This afternoon, Don Berwick, the head of the Centers for Medicare and Medicaid Services (CMS), responded to Arizona Governor’s Jan Brewer’s (R) request to exempt 280,000 residents from the Medicaid rolls in order to balance the state budget. Under the Affordable Care Act, states that change their Medicaid eligibility rules also forgo federal funding for the program. The provision has placed many governors in a tough fiscal conundrum and has led some to seek leeway in the law.
Appearing at Family USA’s annual Health Action Conference, Berwick hinted that the agency would deny Brewer’s waiver request. He pledged to work with the states to help them meet their requirement, but urged governors like Brewer to take a longer view of reform:
BERWICK: I’m fully aware of the stress and distress that states are feeling…..What we can commit to is process –- which is we will be in dialogue. We will talk with the states, we will be talking with the governors. We are already in constant contact with them, we’re going to see state by state, community by community, the best kinds of solutions we possibly have, all the while protecting the beneficiary. […] We are here to protect the beneficiaries and to help the states do that.
I’ll say the real answer here has got to be a little longer run than what the states are thinking right now. If I were a governor of a state, I’d think short term also. But you know, we’ve got to work our way out of it. The Medicaid problem, the state problem in health care is the health are problem. It’s just more vivid because of the way state budgets are run. But it’s true for the whole system. A sustainable health care system for our country is a different health care system.
Thirty-three Republican governors have asked the federal government for a waiver to cut back on their existing Medicaid program without losing federal funding, and Arizona has previously jumped through some fairly small legislative hoops to avoid giving up this revenue stream. In March, the Arizona legislature eliminated funding for KidsCare, the state’s CHIP program, only to reestablish it months later in order to avoid losing billions of dollars in federal matching funds.
Last night, the White House announced that it was re-nominating Berwick, who was recess appointed last year after sparking controversy with Republicans.