UPDATED: Centers for Medicare and Medicaid Services releases Long-Awaited Block Grant Guidance

2/7/2020 Update: Click here for a detailed analysis of the Healthy Adult Opportunity (HAO) guidance (SMDL 20-001) from PCG’s Health Policy News subject matter experts.

The Centers for Medicare and Medicaid Services (CMS) releaseits long-awaited guidance promoting block grant waivers – being referred to as the Healthy Adult Opportunity (HAO) – yesterday. As expected, under guidance, in exchange for funding limited to an annual aggregate cap or per capita cap that would take into account enrollment changes (rather than funding dependent on the cost of the program) a state could get additional flexibilities, including relative to eligibility, benefits, cost sharingand program administration. These include more limited drug coverage, broader copays than allowed currently, and flexibility relative to traditional Medicaid services including non-emergency medical transport and Early and Periodic Screening, Diagnostic and Treatment. In general, the guidance notes that states would be expected to align coverage under the waiver with the state’s individual health insurance market. State Medicaid Managed Care programs could also be subject to less federal oversight, and states with HAO waivers would have the opportunity to share in federal savings. Waivers would specifically apply to the covered adult population under age 65 who are not eligible for coverage based on a disability or the need for long-term care services and supports or otherwise under the state plan. 

HPN subject matter experts continue to review the guidance in detail. Keep an eye on the blog next week for a more detailed analysis. In the meantime, you may find these materials from CMS helpful as you consider the implications for your state: 

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