Medicare Compliance & Reimbursement

Governors disagree about cooperativeness of federal government.

There seems to be some partisan disagreement as to whether the federal government is taking too long to grant Medicaid waivers.

Combing state waiver requests for intergovernmental transfers can be a lengthy process, and at a Feb. 23 National Governors Association briefing, governors Jennifer Granholm (D-MI) and Kathleen Sebelius (D-KS) complained of a general slowdown in CMS' handling of waivers. In addition, Jane Woods, Virginia's Superintendent of Health and Human Resources, said at a Dec. 9 National Conference of State Legislatures meeting on health care that if anyone from CMS was in attendance, "I would like to meet you in a dark hall after the meeting." She complained that Virginia had worked with CMS for two years on several waivers, focusing on "our array of care, for the elderly particularly," only to see the agency switch from "applauding us" to "in the last month saying, 'Don't even bother to submit these waiver amendments. We will not approve them.'"

Pierce said that in examining financing issues in waiver requests, HHS was simply trying to prevent "improper payments ... We're just trying to get them stopped now in advance, as opposed to having to go back later and fight with the state over them." He also said that "states, which are now using the waiver process quite extensively, are getting much more sophisticated with their waivers, and that does take a little more time to review."

But Pierce vigorously asserted that, overall, "the process has not slowed down." Thompson has "completely changed the culture around, from one of 'no' to 'yes.' We approve waivers around here," he said. Pierce said emphatically that HHS was in no way using the waiver process to promote its legislative Medicaid agenda, and he noted that it was Democratic governors and their appointees who were alleging a slowdown.

Indeed, at the NGA briefing, Republican governors like Mike Huckabee (AK) said they had not observed any slowdown. However, at the Dec. 9 NCSL meeting the Lewin Group's Chuck Milligan said CMS is no longer approving many waivers because, "as somebody from CMS said at a meeting a few months ago, it somewhat undermines the arguments that you need legislative block grants if you can get the flexibility through waivers."

At the same event, Vicki Wachino, associate director of the Kaiser Commission on Medicaid and the Uninsured, said Virginia's experience as described by Woods was not uncommon.

"Anecdotally, as we talk to the states, we hear more and more that CMS is very thoroughly reviewing waivers and state plan amendments," Wachino said. "CMS's present posture is that they are going to scrutinize all the changes states are making to their programs in an effort to try to clamp down [...]