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Senators Call for More Transparent Medicaid Waiver Process

  • July 16th, 2004

We have reported that the Republican governors of four states '“ Schwarzenegger in California, Bush in Florida, Rowland in Connecticut and Benson in New Hampshire '“ are (or were, in the case of Connecticut's Rowland, who recently resigned) working behind the scenes with the Centers for Medicare and Medicaid Services (CMS) to gain approval of so-called "super waivers," which would allow them to turn their Medicaid programs into block grants in exchange for a great deal more flexibility in administering their programs. See "GOP Governors Seeking 'Super Waivers' to Change Medicaid," June 14, 2004.

The secretive nature of these discussions with CMS has drawn the attention of a U.S. Senate committee, which is now insisting that CMS begin sharing information.

On June 16, Sens. Charles Grassley (R-Ia.) and Max Baucus (D-Mo.), respectively the chairman and ranking member of the Senate Finance Committee, sent a letter to CMS Administrator Mark McClellan demanding that the agency share information on communications CMS has had with states on such proposals.

'We understand," the letter says, "that several states are developing waiver proposals in consultation with the Centers for Medicare and Medicaid Services (CMS) that, if approved, would modify the federal-state financing relationship and guarantees for beneficiaries that the Congress has enacted over the last four decades of the Medicaid program. In the exercise of our oversight responsibilities, we urge you to inform the Committee of the status and content of any proposals under development that rely on the [Section] 1115 waiver authority [provided by federal law].'

The letter goes on, 'These proposals, and similar ones, if approved and implemented, could potentially make fundamental changes to the Medicaid program in ways that Congress did not anticipate or intend. We strongly believe that, over time, these changes could have far reaching implications and debate over these changes should include the Congress and relevant stakeholders.'

The letter also questions whether CMS has the authority to approve any change in the traditional federal-state Medicaid financing arrangement.

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Last Modified: 07/16/2004

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