Trump Administration Rejects Lifetime Limits for Medicaid Beneficiaries in Kansas

The Trump administration announced Monday that it is rejecting Kansas’s request to impose lifetime limits on Medicaid benefits, with CMS chief Seema Verma telling the American Hospital Association that "Medicaid remains the safety net for those that need it most."

Later Monday, CMS and New Hampshire announced that work requirements were approved for those receiving benefits in that state.

The administration has already approved work requirements in Medicaid in an effort to refashion the program from one providing medical benefits to one of self-sufficiency and a path out of poverty.

In its letter to state officials in Kansas announcing its decision, Verma said, "We have approved, in other states, meaningful incentives for certain adults to participate in community engagement activities and to take greater responsibility for their health and well-being, including periods of ineligibility for failing to comply with these requirements. In every case, these incentive structures are designed to engage beneficiaries in ways that promote positive health and well-being."

Kansas wanted to cap benefits at 3 years, prompting an outcry from healthcare providers and hospitals in the state, as well as advocates who called the proposal cruel.

"We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them," Verma said in her speech.

Three states so far have approval for their plans to impose work requirements, and more are pending. The administration has been sued by advocates in Kentucky, which was the first state to win approval to impose work requirements.

A fourth was approved Monday when New Hampshire announced that CMS had approved its plan to require residents receiving Medicaid to go to work.

"Work requirements help lift able-bodied individuals out of poverty by empowering them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs," said Governor Chris Sununu in a statement. "They help people gain the skills necessary for long-term independence and success. We are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole.

The requirements apply to adults ages 19 through 64, with certain exemptions, who must participate in 100 hours per month of activities such as employment, education, job skills training, or community service.

In her speech, Verma touched on several other issues, including accountable care organizations (ACOs) and 2-sided risk.

Last week, the National Association of Accountable Care Organizations (NAACOS) released a survey that said 71% of respondents indicated they are likely to leave the Medicare Shared Savings Program due to concerns over having to assume risk. NAACOS said it does not support the government's current strategy of forcing ACOs to move to 2-sided models if they don't feel ready to assume more risk.

Verma said the ACOs that refuse to move are increasing Medicare spending, and that 1-sided risk models may be "encouraging consolidation in the market place, reducing competition and choice for our beneficiaries. While we understand that systems need time to adjust, our system cannot afford to continue with models that are not producing results."