Besides the non-news of the taxes: https://www.hhs.gov/sites/default/files/sec-price-cms-admin-verma-ltr.pdf
Not sure exactly what all that is, but it seems like a shitstorm's a-brewin.
....did you read it?
Because it appears to be the opening move of dismantling Federal Medicaid administration, and making the states themselves primarily responsible for administering Medicaid services and, in fact, designing the programs. It starts talking about how they have a duty to provide the highest quality of service to Americans. Then it takes a direct stab at big government, top of the second paragraph, as the reason it can't do so. Then goes right into naming the ACA as the reason Medicaid is overburdened, (a "clear departure from the core, historical mission of the program.") then into how the Federal structure of Medicaid can't handle the vagaries and complexities of state health care needs. It goes on to say how one of their primary goals is to facilitate faster processing of waiver requests from states. I'll just quote the next bit:
Align Medicaid and Private Insurance Policies for Non-Disabled Adults. States may considering creating greater alignment between Medicaid's design and benefit structure with common features of commercial health insurance, to help working age, non-pregnant, non-disabled adults prepare for private coverage. These state-led reforms could include, as allowed by law:
Followed by some stuff you can read one way or the other. "Alternative benefit plans and cost-sharing models", HSAs, employer-sponsored health insurance options, "reasonable premiums", "appropriate protections for high-risk populations", more mentions about waivers.
It goes on to then extend a deadline for states to comply with the Home and Community Based Services rule, adopted January 16 2014. Here's this wonderful bit:
Additionally we will be examining ways in which we can improve our engagement with states on the implementation of the HCBS rule, including greater state involvement in the process of assessing compliance of specific settings."
So yeah. You can probably say a shitstorm is coming. They're going to basically just turn responsibility for Medicaid over to the states with HHS in an oversight role to make sure they meet "the right standards", and are promising to fast track waivers and exceptions on a case by case basis. Eager to work with states on that front, in fact. They're encouraging states to adopt common practices in the insurance industry to structure benefits of said Medicaid program, including charging premiums.
They're turning a federally funded program into a state handled affair and telling them to make money while doing it. They're promising the states a field day with Medicaid, on whom the cost and implementation of all this falls, and who apparently can just get a waiver from HHS if they can't meet compliance for one reason or another.
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