MACPAC urges Congress to allow managed care without a waiver
A panel that advises Congress on Medicaid issues wants to make it easier for states to place beneficiaries into managed care without first seeking a waiver from the CMS.
The Medicaid and CHIP Payment and Access Commission on Friday voted to ask Congress to amend federal statute to allow states to enroll Medicaid beneficiaries in managed care via a state plan amendment. Under current Medicaid rules, states tend to make this change via 1915(b) or 1115 waivers.
The panel voted 12-0 with two abstentions on the proposal which will be in the commission's March report to Congress. Last month, the commission also signed off on proposals asking Congress to extend waiver renewal periods and streamline the application process.
Industry consultants and Commissioners Marsha Gold and William Scanlon abstained from voting on the managed-care proposal Friday. They had previously raised concerns that the state plan amendment process may not have the same level of regulatory oversight and public commenting processes as waivers.
MACPAC is seeking the statutory change in order to reduce the administrative burden on states. There is a 90-day review process for state plan amendments, while there is not a set review time for waivers. Also, a state only has to give a budget estimate for plan amendment costs, while waivers have to either be cost-effective or budget-neutral.
State plan amendments also don't require renewal, while waivers need to be renewed after five years.
"We talk a lot about state capacity and state resources, and if this is an opportunity to simplify the process without harm (to beneficiaries), we should take it," said Commissioner Chuck Milligan, CEO of UnitedHealthcare Community Plan of New Mexico.
Not only will states be pleased with the change if Congress signs off on it, but CMS officials will likely be as well, according to Camille Dobson, a former staffer at the agency who used to review waivers and current deputy executive director of the National Association of States United for Aging and Disabilities.
At the meeting, Dobson said agency staff felt they were spending too much time evaluating waivers' cost-effectiveness rather than thinking about the substance of the request and what benefit it may have on enrollees.
"The hoops states have to jump through for waivers doesn't add any value from either a CMS or state perspective," she said.
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