Mass. seeks to move adults off Medicaid, limit drug coverage
Facing steadily rising costs, Massachusetts has sought federal permission to cull its Medicaid rolls, curb access to in-home and long-term care and support services and limit the number of drugs it must cover.
Massachusetts has seen its Medicaid and Children’s Health Insurance Program populations jump more than 30% since it expanded Medicaid under the Affordable Care Act. Medicaid covers 1.9 million Massachusetts residents, or onethird of the state’s population.
But as the federal government no longer covers the total cost of expansion, Massachusetts said it needed to slim down the program because the costs are unsustainable.
“At 40% of the commonwealth’s budget, MassHealth’s continued growth will constrain the state budget unless significant reforms are implemented and key aspects of the program are restructured,” Marylou Sudders, state health and human services secretary, said in a Sept. 20 letter to CMS Administrator Seema Verma.
The CMS will accept comments on the state’s waiver request through Oct. 20.
Massachusetts’ share of Medicaid spending jumped 20% from $6.4 billion in fiscal 2013 to $7.7 billion in fiscal 2016, according to federal data.
The state has asked for permission to move childless, non-disabled adults with incomes above the federal poverty level into subsidized commercial plans through the state’s exchange. Arkansas uses a similar model to cover this population.
Under the proposal, non-disabled beneficiaries at or below the poverty level would be moved to a version of Massachusetts’s Medicaid program that does not cover longterm support and services, such as personal care attendants.
The state also seeks to create a formulary that would limit which drugs the state would have to cover for Medicaid beneficiaries, making the state’s program more similar to a commercial insurance plan.