States get more flexibility in Medicaid/CHIP program design with coverage for adults

The Centers for Medicare & Medicaid Services (CMS) is implementing the newly minted Health Insurance Flexibility and Accountability Initiative so that states will find it easier to expand access to health care coverage for low-income individuals through Medicaid and the state Children’s Health Insurance Program (CHIP).

The initiative is based in part on recommendations from the National Governors Association, which supports the changes.

Governors have an ally

Secretary of Health and Human Services Tommy Thompson, the former governor of Wisconsin, said the agency’s goal is to "give governors the flexibility they need to expand insurance coverage to more Americans through innovative approaches, including the kind of health insurance options available in the private sector.

"Through this initiative, we are creating a new, simpler process for states to propose and implement creative ideas to help uninsured residents," he explained.

Some of the elements in the initiative include:

  • States will have more flexibility to design benefit packages that will promote expanded access to health care coverage and meet the need of residents.
  • Special emphasis will be placed on coordinating Medicaid and CHIP with private-sector insurance programs to achieve seamless coverage for low-income individuals.
  • In exchange for upfront flexibility, states will be required to set goals for reducing the number of residents without health care coverage and then document their progress toward reaching that goal.
  • A new electronic application will make it quicker and easier for states to propose and implement new approaches to promote access to health care coverage.

Agency officials say the new approach will encourage states to design benefit packages that will best meet the needs of their residents. Thus, different benefits could be made available for different populations, expanding coverage to more individuals and families who might not be eligible for Medicaid or CHIP under current law.

States should find it easier to operate demonstration projects that are designed to extend health care coverage to their uninsured residents. As in the past, such projects must be budget neutral, meaning states would have access to the same amount of federal funding under the demonstration as they would have received under current law.

Speeding up the process

States wanting to take advantage of the opportunities in the initiative and seek an expedited review of a waiver request will be able to use an on-line application.

"We intend to use today’s technology to speed up and simplify the process and cut down on the bureaucratic red tape and paperwork that stifles new approaches to expanding health coverage," Mr. Thompson said.

"By increasing flexibility, promoting innovation, and demanding accountability, we are giving states more options to increase the number of individuals with access to affordable health insurance," he explained.