Proposed Rule and Waiver Guidance Would Change How States Finance Medicaid

February 10, 2020

GNYHA Comments on Proposed Medicaid Fiscal Accountability Rule

GNYHA recently submitted comments (attached) on a Centers for Medicare & Medicaid Services (CMS) proposed rule that would overhaul longstanding Medicaid financing rules. The proposed rule would limit which providers can make intergovernmental transfers, create new requirements on provider taxes used to finance the state share of Medicaid, and modify the upper payment limit methodology.

GNYHA strongly opposes the proposed changes and urged CMS to rescind the proposal in its entirety given the devastating financial impact it would have on our member hospitals and the patients they serve. Although CMS provided no impact analysis, the American Hospital Association (working with Manatt Health) estimated that the proposed rule would reduce Medicaid funding to providers by $37 to $50 billion nationally based on a 50-state survey.

GNYHA is working to educate Congress about the proposed rule’s impact and believes legal action could commence if the rule is finalized.

Waiver Guidance to States on Medicaid Block Grants

CMS released Medicaid guidance that would allow states to apply for 1115 waiver authority—the “Healthy Adult Opportunity” (HAO) waiver—to receive a defined amount of Federal funding on either an aggregate or per capita basis to cover services for certain adult populations under age 65 that do not require long-term care services and supports. States that opt to receive an aggregate funding allotment could share in Federal savings that result from implementing new approaches. Under an HAO waiver, states would be permitted to make changes to eligibility and benefits, including adding work requirements. States would also be allowed to change provider payments without further CMS approval.

GNYHA does not expect New York to apply for an HAO waiver.

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