ACP calls for CMS to reverse Healthy Adult Opportunity plan

Robert M. McLean

CMS announced the launch of the Healthy Adult Opportunity plan, which allows individual states to change their Medicaid spending and benefits for individuals aged younger than 65 years who are eligible for coverage under Medicaid expansion and do not have a disability or need long-term care.

States that choose to participate in the Healthy Adult Opportunity (HAO) will be required to stay within a set budget based on total expenses or on a per-enrollee basis.

“ACP strongly opposes transforming Medicaid’s existing financing structure into a block grant approach because it will increase the number of people without health insurance coverage for essential health care services,” ACP President Robert M. McLean, MD, MACP, said in a statement. “Likewise, the per-capita cap option will restrict crucial health care funding.”

McLean expressed concern that a Medicaid funding cap could cause states to be unprepared to respond timely to public health crises, such as an unexpected economic downturn that could leave people unemployed and uninsured. He explained that prescription drug benefits could also be at risk if states decide to cut them in an effort to reduce costs.

 

CMS announced the Health Adult Opportunity plan, which would allow individual states to change their Medicaid spending and benefits for aged 65 years eligible for coverage under Medicaid expansion and do not have a disability or need long-term care.

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Additionally, a restriction on federal funding could also lead to lower payments to physicians under Medicaid, which McLean noted could make it more difficult for PCPs to continue seeing Medicaid beneficiaries.

The HAO, using authorities under section 1115(a)(2), would allow participating states to make program changes without federal approval, add new conditions for eligibility, waive requirements for retroactive coverage and hospital presumptive eligibility and adjust cost-sharing requirements, according to CMS.

McLean explained that the latter is an issue, as “we know that imposing cost-sharing dissuades low-income beneficiaries from seeking needed care.”

States that participate in HAO will be required to follow federal disability and civil rights laws, complete a notice process for the public and beneficiaries, regularly report performance metrics and have benefits that meet the minimum standards for Essential Health Benefits.

In addition, states implementing HAO would be required to ensure people with HIV or behavior health needs have access to medications and not allow the aggregate limit for premiums and cost-sharing to go over 5% of a family’s income.

“As a physician, I worry about what will happen to my patients who depend on Medicaid for their health care,” McLean said in the statement. “Medicaid programs across the country are vital in the effort to ensure that our nation’s most vulnerable population has access to health coverage. ACP calls on the [CMS] to reverse this guidance that would drastically weaken coverage under the Medicaid program for low-income adults and instead focus on policies that would strengthen it.” – by Erin Michael

References:

CMS. Healthy Adult Opportunity fact sheet. https://www.cms.gov/newsroom/fact-sheets/healthy-adult-opportunity. Accessed on Jan. 31, 2020.

CMS. Trump Administration announces transformative Medicaid Healthy Adult Opportunity. https://www.cms.gov/newsroom/press-releases/trump-administration-announces-transformative-medicaid-healthy-adult-opportunity. Accessed on Jan. 31, 2020.

Disclosure: McLean is president of the ACP.