New CMS chief touts ‘per­sonal re­spon­si­bil­ity’

Modern Healthcare - - NEWS - By Vir­gil Dick­son

Given her ex­ten­sive ex­pe­ri­ence re­form­ing state Med­i­caid agen­cies, Seema Verma, the next CMS ad­min­is­tra­tor, could lead a na­tion­wide ef­fort to make the poor on Med­i­caid pick up some of the costs of their in­sur­ance cov­er­age.

As founder of SVC, a na­tional health pol­icy con­sult­ing com­pany, Verma helped craft Med­i­caid expansion plans in In­di­ana, Iowa, Ken­tucky, Michi­gan and Ohio. Her In­di­ana plan, com­pleted for Gov. Mike Pence, was the first in the na­tion to make Med­i­caid re­cip­i­ents pay small sums when they signed up for cov­er­age.

Pa­tient ad­vo­cacy and pol­icy ex­perts agree that Verma’s philosophy, which is dubbed “per­sonal re­spon­si­bil­ity,” en­cour­ages peo­ple to take charge of their health­care. Verma has sup­ported charg­ing pre­mi­ums to in­di­vid­u­als above and be­low the poverty line and freez­ing ben­e­fi­cia­ries out of cov­er­age if they don’t pay.

She is also in fa­vor of man­dat­ing un­em­ployed en­rollees search for work while be­ing cov­ered and that they are timely when reap­ply­ing for Med­i­caid cov­er­age or else face a lock­out pe­riod that could last a year. Many ad­vo­cates for the poor worry such an ap­proach will re­duce en­roll­ment in the pro­gram. “The vi­sion of Med­i­caid un­der Verma is trou­bling,” said Joan Alker, ex­ec­u­tive di­rec­tor of the Ge­orge­town Center for Chil­dren and Fam­i­lies. “It’s a vi­sion where there will be many new bar­ri­ers to cov­er­age.” Even small con­tri­bu­tions can cause some low­in­come peo­ple to choose to by­pass cov­er­age, ac­cord­ing to Judy Solomon, a vice pres­i­dent for health pol­icy at the left-lean­ing Center on Bud­get and Pol­icy Pri­or­i­ties. For ex­am­ple, a re­cent state eval­u­a­tion of In­di­ana’s HIP 2.0 waiver found that about one-third of those el­i­gi­ble don’t en­roll be­cause they can’t or don’t want to pay a pre­mium, Solomon said. The Obama ad­min­is­tra­tion has largely de­nied more con­ser­va­tive sug­ges­tions made by Verma in craft­ing waiver re­quests. They in­clude such things as a re­quire­ment to be ac­tively look­ing for work as a con­di­tion of cov­er­age or kick­ing those un­der the fed­eral poverty level off cov­er­age for not pay­ing pre­mi­ums. Yet her his­tory in pur­su­ing waivers re­veals an abil­ity to cross party lines to en­sure cov­er­age, said Tr­ish Ri­ley, ex­ec­u­tive di­rec­tor of the Na­tional Academy for State Health Pol­icy. “She helped forge a mid­dle ground that en­abled some more con­ser­va­tive states to cover more peo­ple—child­less adults—through Med­i­caid expansion via pri­vate op­tions.” Verma is de­clin­ing in­ter­views prior to her con­fir­ma­tion hear­ing.

Seema Verma helped craft Med­i­caid expansion plans in In­di­ana, Iowa, Ken­tucky, Michi­gan and Ohio.


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