New York officials have withdrawn a request to use Medicaid funding to cover healthcare services for prison inmates and expedite access to HIV treatment. Earlier this week, California officials chose to withdraw their 1332 state innovation waiver request to offer undocumented residents unsubsidized coverage through the state marketplace.
Officials in both states said they weren't sure their requests would be approved by the Trump administration, which has signaled cuts to Medicaid.
Patient advocates consulting with the New York state officials also worried the Trump administration would possibly require work search requirements, cost-sharing or other conservative ideas as a condition of approval of the waiver requests, according to Charles King, CEO of not-for-profit Housing Works. “These are ideas where studies have shown people lose coverage, so it was antithetical to what we were trying to do in New York."
New York state's Health Department wanted federal Medicaid matching funds to provide care management and other supportive services to incarcerated individuals in the 30 days prior to their release. Eligible individuals would receive care management, clinical consultation services, and coverage of certain medications, including those treating behavioral health and substance use disorders.
The aim of these changes was to enable continuity of care and an easier transition to community-based services and health home enrollment upon release.
Medicaid patients lose coverage if they enter prison. A provision covers inpatient treatment provided by a medical facility not associated with the prison. That scenario happens if a prison inmate goes to a hospital and remains there for over 24 hours.
A separate waiver aimed to expand a New York City effort that places newly diagnosed HIV patients on treatment with no wait time was also withdrawn.
New York state officials formally submitted the incarceration waiver in October and the HIV waiver last month. They say they might resubmit.
“We want to allow time for the state to have conversations with the new administration and to see where we may align on these issues,” said a spokesperson for the New York Department of Health.
The state anticipated that the HIV proposal would have needed $45 million in federal funds. The state was estimating the cost of the incarcerated proposal before it withdrew the waiver request.
California officials withdrew their request to provide unsubsidized coverage to immigrants through the state marketplace after President Donald Trump signed a number of executive orders aimed at curbing illegal immigration. They include construction of a southern border wall that would be partly through a tax on imported Mexican goods. Other orders would suspend the U.S. refugee program, restrict the arrival of refugees from Syria and suspend issuing visas to seven predominantly Muslim countries.