Category: Curator

HHS Curator is our free research service published by our team. We read hundreds of Medicaid news items each week and highlight and summarize them for you to save you time.

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Centene CEO: Missouri Medicaid decision an ’embarrassment’

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Centene CEO takes the gloves off and adds to rumors of the MCO giant moving HQ out of the state.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

JEFFERSON CITY, Mo. (AP) — The CEO of Centene Corp. has called Missouri an “embarrassment” after Republican Gov. Mike Parson and the GOP-controlled Legislature failed to approve funding for voter-approved Medicaid expansion.

The St. Louis Post-Dispatch reported Wednesday that Centene chief Michael Neidorff made the comments to Health Payer Specialist, a health industry trade publication.

“As the largest provider of Medicaid in the United States and a Fortune 42 company I have to ask myself, ‘Why am I in this state?'” Neidorff said. “This is a state that frowns on this business — what am I doing here?”

“It’s an embarrassment,” he added.

The comment raised further concern about Centene’s future in the St. Louis area, where it is among the region’s largest employers. Centene announced it June it would add thousands of jobs in North Carolina, rather than St. Louis County, with Neidorff citing worries about crime in St. Louis.

Medicaid expansion, approved by voters in August, would bring health coverage to 275,000 low-income adults starting in July. But without funding, it is expected to end up in court.

In an emailed statement, Parson said Medicaid expansion can’t proceed without a revenue source or funding from the Legislature. He said he is “grateful for Centene’s investments in Missouri.”

 
 

Clipped from: https://apnews.com/article/michael-brown-business-medicaid-5f25a838b47176263c377522a6c6d0d5

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Hospitals question fee increase to help pay for Medicaid expansion

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OK hospitals are not happy about a proposed 1.5% increase on the “taxes” they pay to get more federal draw down funds.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

OKLAHOMA CITY — Despite an influx of hundreds of millions of federal dollars earmarked to help pay for Medicaid expansion, lawmakers are proposing increasing fees paid by hospitals with the money to be used for the same purpose.

“While we’re not opposed to doing our part to increase access to care, we are disappointed that the Legislature chose not to use the hospital fee as a backstop considering that we have federal funds available for the next eight quarters,” said Patti Davis, president of the Oklahoma Hospital Association.

She said the state’s hospitals are still in “recovery mode” from the pandemic, and they would prefer legislators would first use the hundreds of millions in additional federal funding before increasing their assessment rate.

The state’s Supplemental Hospital Offset Payment Program, or SHOPP fee, is a self-assessment that allows hospitals to maximize federal Medicaid matching funds by supplementing state Medicaid funding.

Senate Bill 1045, which already cleared the state Senate this week, would increase that assessment rate from 2.5% to 3% for calendar year 2022, then raise it to 3.5% in 2023 and finally to 4% in 2024.

Currently, 68 hospitals are obligated to pay the fee out of their annual operating budget, including those in Duncan, Claremore, Chickasha, Enid, McAlester, Stilwell, Ada, Norman, Tahlequah, Muskogee, Oklahoma City, Tulsa and Stillwater.

In a bid to help states, Davis said the federal American Rescue Plan Act earmarked specific funds to states to cover costs of Medicaid expansion. Oklahoma received more than enough to cover its expansion for the first two years, she said.

“While we understand it’s one-time funds, we were certainly hoping that that might provide a little bit more gap for hospitals,” she said.

Davis also said she hasn’t gotten any clarity from the Health Care Authority or the Legislature just how exactly they’re going to use that supplemental federal funding.

Melissa Richey, a spokeswoman for the Oklahoma Health Care Authority, said there is no explicit directive from the federal government over how those American Rescue Plan and Families First Coronavirus Response Act funds are to be used.

The state agency has received only $240 million in enhanced federal funds to date, she said. The benefit is received over time and not as a lump sum.

State Rep. Kyle Hilbert, R-Bristow, the House author, said the federal coronavirus funds went toward Medicaid expansion, which freed up $164 million in state money to be put into a rate preservation savings account. That brings the fund’s balance up to about $197 million.

In 2019, the Legislature created the fund to save a portion of the match the state receives on its federal dollars when its reimbursement rate is high. The amount the state receives from the federal government fluctuates based on the health of the state’s economy, Hilbert said.

