Maine takes legal action to get Medicaid cuts approved; court rejects lawsuit

Posted on September 13, 2012 | No Comments
Filed under Centers for Medicare & Medicaid Services, Department of Health and Human Services, Judiciary, Key Developments, Medicaid and CHIP

PDF Version

Details

Key Developments

Implementation Briefs

Library

Maine Attorney General William Schneider filed documents with the 1st Circuit Court of Appeals in Boston requesting review of a Centers for Medicare and Medicaid Services’ (CMS) determination that it would not be able to grant Maine’s request for an expedited ruling on the state’s August 1 proposed state plan amendment (SPA), which makes significant cuts to their Medicaid program. Schneider also asked the court to order federal officials to pay Maine’s share of related Medicaid expenses for the time they take in considering the request.

By law, the federal government has 90 days to rule on the Medicaid consolidation request. The Maine department of Health and Human Services had planned to implement the Medicaid cuts by October 1. However, if the government employs the full 90-day time frame to rule on state’s request, Maine could be waiting on a decision until the end of October.

In a one page decision filed today, the court threw out the LePage lawsuit.

No Comments

Public comments are closed.

Maine governor denounces CMS for delayed information

November 7, 2012

Last week, Maine Governor Paul LePage (Republican) accused the Centers for Medicare & Medicaid Services (CMS) of "delaying tactics," after CMS requested more information regarding Maine's Medicaid cuts. The CMS request, sent October 26, "could have been answered with a quick telephone call," according to a letter LePage wrote to the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius. The request will restart a 90-day review period for the agency to examine Maine's request to enact cuts to the state's Medicaid program. Maine's proposed cuts would impact over 27,000 low-income residents, ending coverage for 19- and 20- year-olds and reducing coverage for nonpregnant and nondisabled adults with incomes above 100 percent of the federal poverty level (FPL). Maine sent the original proposal to CMS on August 1 and asked the agency to review it before October 1.

Measure to repeal tax on premiums garners support in the House

September 24, 2012

Representative Charles W. Boustany's H.R. 1370, a measure to repeal the Affordable Care Act's (ACA's) tax on health insurance premiums, has garnered enough co-sponsors to pass through the House chamber. The elimination of this tax, which is estimated to cost around $87 billion over 10 years, is supported by insurers and the National Federation of Independent Business (NFIB). The tax applies to group and individual plans but exempts self-insured entities. According to STOP The HIT, a coalition of associations working to repeal the tax, H.R. 1370 now has 221 co-sponsors.

HHS releases final rule on Medicaid eligibility

March 16, 2012

Today the U.S. Department of Health and Human Services released the final rule for Medicaid program eligibility changes under the Affordable Care Act (ACA). Similar to the exchange final rule, certain provisions of the Medicaid final rule were issued as interim final, with a 45 day comment period. Under the ACA, individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level (currently $14,856 for an individual and $30,656 for a family of four) are eligible for Medicaid coverage. Medicaid expansion will become effective in 2014 when the Exchanges begin operation. The federal government will pay 100 percent of the association expansion cost for the first three years and at least 90 percent after that. The final rule announced today deviates from the August 2011 proposed rule enrollment rules. The proposed rule would have given the Exchanges the responsibility of determining who is eligible for Medicaid in order to facilitate "one-stop shopping" for coverage options. Under the final rule, however, states will now be able to choose whether the Exchange will enroll people in Medicaid or whether the state Medicaid agency alone will have that power.

Update: Legal Challenges to the Affordable Care Act’s Medicaid Maintenance of Effort Provisions

September 26, 2012

The Affordable Care Act (ACA), in addition to expanding coverage to individuals with incomes below 133 percent of the federal poverty level (FPL), includes provisions designed to preserve existing Medicaid coverage -- known as the maintenance of effort provision, or MOE -- until the ACA is fully implemented. The ACA’s MOE provision requires states to maintain their current Medicaid eligibility standards, methodologies, and procedures until the Secretary of the Department of Health and Human Services (HHS) determines that a state Exchange is fully operational. For children, the ACA’s MOE extends through September 30, 2019. States may reduce eligibly for certain non-pregnant, non-adult...

A Closer Look at the Medicaid Holding in NFIB v Sebelius: Key Implementation Questions

July 3, 2012

In NFIB v Sebelius the United States Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA or the Act). At the same time, the decision adds a new dimension to the implementation of §2001(a) of the Act, which establishes expanded Medicaid eligibility for certain low-income people. This Implementation Brief begins with a discussion of exactly what the Court held in its Medicaid ruling. It then discusses the significance of the majority conclusion, as well as the key implementation questions that arise in the wake of this opinion.

Medicaid Access Rule

May 26, 2011

Access to health care has been a prime focus of the Medicaid program since it’s enactment in 1965. A key aim of the Medicaid statute has been to integrate Medicaid beneficiaries into the general health care system, affording them insurance coverage that would enable them to secure care from the participating provider of their choice in a manner similar to that enjoyed by privately insured individuals and Medicare beneficiaries. It is evident, however, that despite Medicaid’s enormous achievements, access to “mainstream” medical care has remained elusive.

Medicaid and CHIP Maintenance of Effort Provisions Under the Affordable Care Act

March 9, 2011

In recessionary times, states seek to reduce Medicaid spending; paradoxically, this is when the need for public insurance may be the highest. During the recession that occurred in the early 2000s, two-thirds of all states reduced Medicaid eligibility, removing between 1.2 and 1.6 million children and adults from the program before Congress enacted legislation barring further cuts as a condition of additional federal assistance. The current recession is far more serious, and state budget shortfalls, far greater.

GAO releases Medicaid expansion report

August 1, 2012

The Government Accountability Office (GAO) recently released a report on Medicaid expansion under the Affordable Care Act (ACA). The report does not take into account the June 28th United States Supreme Court decision. Congress asked the GAO to report on the actions states are taking to implement the Medicaid expansion. This report addresses the following questions...

CBPP paper reviews how Medicaid expansion will impact state budgets

July 13, 2012

The Center on Budget Policy and Priorities (CBPP) published an article which found that the Affordable Care Act's (ACA's) Medicaid expansion would "add very little to what states would have spent on Medicaid without health reform, while providing health coverage to 17 million more low-income adults and children." The paper reported that "contrary to claims made by some of the Medicaid expansion’s critics, the expansion does not impose substantial financial burdens on states," as the additional projected spending "equals 2.8 percent of what states would have spent on Medicaid in the absence of health reform."

Center for Health Care Strategies advises States on how to prepare for Medicaid eligibility expansion

March 9, 2011

Under the Affordable Care Act (ACA), 16 to 20 million more Americans will become eligible for Medicaid, starting in 2014. To help meet this large demand, the ACA requires state Medicaid agencies to increase primary care provider (PCP) reimbursement to the level of Medicare rates in 2013 and 2014 and provide federal funding to cover the additional cost. With Commonwealth Fund support, the Center for Health Care Strategies has created a guide for states, "Implementing Medicaid Primary Care Rate Increase: A Roadmap for States," which outlines key implementation and planning activities that states can undertake now to prepare for these changes. The roadmap provides advice on how to analyze fee schedules, engage stakeholders, leverage policy opportunities, and other tasks.