CMS Officials Offer Hints On DSH, Medicaid Phase-In Policies
Posted: September 13, 2012
CMS Medicaid chief Cindy Mann on Thursday (Sept. 13) strongly suggested that the administration does not intend to allow states to expand their Medicaid population to levels below the 138 percent threshold in the health reform law, at least for the first three years during which the federal government will pay 100 percent of the cost for newly eligible beneficiaries. Mann also affirmed that CMS was in the process of drafting a proposed rule on another key issue related to the Medicaid expansion -- if the agency would consider a state's decision on expansion when determining reductions to the disproportionate share hospital payments -- but she gave no indication of where the agency would land. Another Medicaid official, however, said at a separate event that the agency was leaning toward not treating states differently on DSH reductions regardless of the whether a state chooses to expand its Medicaid program.
CMS' Jennifer Ryan made the comments on the DSH payments during an America's Health Insurance Plans panel. Mann was speaking to stakeholders on a teleconference, the first in a planned monthly series that aims to update stakeholders on CMS policy on the health reform law's Medicaid expansion.
A state Medicaid source says it is not surprising that CMS would lean toward not treating states differently on the DSH payments as to do otherwise would essentially “reward” states for not taking up the expansion.
It seems that what the law provides for is that states expand their programs to cover all people up to 133 percent of the Federal Poverty Level, Mann said in response to a stakeholder's query. CMS has not issued guidance on states' ability to phase-in to that level, she said. Mann further gave no indication that CMS planned to offer more information, instead suggesting that the agency believes it has already answered such queries.
CMS has said that a state can come in when it chooses, and “at least in the short term” this would address questions about a phase in, Mann said. Essentially, states would have time to analyze participation in the program and other issues “long before being required to put up state dollars,” she said.
Although she did not specifically say so, her answer may suggest that CMS could re-evaluate the issue in later years when the 100 percent matching rate no longer applies.
The state Medicaid source also says that Mann was likely implying that the agency will not allow the phase-in or partial expansion, but is balking at coming right out and saying so as it's a political decision.
States can start late and states can end early, unless Congress chooses to enact another “maintenance of effort” provision, says the source. But the question of whether states can elect to cover a population up to 100 percent of the federal poverty level, either as a final decision or on the path toward the 138 percent threshold, remains unresolved, the source says, adding, “I think she's implying the answer will be “no,” but (CMS officials) haven't actually said it yet.”
The source also takes umbrage with Mann's assertion that the law provides for states to expand to 138 percent of the poverty level, as a possible reason why states should go all or nothing.
That provision, the source points out, was declared unconstitutional by the Supreme Court.
“The road forward is unprecedented and unclear,” the source says. “The ultimate decision will be a political one.” --Amy Lotven (alotven@iwpnews.com)
David Machledt
Policy Analyst
National Health Law Program
CMS' Jennifer Ryan made the comments on the DSH payments during an America's Health Insurance Plans panel. Mann was speaking to stakeholders on a teleconference, the first in a planned monthly series that aims to update stakeholders on CMS policy on the health reform law's Medicaid expansion.
A state Medicaid source says it is not surprising that CMS would lean toward not treating states differently on the DSH payments as to do otherwise would essentially “reward” states for not taking up the expansion.
It seems that what the law provides for is that states expand their programs to cover all people up to 133 percent of the Federal Poverty Level, Mann said in response to a stakeholder's query. CMS has not issued guidance on states' ability to phase-in to that level, she said. Mann further gave no indication that CMS planned to offer more information, instead suggesting that the agency believes it has already answered such queries.
CMS has said that a state can come in when it chooses, and “at least in the short term” this would address questions about a phase in, Mann said. Essentially, states would have time to analyze participation in the program and other issues “long before being required to put up state dollars,” she said.
Although she did not specifically say so, her answer may suggest that CMS could re-evaluate the issue in later years when the 100 percent matching rate no longer applies.
The state Medicaid source also says that Mann was likely implying that the agency will not allow the phase-in or partial expansion, but is balking at coming right out and saying so as it's a political decision.
States can start late and states can end early, unless Congress chooses to enact another “maintenance of effort” provision, says the source. But the question of whether states can elect to cover a population up to 100 percent of the federal poverty level, either as a final decision or on the path toward the 138 percent threshold, remains unresolved, the source says, adding, “I think she's implying the answer will be “no,” but (CMS officials) haven't actually said it yet.”
The source also takes umbrage with Mann's assertion that the law provides for states to expand to 138 percent of the poverty level, as a possible reason why states should go all or nothing.
That provision, the source points out, was declared unconstitutional by the Supreme Court.
“The road forward is unprecedented and unclear,” the source says. “The ultimate decision will be a political one.” --Amy Lotven (alotven@iwpnews.com)
David Machledt
Policy Analyst
National Health Law Program
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