3 things CMS’s Verma said about agency’s Medicaid, ACA moves

CMS Administrator Seema Verma, MPH, speaking at a Washington Post event on May 15, 2018

CMS Administrator Seema Verma, MPH, spoke at a May 15 Washington Post event focused on health policy, offering some hints on where her agency’s Medicaid and Affordable Care Act (ACA) regulations may be headed.

Here are three of the key takeaways from her interview:

1. They’re “community engagement” requirements, not work requirements

Requirements for Medicaid beneficiaries to work, go to school or volunteer—or else risk losing coverage—have been both a major priority and a source for controversy for CMS under Verma and the Trump administration. Verma used the repeatedly used the term “community engagement” rather than work requirements, arguing Medicaid can be used as “a pathway out of poverty” for able-bodied adults.

If that leads to reducing the number of people enrolled in Medicaid, Verma said she would consider it a success.

“It’s a much higher goal that we have to actually help these individuals lead independent lives,” Verma said.

2. What CMS will and won’t allow on Medicaid changes

While CMS has encouraged states to submit Medicaid waiver proposals, it hasn’t uniformly approved those requests. Recently, the Kansas plan to impose a three-year lifetime limit on Medicaid benefits was rejected by the agency, and Verma indicated four- or five-year limits wouldn’t be approved, either.

“What we have approved are temporary lapses in coverage, so an individual may not comply with the requirement around cost-sharing and they could potentially lose coverage,” Verma said. “But we want to make sure there’s a pathway back into the program.”

Another potential Medicaid change from CMS would be approving states’ requests looking to partially expand Medicaid above current eligibility but below what was allowed under the ACA. Verma said the agency is still looking into those ideas but cautioned her agency wouldn’t be seeking to promote Medicaid expansion.

“If a state comes to us with a state plan amendment request, under the law we’re required to process that application and we’re going to do so accordingly,” she said. “At the same time, we’re not going to do the types that the previous administration did and try to strongarm and force states into expansion.”

3. She’s still hoping for ACA repeal

Under Verma, CMS has taken controversial actions in regards to the ACA, including proposing rules to expand the availability of short-term plans which don’t comply with ACA insurance standards. Verma said she doesn’t believe those options will siphon away healthier customers from the insurance exchanges and argued the law has made many plans too costly and given insurers “monopolies” in counties where they’re the only carrier on the exchange.

“Unfortunately, we’re in a difficult situation because Congress has not addressed the issues of the Affordable Care Act,” she said. “We need a comprehensive solution. This administration has been about trying to address the problems, repeal and replace, because we know it’s just not working.”

Since President Donald Trump took office, gains in insurance coverage since the ACA took effect have begun rolling back. Verma said she believes the rise in the uninsured rate is due to the ACA causing premiums to go up, which is why the agency has sought ways to expand coverage options.

She’s still “hopeful” for a repeal of the ACA, but “in the meantime, what we’ve tried to do is focus on what we can do on a regulatory level.”