The CMS issued proposed operational rules Monday (PDF) for health insurance exchanges and Medicaid programs, which included an increase in allowable beneficiary cost-sharing in the latter.
Notably, the rule would change Medicaid premiums and cost-sharing requirements to allow states to establish higher cost-sharing for nonpreferred drugs, and to impose higher cost-sharing for nonemergency use of emergency departments.
Specifically, the rule would allow states to change their Medicaid programs without a waiver to require an $8 cost share for non-emergency ED use for Medicaid enrollees with incomes of 100% to 150% of the federal poverty level. States would have no limit on the cost-sharing they could impose on emergency department use for non-emergencies by Medicaid enrollees with incomes over 150% of the federal poverty level.
The expanded Medicaid cost-sharing was intended to “promote more effective use of services,” Cindy Mann, director of the Center for Medicaid at CMS, said in a call with reporters.
“Today, we are proposing a rule to provide Americans with access to affordable, high quality health coverage and give states more flexibility to implement the law in a way that works for them,” HHS Secretary Kathleen Sebelius said in a news release.