The CMS rolled out new tools on Thursday to help states get approval to make changes to Medicaid such as implementing work requirements.
The CMS Administrator Seema Verma defended the administration's push to get more states to pursue 1115 demonstration waivers even as the agency faces criticism over coverage losses due to work rules.
"The Medicaid program was designed to serve our most vulnerable populations like children and people with disabilities, so it's logical that the nature of demonstration projects would change given the unprecedented expansion of Medical eligibility to childless, working-age adults that occurred under Obamacare," wrote the CMS Administrator Seema Verma in a Thursday.
The new tools include templates to implement and monitor changes and guidance on how to evaluate the demonstration.
Each tool is intended to help a state comply with federal requirements to submit quarterly and annual monitoring data to the CMS. To get a waiver, states must also tell the CMS how they are going to evaluate the demonstration and collect the data.
For example, the tools can help a state determine how to test whether a work rule led to increased or sustained employment for impacted beneficiaries. Work rules require certain beneficiaries to work a certain number of hours a month, volunteer, or attend school or job training in order to remain on Medicaid.
"It provides examples of data sources, research methods, and analytic approaches that can be used to effectively evaluate this question," Verma wrote in the CMS blog.
The CMS also lets a state get a waiver for changes to Medicaid such as eliminating retrospective Medicaid eligibility.
So far the CMS approved work requirement waivers for seven states: New Hampshire, Michigan, Kentucky, Indiana, Arkansas, Arizona and Wisconsin. Of those sevens states only Arkansas, Indiana and New Hampshire has implemented the programs.
"We support states having the ability to pursue different approaches to meet similar goals or administer common policies," Verma wrote. "Arkansas is implementing community engagement differently than New Hampshire, which has a different approach than Indiana."
But the CMS has faced numerous questions over its implementation of work requirements.
A February report in the Los Angeles Times none of the states that were approved for a work requirement have a plan to track whether the enrollees got a job or improved their health—key requirements under the waiver program.
So far in Arkansas more than 18,000 people have dropped from Medicaid coverage since the work rule went into effect last year.
HHS Secretary Alex Azar told the House Energy & Commerce Committee's health subcommittee on Tuesday that the agency doesn't know why the people lost coverage but it is collecting data on the losses.
But Rep. Joseph Kennedy (D-Mass.) shot back at Azar that the president's budget proposal released on Monday calls for all states to adopt mandatory Medicaid work rules.
"You just said you are not sure why people are losing [coverage] yet you have now said you want to want to extend it to every single state," he said. "What is the logic in that?"