CMS Will Fully Fund Broader Set of Services for Medicaid-Eligible American Indians and Alaska Natives

CMS's new policy broadens the scope of services for which the federal government will fully cover the cost of care for Medicaid-eligible American Indians (AI) and Alaska Natives (AN), which may have significant implications in states with large AI/AN populations. Full federal funding was previously limited to services that IHS/Tribal facilities could provide directly, but CMS will now fully fund all services permitted under IHS rules that are also covered under a state's Medicaid plan, including transportation and long-term services and supports. Additionally, CMS will cover the cost of services provided by non-IHS/Tribal Medicaid providers who receive referrals from IHS/Tribal facilities pursuant to a written care coordination agreement, as long as the IHS/Tribal facility has a preexisting relationship with the patient and maintains responsibility for the patient's medical record and future care needs.

8.8 Million Uninsured Are Eligible for Medicaid or CHIP

More than a quarter of the nation's 32.3 million non-elderly uninsured individuals (8.8 million) are eligible for Medicaid or CHIP, and of the uninsured and eligible, 77% (6.8 million) live in states that have expanded or are moving forward with expanding Medicaid, according to the Kaiser Family Foundation. The percentage of uninsured individuals that are eligible for Medicaid is higher in expansion states (41%) versus non-expansion states (13%). Across all non-elderly uninsured and eligible individuals, half have incomes below poverty, just under 60% are people of color and three-quarters have part-time or full-time workers in the family.

Alabama: Medicaid Commissioner Says Senate Budget May Put 1115 Waiver Funding At Risk

State Medicaid Commissioner Stephanie Azar said that resources for implementing and monitoring Alabama's newly approved 1115 waiver could be at risk if the General Fund budget passed by the Senate last week, which includes no funding increases for Medicaid, is signed into law. The 1115 transformation waiver approved by CMS allows the State to transition its Medicaid program to managed care delivered through hospital- and provider-led entities called Regional Care Organizations but also requires the State to ensure the availability of adequate resources for outreach and enrollment, maintaining eligibility systems, compliance with cost sharing requirements, and financial reporting related to the waiver. The budget now goes to the House for consideration.

Iowa: Medicaid Managed Care Transition Approved for April 1

CMS approved Governor Terry Branstad's (R) plan to transition Iowa's Medicaid program to managed care but delayed implementation until April 1. This is the second delay of the Governor's plan, originally slated for January 1, due to concerns about the State's communication with beneficiaries and the provider networks of the managed care organizations (MCOs) hired to run the program. In a letter to Iowa's Medicaid director, CMS officials said the State and MCOs had taken significant steps to address both concerns. Governor Branstad praised CMS's decision, saying the program will increase access to care and lead to a more financially sustainable Medicaid program. The State will continue to administer the program until April and beneficiaries will have until the middle of June to switch MCOs for any reason.

South Dakota: Governor Pauses on Medicaid Expansion

Governor Dennis Daugaard (R) announced that he will not pursue Medicaid expansion during the remaining two weeks of the current legislative session, despite CMS's recently-released guidance that broadens the circumstances under which costs for care delivered to Medicaid-eligible Native Americans and Alaska Natives are eligible for 100% federal match. Governor Daugaard's administration had sought the policy change in order to free up State money to expand Medicaid to approximately 50,000 South Dakota residents. The Governor noted that he expects to take up expansion in the future, possibly through a special legislative session. The CMS announcement and the Governor's press conference follow passage of H.R. 1234 by the State's House of Representatives last week, which requires the Governor to seek explicit legislative approval for Medicaid expansion.