Some Insurers Balk, but Analysts Are Not Overly Concerned by Medicaid Block Grant Guidance

On Jan. 30, CMS released its long-awaited “Dear State Medicaid Director” letter containing detailed guidance that paves the way for states to receive capped federal Medicaid funding in exchange for more flexibilities. While such a waiver program is a long way from implementation in any state, that didn’t prevent insurers from reacting and analysts from speculating about how it would affect the managed care industry.

CMS’s 56-page letter outlines what it calls the “Healthy Adult Opportunity (HAO) initiative,” which would allow states to apply for Section 1115 waivers that cap spending on their Medicaid expansion populations. States would assume financial risk for any costs exceeding an “annual aggregate or per capita cap.” If states opt for an aggregate spending cap — also known as a block grant — and are able to spend less than the cap, they may be eligible to use a portion of that savings to reinvest in their Medicaid programs.

0 Comments
© 2024 MMIT
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.

Related Posts

mental-health-patient
May 24

Digital Therapeutic Helps Kentucky WellCare Members With PTSD

READ MORE
healthcare
May 24

Under New Rule, DACA Recipients Can Sign Up for ACA Marketplaces in 2025

READ MORE
business-meeting
May 24

Medicaid MCOs Have ‘Quite A Lift’ to Meet New Access, Quality Rules

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today