Because Oklahoma’s economy is thriving and its budget has seen a $1 billion surplus, lawmakers are bracing for a steep drop in the reimbursement rate in the next three years.

In the past those drops resulted in provider rate cuts, but the new rate preservation fund is designed to prevent cuts across the board, Hilbert said. The state’s current match rate is 68%, but could drop as low as 50% depending on the health of the economy, he said.

Every 1% drop in federal matching funds will cost taxpayers about $54 million, he said.

The new SHOPP fee is expected to generate $37 million in the first year, and will help offset some of the $164 million price tag to pay for Medicaid expansion, he said. Lawmakers expect an additional 200,000 people to be eligible for the program.

Hilbert said it’s irresponsible to pay for ongoing expansion expenses with one-time revenue sources.

“It’s just like drawing down your retirement fund to start making payments on your mortgage,” he said. “Eventually you’re going to run out of retirement money. You’ve got to have some revenue source to help fund your ongoing expenditures, and that’s why the increase in SHOPP is necessary to fulfill the will of the Oklahoma voters and funding Medicaid expansion.”

Janelle Stecklein covers the Oklahoma Statehouse for CNHI’s newspapers and websites. Reach her at jstecklein@cnhinews.com.


Clipped from: https://www.stwnewspress.com/news/hospitals-question-fee-increase-to-help-pay-for-medicaid-expansion/article_689342fc-b900-11eb-b270-37fd5e8a42d4.html

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Potential seen for big financial paybacks from insurers to Medicaid

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Georgia is getting ready for its next round of MCO procurements.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The state’s Medicaid agency is setting up plans for a health insurer bidding competition that will award a new multibillion-dollar medical contract.

“We’ll be looking for the best bang for the buck,” Frank Berry, commissioner of the Georgia Department of Community Health (DCH), said last week at an agency board meeting.

 
 

Berry

The current Medicaid insurers are being paid a total of about $4 billion a year for delivering medical services to more than 1 million members.

Long before a new contract is reached, there could be a substantial payback of money by the insurers, called care management organizations (CMOs), to the government program.

According to industry rumors, the “clawbacks” of money from these insurers in Georgia could exceed $200 million.

Medicaid is jointly financed by the state and federal governments, covering low-income and disabled residents. The CMO insurers – Peach State, Amerigroup and CareSource – are paid a per-member, per-month rate to care for Medicaid members.

DCH officials told GHN that they are “reviewing for any clawbacks that may currently be unresolved.”

Clawbacks come when an organization believes it has overpaid for services, and “claws back that money,” said Bill Custer, a health insurance expert at Georgia State University. “It happens quite a bit in Medicare and Medicaid. Depending on the amount, it may be a big deal or not.”

State officials did not disclose the amount under review.

An insurance industry official who represents the CMOs, Jesse Weathington, also did not specify the amount of money being scrutinized.

“We appreciate Commissioner Berry’s willingness to have further discussion about the true effects of the COVID-19 pandemic on Medicaid,” said Weathington, executive director of the Georgia Quality Healthcare Association, in a statement Wednesday. “Like other health plans, we saw [medical care] utilization bounce back to normal levels very quickly following the statewide shutdown last year.  We look forward to working with DCH to ensure their estimates are based upon factual data.

“Our mission to improve health care outcomes in the most cost-efficient manner for over 1.5 million Georgians remains the same,” he said, “and not even a 100-year pandemic will deter us from that objective.”

Expanding managed care?

The current CMO contract is set to expire June 30, 2022. But DCH says it’s looking to extend the contract for another two years ”to allow for additional time to complete the new procurement.” That would mean an expiration date of June 30, 2024.

DCH officials said the state aims to focus primarily “on quality, performance and [medical] outcomes” with the new contract.

An open question is whether the state will eventually launch managed care for members who are eligible for Medicaid because they are “aged, blind or disabled.”

DCH said it “will first seek to explore what is best for this population in terms of quality, performance and outcomes prior to making this determination.

Many states have moved their aged and disabled Medicaid beneficiaries into managed care.

Georgia State’s Custer said such a shift would require the formation of provider networks to serve that population, such as nursing homes.. An estimated 75 percent of nursing home residents in Georgia are covered by Medicaid.

Managed care for the aged, blind and disabled “would look very different” from the current format, Custer said. “The idea is to develop a medical home for that person.” A “medical home” is a model of care in which a patient’s total medical needs are coordinated by a specific provider.

