Federal Court Decision Blocks Medicaid Work Requirement in Kentucky In January, the Centers for Medicare & Medicaid Services (CMS) approved a Medicaid waiver in Kentucky that would allow the state to make participation in a work or “community engagement” program a condition for Medicaid eligibility. A group of advocates sued on behalf of Kentuckians who would be at risk of losing Medicaid coverage, and last month a federal judge put Kentucky’s Medicaid work requirement on hold. His decision called into question CMS’s attention to vital details about the Kentucky Medicaid
waiver, including whether the waiver violates one of the primary purposes of the Medicaid statute—to provide health coverage. The judge said that the agency was “arbitrary and capricious” in its decision-making, and showed no evidence that it considered the concerns that stakeholders raised in comments on the proposal. In addition, the agency did not appear to independently evaluate the waiver’s impact on coverage for people with Medicaid. As a result, the court’s decision invalidates the approval of the waiver and leaves open several options. In
response to the decision, CMS could appeal to a higher court; they could revisit the waiver to correct the errors that led to the court decision, if possible; or they could abandon the waiver attempt. It is unclear at this point if the waiver can conform to the court’s requirement that it not violate a primary purpose of Medicaid. Importantly, this does not mean that states cannot limit eligibility based on work. The decision only ends the work requirement in Kentucky. It is likely, however, that advocates in other states will bring suits based on the reasoning of this
case. Medicare Rights opposes the implementation of Medicaid waivers that appear to be intended to push people out of the Medicaid program. Most Medicaid beneficiaries who can work are already working, and increasing bureaucratic burdens will do nothing to help them keep jobs or health insurance coverage. Such requirements can also hurt family caregivers for people with Medicare. Read our concerns about the Kentucky waiver. Read the court’s decision. Read more about the implications of this decision from Kaiser Family Foundation.
Report Examines How Medigap Rules and Enrollment Vary Widely by State This week, the Kaiser Family Foundation (KFF) released an issue briefanalyzing the availability of, and enrollment in Medigaps across different states. One in four people in traditional Medicare had this private, supplemental health insurance in 2015. Medigaps help cover Medicare deductibles and cost-sharing, reduce the outof-pocket burden associated with accessing care, and protect against high costs because of catastrophic illness or injury. The issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal and state law that can affect beneficiaries’ access to Medigaps. In particular, the brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period. KFF finds that the share of beneficiaries with a Medigap policy varies widely by state— from 3% in Hawaii to 51% in
Kansas. Because federal law provides limited consumer protections—largely, a onetime, six-month open enrollment period that begins when a person is first over 65 and enrolled in Medicare Part B—state variances can have significant impact. States have the flexibility to institute consumer protections for Medigaps that go beyond the minimum federal standards. For example, 28 states require Medigap insurers to issue policies to eligible Medicare beneficiaries whose employer
changed their retiree health coverage benefits. Only four states (Connecticut, Massachusetts, Maine, and New York) require either continuous or annual guaranteed issue protections for Medigaps for all beneficiaries in traditional Medicare ages 65 and older, regardless of medical history. Guaranteed issue protections prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions, but they may institute waiting periods in some instances. In all
other states and the District of Columbia, people who switch from a Medicare Advantage plan to traditional Medicare may be denied a Medigap policy due to a pre-existing condition, with few exceptions. The issue brief also discusses potential strategies policymakers should consider to broaden access to Medigaps, including requiring annual Medigap open enrollment periods or making voluntary disenrollment from a Medicare Advantage plan a qualifying event with guaranteed issue rights for a Medigap policy. The brief adds that though these expanded guaranteed issue protections would increase beneficiaries’ access to Medigaps—especially for people with pre-existing medical conditions—and would treat Medigaps similarly to Medicare Advantage, it could result in some beneficiaries waiting until they have a serious health problem before purchasing Medigap coverage, which would likely increase premiums. Read the KFF brief.
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