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CMS Has No Authority To Limit State Efforts To Expand Medicaid Eligibility

Armen Hareyan's picture

House andSenate Democrats on Tuesday in a letter to HHS Secretary Mike Leavitt wrote that CMS does nothave the authority to limit states' ability to expand Medicaid coverage to morechildren, CQ HealthBeat reports (Carey, CQ HealthBeat,1/15).

CMS has reportedly imposed restrictions on the ability of states to expand theirMedicaid programs that mirror a policy directive announced in August 2007 thatlimits states' abilities to expand SCHIP. The SCHIP guidelines state thatbefore expanding SCHIP eligibility to children in families with incomes greaterthan 250% of the federal poverty level, states must demonstrate that they have"enrolled at least 95% of children in the state below 200% of the federalpoverty level" who are eligible for Medicaid or SCHIP, according to aletter sent by Dennis Smith, director of the Center for Medicaid and State Operations (Kaiser Daily Health Policy Report, 1/4). CMShas imposed the directive on several states that were considering Medicaidexpansions, including Ohio, Louisiana,New York, Wisconsinand Oklahoma.

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The lawmakers -- which included Senate FinanceCommittee Chair MaxBaucus (D-Mont.), House Energy andCommerce CommitteeChair John Dingell (D-Mich.) and House Oversightand Government Reform Committee Chair Henry Waxman (D-Calif.) -- wrote, "Despite repeated warningsabout the legality of the Aug. 17, 2007, directive and the absence of a formalrule making process, your administration has continued to pursue a policy thatis contrary to federal law and that limits children's access to healthcare." They added, "Federal law does not authorize CMS to effectivelyimpose an income eligibility cap in (SCHIP) or Medicaid, nor does it requirestates wanting to cover children at levels higher than 250% of poverty to haveto use 100% state-only funds to do so" (CQ HealthBeat, 1/15).

According to the letter, recent denials of state requests to expand Medicaideligibility above 250% of the poverty level "are just the latest in agrowing list of unilateral changes to longstanding law and policy withoutstatutory authority. ... The president has made repeated statements about hisdesire to cover more uninsured children. However, the actions of yourdepartment contradict those statements. Moreover, the department's actions areinconsistent with federal law" (Johnson, CongressDaily,1/15).

The lawmakers requested that CMS reverse the decision and that Leavitt respondby Jan. 31 (CQ HealthBeat, 1/15).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.