Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


House Democrats Urge CMS Against Caving to Pressure to Reduce Medicaid Rolls

By John Reichard, CQ HealthBeat Editor

Rep. Raúl M. Grijalva of Arizona and 41 other House Democrats have written a letter to top Department of Health and Human Services officials urging them not to grant waivers to states permitting them to reduce Medicaid coverage levels beyond their right to do so under the health law.

"We write today to reaffirm congressional intent for the Patient Protection and Affordable Care Act 'maintenance of effort' (MOE) provision," the lawmakers said in the June 27 letter.

The MOE provision of the health law requires states to maintain "eligibility standards, methodologies and procedures" for adults on Medicaid until 2014 when state health insurance exchanges start, and for children on Medicaid through 2019. The MOE rule also applies to states' Children's Health Insurance Programs through 2019.

The health law does permit states meeting certain criteria to obtain waivers from the MOE. Supporters of the current Medicaid program worry that the Centers for Medicare and Medicaid Services will go even further and grant waivers that don't meet the criteria. They note that the federal government is under pressure from many states to let them do more to chop Medicaid spending.

Medicaid advocates also worry that the criteria for exemptions will be eased in debt ceiling negotiations, says Bruce Lesley, president of First Focus, a children's health advocacy organization.

The letter from the House Democrats states that "it is imperative that this [MOE] language is enforced to the strict standard intended by Congress and that it is made clear that waiving this section is not permitted unless the waiver request meets" certain explicit criteria, they added.

The health law permits a state to file for an exemption from the MOE if it certifies that it has a budget deficit; seeks the exemption for adults not eligible for Medicaid on the basis of pregnancy or disability; and seeks it for adults whose incomes are above 133 percent of the federal poverty level.

Grijalva's communications director, Adam Sarvana, says Arizona is seeking a waiver to drop coverage for populations not meeting the three requirements. He expects other states to do so as well, and the letter is a reminder to CMS to stick to the law, Sarvana said.

As it is, a number of states appear to potentially qualify for exemptions under the three criteria. According to the Kaiser Family Foundation, 22 states provide at least some Medicaid coverage to non-pregnant, non-disabled adults with incomes above 133 percent of the federal poverty line.

These states haven't filed waiver requests under the exemption criteria thus far, but that could quickly change. "This is likely because a reduction made prior to July 1, 2011 would result in a loss of the ARRA enhanced matching funds," the Kaiser Family Foundation said in an analysis of the MOE requirements. But those extra federal Medicaid payments that were provided under the 2009 economic stimulus law are now no longer available—which suggests that exemption requests may soon be arriving.

Publication Details