1. On June 29, 2018, the DC federal district court issued a decision in Stewart v. Azar. The court invalidated the waiver approval and sent it back to HHS to reconsider the following provisions: the work requirement, monthly premiums up to 4% of income, coverage lockouts for failure to timely renew eligibility or timely report a change in circumstances, heightened cost-sharing for non-emergency ER use, and elimination of retroactive eligibility and non-emergency medical transportation. The separate “institution for mental disease” substance use disorder payment waiver continues.
2. “Non-expansion” populations include traditional Medicaid populations (low-income parents, Transitional Medical Assistance, former foster care youth,
medically needy, etc.) but may also refer to narrow/limited populations that gained coverage through the demonstration waiver. For example, WI’s waiver covers childless adults ages 19 to 64 with income up to 100% FPL (without enhanced ACA matching funds). UT’s waiver expanded eligibility and provided a limited benefit package to certain nonelderly adults up to 100% FPL (the “PCN group”), and recently extended coverage to a limited group of childless adults who are homeless and have behavioral health needs up to 5% FPL. The pending waiver would apply differential benefit packages to parents up to 100% FPL and for childless adults up to 100% FPL (although benefits within each group would be the same).
3. IA: Premiums are waived for the 1st year of enrollment. In later years, premiums are waived if beneficiaries complete specified healthy behavior activities.
4. WI: Waiver covers childless adults ages 19 to 64 with income up to 100% FPL (without enhanced ACA matching funds).
5. NH: A pending NH waiver extension request would end QHP premium assistance effective January 1, 2019.
6. Six other states (DE, MA, MD, RI, TN, and UT) have retroactive coverage waivers that pre-date the ACA and may have been associated with achieving the budgetary savings necessary to expand coverage before federal law authorized the use of Medicaid funds for childless adults. Some of these waivers apply to limited populations, and most have exceptions for seniors and people with disabilities.
AR: State waives retroactive eligibility except for the 30 days prior to the date of application for coverage.
NH: A pending NH waiver extension request seeks to extend its waiver limiting retroactive coverage to the date of application while removing the approved
waiver’s conditions, which included CMS determination that retroactive coverage is unnecessary based on state data.
UT: The approved retroactive waiver provision applies to only the PCN group. The pending waiver would permit retroactive coverage for those individuals eligible under the demonstration beginning no earlier than the demonstration implementation date.
7. Reasonable promptness waivers allow states to delay the start of coverage until after the 1st premium is paid or after the 60-day payment period expires.
8. In a CMS administrator letter to KS on May 7, 2018, CMS rejected KS’ proposal to impose a lifetime limit on Medicaid benefits for eligible beneficiaries.
AZ: Pending waiver request initially proposed adding a five-year maximum lifetime limit on Medicaid coverage for some beneficiaries, but an April 2018 letter from the AZ Medicaid director to the Governor announced the state’s decision to remove the time limit request from ongoing waiver discussions.
9. AZ: Proposes to redetermine eligibility every 6 months for all expansion enrollees and every 3 months for individuals who have a change in circumstance that results in non-compliance with waiver requirements
10. TX’s pending waiver refers to its “Healthy Women” family planning waiver.
11. Requests to limit expansion eligibility to 100% FPL with the enhanced match in AR and MA were not approved by CMS.
SOURCE: KFF analysis of approved and pending waiver applications posted on Medicaid.gov.