Republican-led states that have already expanded Medicaid now are coming back to the Obama administration with requests to make their expansion programs more conservative, including higher cost-sharing, work requirements and coverage time limits.
These moves may test the limits of the administration's flexibility and could lead to rollbacks in Medicaid expansion across the country.
Forthcoming waiver requests from Arizona, Michigan, Ohio and Iowa are raising red flags for the administration. Even Republican supporters of these proposals acknowledge that the provisions are likely to discourage thousands of low-income people from signing up for Medicaid coverage.
These moves come as Republican governors and lawmakers face growing political pressure from conservatives to either make their expansion programs tougher on beneficiaries or end them entirely.
A CMS spokeswoman declined to comment on the emerging proposals, saying only that the requests have not been formally submitted.
In October, Arizona plans to submit a proposal requiring premium contributions for beneficiaries both above and below 100% of the federal poverty level, a job search requirement and the termination of Medicaid benefits for “able-bodied adults” after they have received coverage for five years. Arizona's new Republican governor, Doug Ducey, who opposed Medicaid expansion before becoming governor, signed the little-noticed law in March.
So far, the CMS has not given permission to impose premiums on people below the poverty line with the threat of cutting off coverage. It has not approved any benefit time limits, and it has rejected work requirements. Most people on Medicaid already are employed or are part of working households.