Continuing
last week’s action on reconciliation packages, the House Energy and
Commerce Committee held a markup yesterday which included provisions to
repeal key aspects of the Medicaid program. One provision would repeal
the Maintenance of Effort (MOE) requirement currently required of states
under the Affordable Care Act of 2010 (ACA). Another would repeal bonus
payments for states that increase their Medicaid enrollment. The
proposal was approved by the Committee by a vote of 30-20.
The
MOE requirement was mandated by the ACA and prohibits states from
implementing eligibility standards or procedures that are more
restrictive than those in effect on March 23, 2010. Proponents for
repealing the MOE claim that eliminating it would allow states the
flexibility they need to operate the Medicaid and Children’s Health
Insurance Program (CHIP) as they see fit, and would save $600 million
over ten years.
In
a related move, last month, Representatives Todd Rokita (R-IN), Tim
Huelskamp (R-KS), Paul Broun (R-GA), and Jim Jordan (R-OH), introduced
the
State Health Flexibility Act, H.R. 4160,
which would block grant the Medicaid program and repeal certain
Medicaid and State Children's Health Insurance Program (CHIP)
maintenance of effort requirements (via repeal of the ACA), thereby
allowing states to drop hundreds of thousands of children from their
Medicaid and CHIP rolls. Ensuring a MOE is important to vulnerable
children and their families because as many may recall, prior to
the enactment of the ACA, Arizona Governor Jan Brewer signed a budget
package into law that would have effectively eliminated the state’s CHIP
program. When the Center for Medicare and Medicaid Services notified
the state that the recent action would be in direct violation of the MOE
provision in the ACA, and thus the state stood to lose close to $8
billion in Medicaid funds, Governor Brewer singed a bill to restore the
KidsCare program. However, because Arizona had a freeze on CHIP
enrollment prior to the enactment of ACA, they remain the only state
with an active freeze on CHIP enrollment to date.
Prior
to the ACA, the Children’s Health Insurance Reauthorization Act of 2009
(CHIPRA) authorized “bonus” payments to states for increasing their
Medicaid enrollment above a defined baseline from the prior year.
Despite the fact that statistics show that participation rates for
children in Medicaid and CHIP are at about 85% nationally, with some
states garnering participation above 95%, yesterday, the Committee
approved a proposal to repeal bonus payments to states, claiming that
the bonus program weakens the integrity of Medicaid. Proponents of this
proposal assert that repealing these bonus payments will save
approximately $400 million over ten years.
According
to a memo from Republican House Leadership, the House is expected to
consider a joint reconciliation package in early May.
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