“No” to Having Premiums in Medicaid

Biden Administration (CMS) Says No to Premiums in Medicaid,” Georgetown University Health Policy Institute, Joan Aker

Georgia, Arkansas, and Montana recently had their 1115 Medicaid waiver requests denied. All three states were asking they be allowed to charge premiums to low income adults on Medicaid. A Section 1115 demonstration is intended to test new approaches promoting the objectives of Medicaid. 

The Biden Administration’s painstaking rollback of Medicaid work requirements has been well-documented and publicized. But as we have repeatedly pointed out, there are other policies in section 1115 waivers that constitute barriers to coverage – most notably premiums. CMS had not previously rendered judgment on this question – although a close reading of the Executive Order issued by President Biden on January 28th suggested that work requirements were not the only barriers that would be re-examined.

On December 23, CMS (Centers for Medicare & Medicaid Services) rejected Georgia’s Section 1115 stating the state no longer has the authority to require work activities as a condition of Medicaid eligibility. Neither could the state of Georgia charge premiums in its Georgia Pathways to Coverage demonstration beyond those allowed under the Medicaid statute.

Former president trump had already approved Georgia’s Pathways to Coverage Section 1115 and the Biden Administration (CMC) rejected Georgia’s 1115. None to happy with the Biden Administration, Georgia Governor Brian Kemp has threatened to sue the federal government.

Medicaid fills the gap for reimbursing hospitals for care given to people lacking healthcare insurance. Since the passage of the ACA, Federal funds meant to fill this gap were discontinued. Not allowing or making it impossible for people to be on Medicaid cause hospitals to lose money giving care.