The Big Story Few Are Talking About

The Acting Director for the Centers for Medicaid and Medicare Services recently made a shocking announcement:

Elizabeth Richter, acting administrator for the Centers for Medicare and Medicaid Services, said in a letter to Berry on Friday that “allowing work and other community engagement requirements to take effect in Georgia would not promote the objectives of the Medicaid program.”

Richter said the pandemic has made “community engagement infeasible” and that the federal agency “has serious concerns about testing policies that condition health care coverage on meeting work or other community engagement requirements.”

The Trump administration approved the state’s waiver applications – including a second one that creates a reinsurance program – back in October. The federal agency’s website now shows the plan to slightly expand Medicaid as “pending.”

My colleague Erik Randolph, writes that it would be a mistake for CMS to revoke Georgia’s Medicaid 1115 waiver:

The bulk of Georgia’s uninsured problem lies not below the poverty line, but above it. Therefore, Pathways to Coverage necessarily links to Georgia’s Reinsurance Program designed to drive down costs in the individual markets. The test of the demonstration project will be to see how well Georgia can move people out of poverty into situations where they have better opportunities and more resources for health coverage, such as coverage through affordable individual markets or, better yet, employer-based coverage. 

America has one of the world’s best and most innovative healthcare systems, if you have insurance to afford it. By far, employer-based and private insurance provides the best coverage. Medicaid has among the worst healthcare outcomes, can trap families in poverty (as we and others have demonstrated), and can be an obstacle in moving to the much-better private coverage. Incentivizing people to improve their circumstances is an important strategy that this demonstration project hopes to prove. 

This situation will develop quickly since CMS has only given Georgia 30 days to respond.

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