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Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes

The Affordable Care Act (ACA) significantly modernized and streamlined Medicaid enrollment and renewal processes across all states. Through major investments of time, money, and staff, most states have implemented modernized systems that transformed lengthy, paperwork driven enrollment and renewal procedures to a simplified, technology-driven experience that minimizes burdens on individuals and states. Recently approved and proposed waivers and other proposed policies include new eligibility and enrollment requirements and restrictions that run counter to the ACA’s streamlined processes (Figure 1). This fact sheet provides an overview of how enrollment and renewal processes changed under the ACA and the implications of emerging waivers and other proposed changes on streamlined enrollment and renewal.

Approved Changes in Indiana’s Section 1115 Medicaid Waiver Extension

On February 1, 2018, the Centers for Medicare and Medicaid Services (CMS) approved an amended extension of Indiana’s Healthy Indiana Program 2.0 (HIP 2.0) Section 1115 demonstration waiver. Indiana’s waiver initially implemented the ACA’s Medicaid expansion from February, 2015 through January, 2018 by modifying Indiana’s pre-ACA limited coverage expansion waiver (HIP 1.0). Unlike other states that implemented the ACA’s Medicaid expansion through a waiver, Indiana’s demonstration also changes the terms of coverage for non-expansion adults (low-income parents and those eligible for Transitional Medical Assistance, TMA). The February, 2018 extension continues most components of HIP 2.0 and adds some new provisions.

A Guide to the Lawsuit Challenging CMS’s Approval of the Kentucky HEALTH Medicaid Waiver

On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director letter announcing a new policy that, for the 1st time, allows states to condition Medicaid on participation in a work or “community engagement” program. The next day, CMS approved a new Medicaid waiver in Kentucky. The waiver includes a program called Kentucky HEALTH, which encompasses a work requirement as well as coverage lockouts of up to 6 months for failure to pay monthly premiums (up to 4% of income), timely renew eligibility, or timely report a change in circumstances, among other provisions. Kentucky HEALTH applies to most nonelderly adults, including low-income parents and expansion adults. The state plans to implement Kentucky HEALTH by July, 2018. On January 24, 2018, 15 Kentucky Medicaid enrollees filed a lawsuit in the U.S. District Court for the District of Columbia challenging CMS’s authority to issue the work requirement policy and approve the Kentucky waiver. This issue brief answers 5 key questions about the case.

Why Medicaid Work Requirements Aren’t the Same as Welfare Reform

Drawing on his experience in state welfare reform, Drew Altman, in his Axios column, discusses how new state Medicaid work requirements differ fundamentally from welfare reform, which was built on the idea of a “reciprocal obligation” between both beneficiaries and government to do more.  

What Are States Proposing for Work Requirements in Medicaid?

With the approval of Kentucky’s Medicaid expansion waiver, the Centers for Medicare and Medicaid Services (CMS) has for the first time granted a state permission to make Medicaid eligibility conditional on meeting a work requirement. Nine other states have waivers pending at CMS that would impose work requirements, including Arizona,…

New KFF Resource Tracks Developments in States’ Section 1115 Medicaid Waivers

A new resource from the Kaiser Family Foundation enables users to keep abreast of Section 1115 Medicaid waivers that are pending or have been approved by the Centers for Medicare and Medicaid Services. KFF’s Medicaid waiver tracker includes interactive maps that allow users to view states’ approved and pending waivers…

Medicaid Enrollees and Work Requirements: Lessons From the TANF Experience

This issue brief considers the implications of conditioning Medicaid eligibility on satisfying a work requirement, drawing on state experience with TANF enrollees subject to a work requirement over the past two decades and data about work and the role of health coverage among Medicaid enrollees today.