Medicaid Waiver Whiplash Can Be Problematic for MCOs

Since taking office, the Biden administration has taken a hard line on Section 1115 Medicaid waivers, rescinding multiple demonstrations that were approved by the Trump administration and subsequently becoming ensnared in legal fights with Republican-leaning states. Such disputes may wind up being detrimental to Medicaid managed care organizations, which in some cases spent considerable resources on implementing waiver demonstration programs that may never come to fruition.

The latest legal conflict is in Georgia, where the state is trying to preserve an 1115 waiver that the Trump administration approved. Georgia’s waiver would have imposed premiums and work requirements on Medicaid beneficiaries, with the added twist of expanding Medicaid eligibility just for the population earning up to 100% of the federal poverty level — rather than 138% like with regular Medicaid expansion — and therefore receiving a smaller federal funding match.

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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