The state would have to focus on monitoring quality of care for such an arrangement to succeed, he added.

 
 

Clipped from: http://www.georgiahealthnews.com/2021/05/potential-big-financial-paybacks-georgia-insurers-medicaid/

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The Biden Administration Greenlights $12 Billion In Federal Medicaid Home Care Money. How Will States Spend It?

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CMS has released guidance on the initial $12B of HCBS additional funds states can receive.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

The Biden Administration has given the green light for states to begin to tap into about $12 billion in additional funding for Medicaid home-based long-term supports and services. In guidance issued to state Medicaid directors late last week, the federal Centers for Medicare and Medicaid Services (CMS) granted the states broad flexibility in how they use the money. The funds, included in the American Rescue Plan Congress passed in March, reflect a one-year 10 percentage point increase in the federal contribution to Medicaid home and community-based services (HCBS).

The big immediate question is how will states use the money, and how many will take it at all.

Just as important, the guidance also may signal how the Biden Administration would use a much larger, $400 billion increase in federal Medicaid HCBS spending that it included in the American Jobs Plan that currently is being considered on Capitol Hill.

Medicaid is funded jointly by the federal government and the states, but operated individually by each state. States are required to provide long-term care in nursing homes but home-based care is optional and can only be provided with CMS permission. Every state has requested such a federal waiver for home-based care, but states vary widely in the kinds and amount of home care they provide.  The payment bump will come on top of the federal contribution that ranges from 50 percent in Colorado and other states to 78 percent in Mississippi.

PROMOTED

“Expand, enhance, and strengthen”

In 26 pages of guidance, CMS opened the door to a long list of benefits and services that states could buy with the extra dollars. They range from short-term initiatives such as higher wages or COVID-19 testing for home care aides to longer-term structural reforms.  

However, the guidance explicitly requires states “expand, enhance, and strengthen” Medicaid HCBS and to “supplement, not supplant” existing programs. In other words, Medicaid won’t allow a state to simply offer the same services but with federal dollars replacing state funds.  

To provide a check on state activity, CMS will require states to develop a funding proposal within 30 days and report quarterly on how the funds are used. However, states will be allowed to revise their proposals as needs change. In addition, while the law allows CMS to boost funding for HCBS programs only through March of 2022, states will have until March, 2024 to spend the money. This could give them time to develop new programs.  

A home run

The states also will be allowed to use the extra funds to increase payments to Medicaid managed long-term care programs, but only if the plans increase approved services.

One close observer called the guidance, “a home run.” But it remains uncertain how many states will take the extra funding and what they will do with it.

CMS urged states to build long run reforms to their systems, such as expanding available services, increasing eligibility, and building partnerships with state housing and other programs to develop more coordinated services.

However, because the extra federal contribution is for only one year, many states may think more short term. State officials tell me they are more likely to use the funds to provide one-time enhancements to existing services rather than trying to stand up new long-range initiatives with federal money that could dry up after a couple of years.

How will states respond?

Given wide state variation that already exists in Medicaid HCBS , states are likely to respond very differently to the feds’ offer. Some, such as Oregon and Minnesota, may continue to be extremely creative. Others such as Alabama and Louisiana, which tilt heavily toward nursing home care, may not—and some may not take the money at all.   

CMS is anxious to get the extra dollars out the door. It gave states just 30 days to develop an initial plan and the agency promises to respond within an additional 30 days. Thus, funds could be out the door by mid-July.

States, providers, and advocates anxiously awaited the guidance for two reasons. They want to use the new funding as quickly as possible, of course. But they also see it as a clue about how the Biden Administration would use its proposed $400 billion increase in the federal contribution to Medicaid HCBS.

Any increase in the federal payment for Medicaid HCBS has to walk a narrow line. Too much flexibility and states will find ways to divert the funds to non-Medicaid programs, something they regularly do now. Too little flexibility and one benefit of Medicaid—the ability of states to innovate—would be lost. And, worse, states would be unlikely to even take the money if it comes with too many strings.

CMS has done a good job finding that balance. The question now: How will the states use the money? Will they increase pay for direct care workers? Increase home-based benefits for current enrollees? Or expand eligibility? Even with $12 billion, they won’t be able to do it all.

