IN – Request for Medicaid Recipients to Work Could Face Challenges

July 2017 ~

The Governor of Indiana is seeking permission from CMS to require some Medicaid beneficiaries to be employed or searching for work to be eligible for the Healthy Indiana 2.0 (HIP) plan, but since public comments were not permitted, the state request could be facing some legal challenges.

Under the HIP, beneficiaries pay premium contributions, have health savings accounts, get incentives for healthy behaviors and face a benefit lockout if they don’t pay premiums. Ohio requested the amendment to work requirements when applying to renew its HIP 2.0 waiver.

The Affordable Care Act (ACA) requires 1115 waiver requests to undergo a 30-day public notice-and-comment period, and state officials must show how they considered the issues raised by the public before submitting the final application.

In a notice, CMS said Indiana had met the necessary statutory requirements to submit the amendment, noting the state submitted the amendment with the request for work requirements as part of its renewal application for its HIP waiver to the agency on May 25, a day after it announced its proposal to the public.

According to St. Louis University health law professor Sidney Watson, CMS and Indiana may be violating federal public comment standards for waiver requests. “CMS is not following the guidance that was issued to Medicaid directors and the guidance that is still posted on its own website,” Watson said. “CMS is failing to comply with federal law.”

In 2012 guidance from CMS suggests that states making substantial amendments should go through the comment process. That guidance made amendments for approved 1115 waivers exempt from the notice-and-comment process, but the renewal application for Healthy Indiana has yet to be approved.  Amendments to pending requests aren’t subject to the guidance.

“Since renewals are subject to notice and comment and this essentially changes the renewal, I think there is a strong argument that it should be subject to notice and comment,” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

Source(s): Indy Star; Modern Healthcare;