If you're looking for an indication as to how the Trump administration might approach its relationship to the states and the management of the Medicaid program, you received some clues recently.
In a letter to governors, Health and Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services Administrator Seema Verma outlined several areas where they plan to work with states to improve the Medicaid program. The letter outlines the new leaders' priorities, which largely align with Administrator Verma's previous work on Medicaid reform efforts in Indiana.
The letter lists five areas where HHS/CMS plan to collaborate with states:
Improve Federal and State Program Management
The agencies will engage with the states in the State Plan Amendment process in hopes of making the process more transparent, efficient and less burdensome. Additionally, they aim to "fast-track" approval of waivers and demonstration project extensions.
Support Innovative Approaches to Increase Employment and Community Engagement
The letter reaffirms support for federal, state and local programs that have demonstrated success in assisting low-income adult beneficiaries in efforts to rise out of poverty. This includes the use of existing Section 1115 authority to review and approve work-requirements for able-bodied adults.
Align Medicaid and Private Insurance Policies for Non-Disabled Adults
In this section, the letter encourages greater alignment between the design of Medicaid and commercial health insurance to help working age, non-pregnant, non-disabled adults prepare for private coverage. This could include consumer-directed healthcare, premium contribution requirements and encouragement of continuous coverage.
Provide Reasonable Timelines and Process for Home and Community-Based Services Transformation
CMS will work toward providing additional time so states can comply with the Jan. 6, 2015, Home and Community-Based Services rule. The agency also will be looking for ways to improve engagement with the states on implementation of this rule.
Provide States with More Tools to Address the Opioid Epidemic
The letter expresses a commitment to ensuring that states have tools to combat the opioid epidemic and to work with states to improve care for individuals struggling with addiction under Medicaid state plans. This could include a more streamlined approach for Section 1115 substance abuse treatment demonstration opportunities.
Regarding the issue of Medicaid expansion, the letter states that "the expansion of Medicaid through the Affordable Care Act (ACA) to non-disabled, working-age adults without dependent children was a clear departure from the historic core and mission of the Medicaid program." They argue that because of the higher federal reimbursement rate for the expansion population, states have an incentive to "deprioritize the most vulnerable populations." Price and Verma will therefore "work with both expansion and non-expansion states on a solution that best uses taxpayer dollars to serve the truly vulnerable." The overall theme of the Price/Verma letter is flexibility for states and encouragement of innovation, a message that governors across the country will very likely see as a positive.