I know you’re out there because our blog editor assures me that “section 1115 waiver” is one of the top 50 search terms leading readers to Say Ahhh!
As I blogged about a few weeks ago, CMS recently released proposed regulations as required by ACA that establish a more robust public notice and comment process for Section 1115 Medicaid and CHIP demonstrations. These regulations are very welcome given that waivers can often have enormous programmatic and fiscal consequences but are often negotiated behind closed doors with little meaningful public input. Does anyone else remember the famous Florida Medicaid waiver that was approved in just eight business days??? As a long time “waiver watcher,” I am thinking that we are going to see more waiver requests coming as we get closer to 2014 and the full implementation of ACA so the need for strong regulations is pressing.
For many years, Georgetown CCF and our partners at the Center on Budget and Policy Priorities have convened an informal group known as the Waiver Taskforce. This large group includes a diverse range of consumer and provider groups, most of whom have state chapters or affiliates. We have worked together for many years to monitor waivers and to press for a more accountable public process. Our latest collective effort has been to review the proposed regulations and develop joint comments on how they could be strengthened. The proposed regulations are strong, but they are not perfect. For example, when states are developing a waiver proposal and seeking public input, we believe that the public must be informed of which provisions of the statute the state is actually seeking to waive – this is not required by the proposed regulations. In the past, many state advocates have found themselves in the position of commenting on a PowerPoint presentation that provides few details on why the state actually needs a waiver.
We hope to have a very diverse list of state and national groups endorsing these recommendations. Please take a look at our list of recommendations and sign your organization on by filling out this form by COB November 12. Or feel free to modify and submit these comments from your organization. I also encourage state groups who have experienced a less than optimal waiver process in the past to send in their own comments and suggestions as well. And feel free to call or email me if you want to talk about these issues.