- What other pending waivers with work requirements will CMS approve? Will such approvals include work requirements for expansion and non-expansion (traditional) populations? How will these requirements be enforced?
- Will CMS approve other provisions that restrict eligibility such as time limits, drug testing, lock-outs as well as premiums and cost-sharing?
- With added complexity, how will these new waivers affect enrollment, program costs and administrative burden and costs?
The waiver includes provisions never before approved by CMS, including:
- A work requirement as a condition of eligibility.
- Premiums of up to 4% of income.
- Multiple coverage “lock-out periods” of up to six months (two of which are new).
- Medicaid expansion
- Work requirements
- Eligibility and enrollment restrictions
- Benefit restrictions, co-pays, healthy behaviors
- Behavioral health
- Managed Long Term Services and Supports
- Delivery system reform
We examine recent waiver activity and issues to watch in four key areas.
- Work requirements
- Time limits
- Premiums with lock-out for nonpayment
- A 1-page distillation of information and statistics about the opioid epidemic and Medicaid’s role in covering addiction treatment services.
- Related slideshow: The Evolving Opioid Epidemic and Medicaid’s Growing Role in Treatment
- Medicaid, the primary payer for nursing home care, covers 6 in 10 nursing home residents.
- 1 in 3 people turning 65 will require nursing home care at some point in his or her life.
Medicaid Restructuring and Special Populations
- Medicaid plays an important role for individuals with mental health conditions, particularly those with low incomes
- Adults with mental illness on Medicaid more likely to receive treatment than those with private insurance or no insurance
- Receipt of psychiatric medication is more common among adults on Medicaid compared to those with private insurance or no insurance