On Tuesday, as thousands of Mainers supportedexpanding health care to an estimated 70,000 residents through Medicaid, the federal government signaled support for conservative measures that would likely constrict that access and give states greater control over the program.
The federal Centers for Medicaid and Medicare Services, or CMS, now aims to make it easier for states to customize their Medicaid plans, including changes such as monthly premiums and work requirements that some analysts say could drive down enrollments. Coming against a backdrop of conservative opposition to the Affordable Care Act and the provision that supports and funds the Medicaid expansion, the CMS announcement lends further uncertainty to the future of the voter-approved expansion in Maine.
In a speech Tuesday morning to state Medicaid directors gathered in Arlington, Virginia, CMS Administrator Seema Verma announced the agency’s commitment to working closely with states that seek to require more from “working-age, able-bodied Medicaid enrollees.” The change comes in response to the program’s growth in recent years, she said, and the need to “reset the federal-state relationship.”
Medicaid, known in Maine as MaineCare, is jointly run and funded by the state and the federal governments, providing health insurance to low-income residents.
Verma also said CMS would streamline the processing of state waiver applications designed to give states more flexibility in designing their Medicaid programs.
That’s good news for the LePage administration, which in August submitted its application proposing a monthly MaineCare premium of up to $40, $10 copays for some medical services, a 20-hour-per-week work requirement, and other measures. The application now awaits approval from CMS.
The Maine Department of Health and Human Services said in a statement on Tuesday afternoon that it was “encouraged” by Verma’s announcement.
“Through this waiver, it was the department’s intention to prioritize our limited resources for the Mainers who need them most, while promoting responsibility for one’s individual health and the cost of healthcare,” the statement read, in part. “We look forward to working with the administration to fulfill our shared objective of creating a sustainable Medicaid program through the promotion of individual accountability.”
But Mitchell Stein, an independent health policy consultant who advocates for policies expanding access to health care, said Wednesday that efforts to encumber MaineCare enrollees with work requirements, monthly premiums and other disincentives are intended to discourage enrollment and limit the provision of health services to vulnerable, low-income people.
“Most people on Medicaid who are able to work are already working,” he said. Nationwide, only 13 percent of adults included in the expansion population are able-bodied and not working, in school, or seeking work, Stein said, and of those, three-quarters are either actively looking for work or caring for family members.
“So, the idea that all these people are just sitting around not working is simply not true,” he said.
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