 
 

Clipped from: https://www.forbes.com/sites/howardgleckman/2021/05/19/the-biden-administration-greenlights-12-billion-in-federal-medicaid-home-care-money-how-will-states-spend-it/?sh=479bab8e50e3

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Group ‘reluctantly’ suspends Medicaid expansion ballot push

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The group pushing for expansion in MS has stopped its efforts after the state supreme court ruled the ballot initiative process in general is flawed.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

JACKSON, Miss. (AP) – A group that was pushing to get Medicaid expansion on the ballot in Mississippi is “reluctantly” suspending its campaign.

The decision comes after the state Supreme Court ruled Friday that a medical marijuana initiative passed by voters this fall is void because Mississippi’s initiative process is outdated. That effectively killed other initiatives for which people are already petitioning.

Organizers of Initiative 76 said in a statement that it is halting its campaign “until there is once again a functional ballot measure process in Mississippi.” Medicaid is a health insurance program for the needy, aged, blind and disabled. It is paid by federal and state money.

 
 

Clipped from: https://www.wxxv25.com/2021/05/19/group-reluctantly-suspends-medicaid-expansion-ballot-push/

 
 

 
 

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GOP leaders reject Tony Evers’ proposal for Medicaid expansion

 
 

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Wisconsin Medicaid expansion has been rejected by the legislature during a special session.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

MITCHELL SCHMIDT

State Republican leaders have rejected Gov. Tony Evers’ proposal to expand Medicaid access in the state and use a large chunk of the $1 billion in one-time federal funds that would come with expansion toward economic development projects across Wisconsin.

Evers on Wednesday called the Legislature into session to expand BadgerCare to reach an estimated 91,000 new residents. Hours after the Democratic governor’s proposal, Republicans signaled they remain opposed to expanding Wisconsin’s federally funded health care program for low-income individuals, which has been one of Evers’ signature policy priorities.

During a news conference at Middleton’s Benevolent Specialist Project Free Clinic, the Democratic governor put what he called “a billion-dollar signature” on his executive order calling on the GOP-led Legislature to hold a special session next Tuesday on BadgerCare expansion, which Republicans in the state budget committee stripped from Evers’ proposed 2021-23 biennial budget earlier this month.

“It’s time for Republican leadership to put politics aside and recognize this is a great deal for all of us,” Evers said. “Enough politics. Let’s get to work.”

Later that day, Assembly Speaker Robin Vos, R-Rochester; Senate Majority Leader Devin LeMahieu, R-Oostburg; Assembly Majority Leader Jim Steineke, R-Kaukauna; Senate President Chris Kapenga, R-Delafield; and budget committee co-chairs Sen. Howard Marklein, R-Spring Green, and Rep. Mark Born, R-Beaver Dam, issued a joint statement rejecting the governor’s proposal.

 
 

Clipped from: https://www.lakegenevanews.net/news/state-and-regional/govt-and-politics/gop-leaders-reject-tony-evers-proposal-for-medicaid-expansion/article_1feadcf8-1d94-58ee-b86e-239a7977fda2.html

 

 
 

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Missouri pulls Medicaid expansion

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MO officially withdrew its plan to CMS for Medicaid expansion this week after lawmakers failed to provide the separate funding required by law.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

 

The Missouri Department of Social Services today submitted a letter to the Centers for Medicare and Medicaid Services withdrawing its Medicaid expansion plan.

Gov. Mike Parson’s office issued a news release indicating the executive branch lacks authority to expand MO HealthNet, the state’s Medicaid program, since the ballot initiative was not self-funding and the legislature voted to not appropriate funds.

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” Parson said in the release. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time.”

Amendment 2, the Medicaid expansion ballot initiative, was passed by voters in August 2020 by a roughly 53% margin. Opponents of the legislation have said the state cannot afford Medicaid expansion. In his January 2020 State of the State address, Parson warned expansion could come at the cost of education, workforce development and infrastructure funding, according to past reporting.

The Missouri Senate late last month voted against funding the expansion by a 14-20. According to the St. Louis Post-Dispatch, the decision impacts as many as 275,000 low-income Missourians and likely sets up a court battle.

The nonprofit public policy Missouri Budget Project has estimated the American Rescue Plan Act approved by Congress this year could lower the state’s Medicaid contribution by more than $1 billion over a two-year period, according to statehouse reporter Phill Brooks of Missouri Digital News. The estimated state cost for Medicaid expansion is $130 million per year, he said.

