CMS Releases Long-Awaited Block Grant Guidance

On Thursday, Jan. 30, the Centers for Medicare and Medicaid Services (CMS) released the Healthy Adult Opportunity initiative. In exchange for accepting a cap on federal funding, states would have more leeway to decide which benefits to cover, and would get a streamlined process to add work requirements, add premiums and cost-sharing, and eliminate retroactive coverage or hospital presumptive eligibility. 

Under the guidance, a state that receives a waiver from CMS could adjust benefits for the limited population, or “align benefits more closely to what is available through a commercial insurance benefit package.” The state would then be required to maintain spending on health services at a “level at least 80% of the target amount,” and to the extent, the state achieves savings and demonstrates no declines in access or quality, CMS will “share back a portion of the federal savings for reinvestment in Medicaid.”