By Mike Shileds
KHI News Service
Feb. 23, 2012
TOPEKA — Federal officials have published new rules
intended to make the Medicaid waiver process more open and responsive to public
concerns.
The new rules, which become effective April 22,
could have bearing on the waiver request the administration of Gov. Sam
Brownback is preparing to submit to the U.S. Department of Health and Human
Services as part of its effort to expand managed care within the state's
Medicaid program.
Brownback officials on Jan. 26 submitted to
federal officials a concept paper broadly outlining their upcoming waiver
request. Officials have said they have "no timeline" for submitting
the complete application, but they have announced they intend to launch their
KanCare plan statewide beginning Jan. 1, 2013. Many of the plan's key
provisions would need waiver approval.
In the concept paper, Kansas officials said they
would seek an "1115" waiver, a type used for demonstration or pilot
projects and which HHS has the broadest latitude to accept or reject. More than
35 states operate with some type of 1115 waiver, though they vary significantly
in what they aim to accomplish or demonstrate.
The Kansas proposal, according to its outline in
the concept paper and statements by administration officials, would be
different than most 1115 waivers approved by the Obama or earlier
administrations. Most proposals that have been approved included provisions
that would expand Medicaid coverage to significant numbers of people otherwise
not eligible. The Kansas plan, as outlined, would not do that.
Kansas officials also have said they want a
far-reaching "global waiver" that would cap the amount of federal
Medicaid dollars the state could receive in exchange for freedom from many or
most federal Medicaid regulations. A global waiver, sometimes described as a
block grant, has only been granted once in the history of the Medicaid program,
and Obama officials have made it clear they do not support them.
The new federal rules were in response to changes
in the waiver process included by Congress in the Affordable Care Act. Those
changes in the law came after reports that HHS had done a poor job making the
waiver process transparent and responsive to public input. Those concerns were
heightened by a couple of relatively speedy waiver approvals during the
administration of President George W. Bush, including a so-called global waiver
for Rhode Island approved in the administration's final days and an earlier
approval of a waiver request from Florida when the president's brother, Jeb
Bush, was governor of that state.
Critics said those waivers were granted without
proper public input.
"When Gov. Bush submitted the waiver to his
brother's administration...
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