CMS Draws Line in Sand on Medicaid Caps

Seema Verna, administrator of the Centers for Medicare and Medicaid Services (CMS), today rejected a request by the state of Kansas to cap an individual’s Medicaid benefits at three years.


CMS Administrator Seema Verna

In a letter to Kansas officials, Verna noted that only if Medicaid recipients refused to meet any work requirements would it be possible to cut people off from Medicaid.

“In every case, these incentive structures are designed to engage beneficiaries in ways that promote positive health and well-being,” she wrote.

“We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them.”

Arizona and Utah are also seeking permission to place hard caps on Medicaid eligibility.

An earlier rule issued by CMS allows states to establish work requirements for able-bodied individuals who seek enrollment in Medicaid, and that rule does permit disqualifying a person who fails to meet the work/community service/job education requirement.

The news of no caps was cheered by advocates for women, children and the economically challenged.

“It’s a big deal. There was real uncertainty where the administration would come down and time limits would have a large impact on enrollment,” Eliot Fishman at Families USA, who oversaw Medicaid waivers under President Obama, said in an email to VoxCare.

NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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