Letter to The Hon. Seema Verma, Administrator for Medicare and Medicaid Services - Peters, Stabenow, Kildee Support Michigan's Medicaid Waiver Extension Request for Flint

Letter

Administrator Verma:
We are writing in strong support of the state of Michigan's request to renew the Flint, Michigan Section
1115 Medicaid Demonstration for a ten-year period. A sustained Medicaid waiver is critical to responding
to the long-term health effects of Flint residents who were exposed to lead in their drinking water through
no fault of their own.
Six years ago, the state of Michigan made the misguided and harmful decision to switch the city
of Flint, Michigan's water source to save money, setting off a public health crisis that exposed
100,000 people to high levels of dangerous lead in their drinking water. Today, Flint is still
recovering. Six years later, Flint residents line up many times each week to receive water
distributions, waiting hours for cases of bottled water. While significant progress has been made,
the infrastructure improvements to replace Flint's lead pipes is ongoing. And the negative impact
of the crisis on our most vulnerable populations, including Flint's children, is becoming more
apparent: one in five school children in the Flint Community Schools now has special education
needs as a result of lead exposure--a 56 percent increase as compared to the year before the
water crisis started.
The U.S. Centers for Disease Control and Prevention (CDC) states that there is no safe level of lead. Lead
poisoning has severe implications for childhood development. Lead exposure can lead to behavioral,
endocrine, and cardiovascular conditions, as well as learning difficulties and neurodevelopmental deficits.
The consequences of lead exposure are serious and long-lasting, especially for children.
In 2016, the Centers for Medicare and Medicaid Services (CMS) approved Michigan's application for a
five-year Medicaid demonstration program in response to the man-made public health emergency that
came as a result of the Flint water crisis.
The Flint waiver permits the state to expand Medicaid coverage to low-income children and pregnant
women served by the Flint water system during a state-specified time period. Those who are eligible, can
receive all state Medicaid plan benefits that are exempt from cost sharing and premiums including, for
children, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). In addition, the waiver
allows for targeted case management to assist children and pregnant women with gaining access to
needed medical, educational, social, and other services. The Medicaid expansion also permits federal
funds to be used to identify potential sources of lead exposure in the home for individuals who are not
currently showing elevated blood lead levels. Ongoing access to comprehensive health care and
coordination with other services to minimize and prevent long-term adverse health and developmental
effects is critical for the well-being of individuals whose health has been impacted by the Flint water
supply.
The Medicaid expansion has served as an important tool in Michigan's responses to the Flint's health care
needs resulting from this public health catastrophe. An interim evaluation of the Flint 1115 demonstration
waiver by Michigan State University indicates that it has been a successful, cost-effective strategy to
improve the quality and accessibility of health care for children and families in Flint. It is our belief that
investing in the health of pregnant women and young children produces returns in their future lives,
productivity and contribution back to society, and is a valuable investment of state and federal Medicaid
dollars.
In our response to the Flint water crisis, our focus has always been those who are most at risk of harm
from lead exposure -- children. A ten-year extension of Flint's Medicaid expansion will help to ensure the
youngest children, who face the greatest harm from lead exposure, can continue to access care. Long-term
consistent care is crucial to helping these children grow up to be healthy, successful, and productive
members of our society.
Lead exposure has serious long-term health implications that require an equally serious long-term
solution. A ten-year waiver extension is crucial to ensuring Flint residents continue to maintain reliable
access to high-quality health services to mitigate the life-long effects of lead poisoning. We ask for your
full and fair consideration of his request and appreciate your continued engagement with the State of
Michigan officials as you evaluate its 1115 waiver extension application.

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