Missouri House Minority Leader Crystal Quade, D-Springfield, said the Medicaid decision amounts to Parson “breaking his promise to the people of this state.”

“Whatever reputation he once had for respecting the law is gone forever, and he is just another politician whose word can’t be trusted,” she said in a statement. “Medicaid expansion will still happen as the constitution requires, but because of the governor’s dishonorable action, it will take a court order to do it.”

 
 

Clipped from: https://sbj.net/stories/missouri-pulls-medicaid-expansion,74164

 
 

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Oklahoma lawmakers seek to put ‘guardrails’ on privatized Medicaid expansion

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OK anti-managed care sentiment pivots into increasing the oversight function of MCOs once implemented.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

OKLAHOMA CITY (KFOR) – Gov. Kevin Stitt has been pushing for privatized Medicaid expansion for months and it looks like he will get his wish.

It looks like legislators have given up their fight to keep the expansion, voted for by Oklahomans last year, in the hands of the state, but that doesn’t mean they are done with the issue.

House of Representatives votes on legislation to challenge Gov. Stitt’s plan to privatize Medicaid

They are now focusing on making sure Oklahoma doesnt repeat the mistakes made by the 42 other states that have some sort of managed care.

“There are some things that we have seen in other states that managed care companies have done that make it really hard for providers to be successful,” said Sen. Greg McCortney.

The Republican from Ada is talking about the rewriting of Senate Bill 131. Instead of pushing for state-run Medicaid expansion. The authors say it puts guardrails on the Governor’s privatized plan to make sure Managed Care Organizations keep up their end of the deal.

Gov. Stitt criticizes House Public Health Committee’s challenge to his Medicaid privatization effort

“Making sure our providers get paid in time, making sure that the Medicaid patients themselves don’t have to wait long for prior authorizations,” said Rep. Marcus McEntire, the bill’s co-author.

“In rural Oklahoma, we want to make sure that we protect those providers so our hospitals stay open, our doctors can stay in small town Oklahoma. So we put some guardrails in to make sure that the way they work with these managed care organizations can make everybody successful,” said McCortney.

The bill also makes sure that if MCO’s don’t follow rules they would be breaking state law

“Unfortunately, a lot of these policies have been around for a long time, since it took Oklahoma so long to accept Medicaid expansion. There are a lot of lessons to be learned from other states mistakes,” said Senator Mary Boren.

Oklahoma’s top physician & health groups file motion for injunction against Gov. Stitt’s Medicaid managed care plan

Lawmakers are calling this a compromise bill, but some still think state-run expansion was the way to go. They say only two of the four MCO’s involved are Oklahoma based.

“I just personally don’t want to see Oklahoma’s tax dollars going to enrich huge companies. I’d rather use that money to invest back into our healthcare system within the state,” said McEntire.

“It’s absolutely not my dream come true bill. I’ve come to believe that good policy is policy where everyone is angry and right now we have very good policy, I believe,” said McCortney.

Governor Stitt and Oklahoma Health Care Authority announce managed care organizations to assist with Oklahoma Medicaid, despite pushback from lawmakers

If the bill passes through the House and Senate as expected it would likely face a veto from the Governor.

“If the Governor vetos the bill, I very much expect the legislature to take up an override on the veto,” said McCortney.

We reached out to the Governor’s office. They say they don’t have any comment on the bill at this time. The guardrail bill did pass through the Senate today; it now moves to the House.

 
 

Clipped from: https://kfor.com/news/oklahoma-legislature/oklahoma-lawmakers-seek-to-put-guardrails-on-privatized-medicaid-expansion/

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Federal Incentive Program Fails to Motivate Many Medicaid Providers

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60% of providers did not participate in the Meaningful Use program after the initial larger payouts were made to them.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Florida has distributed roughly $100 million to Medicaid providers that ultimately did not demonstrate they used electronic health records (EHR) in a meaningful way after collecting first-year financial incentives, according to a study by researchers at Florida Atlantic University.

The first-of-its-kind study, published in the ScienceDirect journal, was designed to quantify the rate of provider participation beyond the initial incentive of up to $21,250.

