Hearing of the Health Subcommittee of the House Energy and Commerce Committee - Examining the Administration's Approval of Medicaid Demonstration Projects

Hearing

Mr. Chairman, thank you for calling today's hearing on Medicaid demonstration projects,
and thank you to all of our witnesses for coming to testify.

Section 1115 (11-15) waivers were established for the express purpose of allowing states
to dream big in their Medicaid programs--to design and pilot new ways of delivering care that
support the overarching objectives of the Medicaid program: to strengthen coverage, expand
access to providers, improve health outcomes, and increase the quality of care for beneficiaries.
States already have extremely broad flexibility under an 1115 (11-15) waiver, and that
flexibility is a good thing. But in exchange, it's important that there remains strong public
transparency and evaluation.

That's why I am pleased that after close to twenty years of recommendations for more
transparency into the Medicaid waiver process, the Affordable Care Act included a bipartisan
provision to improve the transparency of Medicaid waivers, in line with longstanding
recommendations from GAO. Today, because of this provision, the public has meaningful
opportunities to provide input into the waiver process at both the state and federal level, waivers
are now evaluated on a periodic basis, and states submit reports on implementation. This was a
huge step in the right direction.

I am further encouraged by CMS' concurrence with GAO recommendations specifically
in their April, 2015 report for better ongoing and transparent documentation of how states spend
Medicaid dollars. This is a recommendation that prior Administrations had refused to correct,
and I continue to believe it is the right thing to do to ensure dollars are following our Medicaid
beneficiaries.

I was also encouraged by the Administration's clear and public articulation over the past
year with states regarding the specific criteria that it would use for approval of waivers for states
with so-called "uncompensated care pools." In many past reports, GAO has expressed concerns
with the structure and distribution mechanisms for uncompensated care dollars that some states
have used. This is another step in the right direction.

Despite these advancements, I believe there is still more to be done. A real conversation
about improving transparency of Medicaid waivers, while carefully balancing the need to
preserve state flexibility, is a conversation worth having.

To be clear, however, states already have broad flexibility. Disguising punitive,
ideological philosophies like work requirements and increased cost-sharing as vital "flexibility"
needed by states has no place in this conversation. Those are policies that undermine the
foundation of our safety net.

There is a real opportunity today to evaluate and learn how to improve the Medicaid
waiver process so we can provide better care to millions of people that count on Medicaid. I
look forward to that discussion.

Source