstration projects, including those that involve work requirements, CMS said.
   

States will be able to get support from CMS both individually and through forums, such as the Community Engagement Learning Collaborative, CMS said. Further instruction and guidance on these tools is forthcoming.