To improve the quality of care and reduce health imbalances in patients receiving Medicaid, the Health Information Technology for Economic and Clinical Health Act began in 2009, encouraging healthcare providers to convert their medical records to an electronic version. The program provides incentive payments for certain providers to use the technology.

After the first-year incentive, providers can earn up to $8,500 annually in the subsequent five years if they attest to Meaningful Use (MU) status, which is using certified EHR or software to boost efficiency, safety and quality of care.

Providers are not required to participate in consecutive years and are not penalized if they do not achieve MU even after collecting the first-year incentive. Many Medicaid providers (57 percent) discontinued participation after collecting their first payment, conservatively totaling approximately $100 million, the researchers said.  

“So about six out of 10 Florida Medicaid providers have basic EHR systems that cannot function in ways that can positively impact patient care,” said Judith P. Monestime, D.B.A., an instructor in FAU’s College of Business and the lead author of the study. “This is concerning because advanced EHR functions – such as Meaningful Use – are necessary precursors to address unmet socioeconomic needs to reduce health disparities. Not meeting these needs leads to higher healthcare costs fueled by a cycle of emergency room readmissions.”

In conducting the study, Monestime, Katherine Freeman, Ph.D., and Pierre K. Alexandre, Ph.D., used 2011-2018 records from the Florida Medicaid Promoting Interoperability program, formerly the Electronic Health Record Incentive program.

“The study was significant for many reasons,” said Alexandre, an associate professor and director of management programs in the College of Business’ Health Administration department. “It tells you that the incentive program, although it had the best of intentions, may not have done enough for certain providers to make it worth continuing in the program.”

Providers often did not continue with the program because the incentive dropped by 40 percent after the first year, and they were not able to continue receiving necessary technical assistance, the researchers said.  

The study found that pediatricians accounted for the largest percentage of providers achieving MU (65 percent) while dentists had the lowest rate (7 percent).

The researchers also noted that 58 percent of providers practicing in rural areas achieved MU compared with 42 percent in urban areas.

“Ultimately, efforts to improve health outcomes, reduce costs, and increase health equity for underserved populations through advanced EHR functions have stalled,” the study stated. “These results may provide timely information on the merits of further legislative efforts to increase MU and promote health information exchange.”

-FAU-

 
 

Clipped from: https://www.fau.edu/newsdesk/articles/florida-medicaid-study.php

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Texas sues Biden admin over decision to pull Medicaid waiver

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The lawsuit accuses CMS of breach of contract and abuse of federal power to compel the state to adopt Medicaid expansion.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Texas has sued the Biden administration over its decision to revoke a waiver that extends the state’s Medicaid program.

The federal lawsuit, filed Friday, calls for the waiver surrounding the state’s Medicaid program to be reinstated. It said the original decision by the Biden administration last month was without warning or proper authority.

“The Biden administration cannot simply breach a contract and topple Texas’ Medicaid system without warning,” said Texas Attorney General Ken Paxton in a statement Friday. “Not only does this violate agency regulations and threaten to rip a $30 billion hole in Texas’ budget.”

The Centers for Medicare & Medicaid Services said in a letter to the state last month that the process to approve the waiver was flawed and that it did not include time for public comment. The agency was also concerned with the length of the extension, which runs through 2030 and is typically longer than waivers for other state Medicaid programs.

Texas’ Healthcare Transformation and Quality Improvement Program expires Sept. 30, 2022, and administers benefits for Medicaid enrollees via the state’s managed care program.

The Trump administration fast-tracked the original waiver and approved it on Jan. 15.

 
 

The lawsuit charges that the Biden administration’s decision is part of an effort to compel the state to expand Medicaid under the Affordable Care Act and called the threat unconstitutional.

It calls for the Biden administration’s decision to be set aside as it imposes “unconstitutional conditions on federal funding for Texas’ Medicaid program.”

Rep. Michael Burgess, R-Texas, grilled Department of Health and Human Services Secretary Xavier Becerra about the waiver withdrawal during a recent hearing before the House Energy and Commerce Committee.

Becerra told lawmakers that the current Medicaid program runs through September 2022, and there is plenty of time to renegotiate a new extension.

He said if there were an extension of an existing waiver, it must comply “with all aspects of the law and the notice and public comment was deficient.”

Clipped from: https://www.fiercehealthcare.com/payer/texas-sues-biden-admin-over-decision-to-pull-medicaid-waiver