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Yesterday, CMS published proposed rules allowing state Medicaid programs more flexibility in program design, similar to SCHIP programs. The change is meant to “implement the Administration’s goals of aligning Medicaid more closely with private market insurance and giving states more control over their Medicaid benefit packages.” If approved the rules would allow states to reduce the Medicaid benefit package to the level of the standard Blue Cross/Blue Shield PPO option under FEHBP, state employee coverage (the choice CT made for HUSKY Part B, our SCHIP program), the state’s largest commercial HMO, or anything HHS approves. States would also be allowed to increase cost sharing for Medicaid consumers to SCHIP levels – no change for consumers living under the poverty level (FPL), monthly premiums can be charged over 150% FPL, but total cost sharing cannot exceed 5% of income above that amount. However 5% of annual income for a family of four living at 150% FPL ($31,800 as of this coming April) is $1,590 – a significant sum. CMS is soliciting public comment on the proposed rules.
Ellen Andrews