A federal advisory panel, concerned the Medicaid waiver program is being stretched beyond its original intent, says it may recommend changes.
The Physician Payment Review Commission will consider recommending that HCFA either expand waiver authority, freeze waiver approvals or set new criteria for waivers.
The panel will decide the issue when it meets in January 1995 to produce its annual report to Congress.
Some commission members favor waivers for programs that are wider in scope than simple demonstrations and for Medicaid reform programs.
Others believe even demonstration programs subvert federal authority and want to freeze all approvals.
Currently, HCFA authorizes changes to state Medicaid programs ostensibly for "demonstrations" that aim to expand coverage. HCFA has approved waivers in eight states and received waiver requests from another seven states.
But critics say waivers are being issued for programs that are more extreme than the small experiments, or demonstrations, for which they were intended. One of those opponents, commission member Joseph Newhouse, a Harvard University health policy professor, at a panel meeting in Washington this month, attacked the trend as a "reform of Medicaid via subterfuge."
Another commission member, Robert Keller, M.D., said if many more waivers are approved, the responsibility for Medicaid may shift from HCFA's Medicaid Bureau to its Office of Research and Demonstration.
Commission analysts estimated a third of Medicaid beneficiaries are affected by demonstration programs. About 31.2 million people were in Medicaid in 1992.
All this comes at a time when many state and federal officials are clamoring for reform of Medicaid and other welfare.
Limiting aid for the poor was part of a platform that propelled Republicans to a congressional majority in the November elections.
Commission members have not reached a consensus on whether to recommend a freeze of waiver approvals or an extension of waivers for broader programs. They did not appear to support new limits and tougher standards for waivers.
"I think to do so would be to ignore the results of the last election," said commission member P. William Curreri, M.D.