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Domestic Violence Amd Women

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On August 4, 2001, President Bush and HHS Secretary Tommy Thompson announced a new policy regarding Section 1115 waivers for Medicaid and the State Children's Health Insurance Program (SCHIP). Although the Health Insurance Flexibility and Accountability Initiative is being touted as a way for states to increase the number of people covered by Medicaid and SCHIP, the new initiative does not provide any extra funds to states to expand coverage, and it is likely to result in significant benefit cuts, increased cost-sharing, and possibly the widespread use of caps on enrollment in Medicaid. In fact, it is unclear that states must even expand coverage to use this waiver. However, should a state apply for a waiver to expand coverage, the severe restrictions on federal funds available to states for expansions imposed by this new policy would require that states drastically reduce benefits for current Medicaid beneficiaries in order to garner enough cost-savings to pay for the expansion. The proposal also gives states the option to increase cost-sharing for many people who are currently eligible for Medicaid, potentially creating a barrier to enrollment and making health care unaffordable for those most in need. Provisions of the new waiver guidance:* Limits on Federal Funding: The waiver guidance indicates that states must adhere to "current-level Medicaid and SCHIP resources" as they seek to expand coverage. It requires that 1115 waiver demonstrations not cost the federal government more than the program would have cost without such demonstrations, but the way this "budget-neutrality" is calculated appears to be significantly more restrictive than the way it has been calculated in the past. It is also unclear whether the budget agreement encompasses only spending on newly covered populations, spending on all of the populations directly affected by the waiver, or spending for the entire Medicaid program. In the latter case, states might cut spending on mandatory groups (see below) in order to stay within the confines of the budget agreed to for the waiver. Such details will determine whether this new policy allows flexibility for states to expand meaningful coverage at all under these waivers. * Eligibility: Divides Medicaid- and SCHIP-eligible people into three groups: mandatory, optional, and expansion. While those in mandatory groups (such as children under age 19 in families with annual incomes up to 100 percent of the federal poverty level) would continue to be entitled to mandatory services and limited cost-sharing, states would have new discretion (and incentive) to cut benefits and to increase cost-sharing for optional groups and for people eligible under new expansions. Optional beneficiaries include 20 percent of all children enrolled in Medicaid, 43 percent of all parents enrolled in Medicaid, 22 percent of disabled enrollees, and 56 percent of seniors enrolled in Medicaid.* Benefit Packages: Allows states discretion to reduce benefits for currently eligible people that the state is not required to cover (optional groups) and for new groups the state expands coverage to through a waiver (expansion groups). The guidance suggests that states provide a benefit package to



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