States Seek CMS Approval For Medicaid, ACA Exchange Flexibility

CMS has approved Florida’s Section 1135 waiver, allowing the state to avoid some of the administrative processes that may weigh down the escalating efforts against coronavirus.

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When the president declared the novel strain of coronavirus, COVID-19, a national emergency, the announcement increased the HHS Secretary’s authority to grant waivers that would enable more extensive coverage and flexibility. CMS encouraged states to take advantage of these flexibilities immediately.

Florida was the first state to submit a waiver and it is the state with the fifth highest coronavirus prevalence, according to data gathered by Johns Hopkins University. As of the evening of March 15, Florida had 149 cases of coronavirus, resulting from an increase of 34 cases in one day following an overnight spike of 39 new cases.

“I want to thank Governor DeSantis for his leadership in Medicaid and for taking full advantage of federal flexibilities,” said CMS Administrator Seema Verma. “CMS is committed to removing all unnecessary administrative and bureaucratic barriers that may hinder an effective response to this public health emergency, and I have directed my team to expeditiously process these requests.”

The flexibilities for Florida include 

• Eliminating access to care barriers
• Simplifying enrollment processes
• Allowing alternative, unlicensed sites of care in cases of evacuation
• Lifting required documentation that increased administrative burdens in nursing homes
• Granting more time for appeals and state fair hearing requests

“Florida is acutely focused on eliminating unnecessary barriers on our health care providers who are on the front lines serving our communities most impacted by COVID-19,” said Florida Governor Ron DeSantis.  “President Trump recognizes this need and Administrator Seema Verma is providing Florida the critical flexibility for our state’s Medicaid program by waiving prior authorization requirements for essential health care services and expedited provider enrollment.”

On March 13, when the president declared the national emergency and Florida had 51 cases of coronavirus, CMS released guidance on potential waivers that states and providers could enact to empower their fight against COVID-19.

The guidance outlined eleven health care provider waivers. These waivers’ flexibilities cover lifting restrictions for critical access hospitals, skilled nursing facilities, acute care units, long-term care acute hospitals, and home health agencies. Others relax the requirements on durable medical equipment orders, provider sites, provider enrollment, and Medicare appeals.

Illinois governor JB Pritzker has also indicated that the state is working on a federal waiver. According to local news outlets, the waiver would help the state’s lower income population better fight the coronavirus “by providing additional medical providers and increased access to medical services.”

States have also pursued relief through other means as they try to ensure coverage for their residents.

On March 15, New Jersey’s Governor Phil Murphy has asked the federal government to extend a special enrollment period for New Jersey’s Affordable Care Act state health insurance marketplace on the federal exchange for at least 60 days.

New Jersey is currently in the midst of a transition from state based exchange on the federal platform to a state based exchange on a state-run platform. It is one of five states that have a state based exchange on the federal platform, most of which are planning to implement a state-based platform in plan year 2021 or 2022.

“While I have coordinated across state agencies to take emergency action to facilitate access to screening, testing and access to care for the residents of New Jersey, more can be done to ensure every individual has access to appropriate health care during this crisis. Therefore, as New Jersey transitions from a State Based Exchange on the Federal Platform to a State Based Exchange, I respectfully urge the Administrator of the Centers for Medicare & Medicaid Services to authorize a Special Enrollment Period in New Jersey to allow individuals to access affordable health insurance options through the federal platform,” Governor Murphy wrote in his letter to HHS and CMS.

The governor pointed out that the growing uncertainty is a sufficient motivator for such taking such measures. He reminded HHS and CMS that the departments had extended special enrollment periods in the past when states experienced hurricanes or other adverse weather events. Despite strong enrollment on federal exchanges, state health insurance marketplaces have seen decreased enrollment. 

Despite a state-administered individual mandate, the uninsured rate in New Jersey is at 7.6 percent as of 2019, according to America’s Health Rankings. In Florida, the rate is especially high, with 13 percent uninsurance. 

Regardless of the percentage, uninsured populations have the potential to increase the medical and financial strain on states fighting coronavirus. These measures are just two options that state governors are considering as they seek to eliminate care complexities and increase coverage.