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Bipartisan Policy Center Governors’ Council Releases Recommendations to Reform Medicaid Waiver Process

Thursday, March 1, 2012

Washington, D.C. – The Bipartisan Policy Center’s (BPC) Governors’ Council today released a series of recommendations to improve the Medicaid waiver process. Formally launched in early 2011, BPC’s Governors’ Council includes former Governors Phil Bredesen (D-TN), Jim Douglas (R-VT), Brad Henry (D-OK), Linda Lingle (R-HI), Mike Rounds (R-SD), and Ted Strickland (D-OH). Click here to read the full report, entitled, Reforming Medicaid Waivers: The Governors’ Council Perspective on Federalism Today.

“We believe the Medicaid waiver process can and should be improved. Common sense reforms will benefit leaders at all levels of government, and it has become clear that states need more flexibility to meet their coverage and benefit goals,” said Governor Jim Douglas. “We must continue to ensure that the Medicaid program is effective and sustainable in the future, and reforming the Medicaid waiver process is a step in that direction.”

The former state executives believe that the Medicaid waiver process must allow states to test new strategies that could improve care and lower costs for taxpayers. As current state leaders struggle with budget deficits and reduced revenues, the need for additional flexibility in the Medicaid program is great.

The report offers five recommendations for the administration to consider:

  • CMS should establish and circulate a detailed and transparent process for state-federal budget neutrality negotiations and waiver evaluations. CMS should ensure that all relevant parties are engaged at the beginning of the waiver approval process, since multiple layers of approvals create an inefficient and duplicative process for states.
  • Establish a mechanism for converting successful waivers into permanent or semi-permanent state innovations in the Medicaid program. Frequent waiver renewals are a burden on high performing state programs and an inefficient use of scarce state and federal resources.
  • Develop State Plan Amendment templates for effective Medicaid strategies. CMS should equip states with tools to implement targeted program changes and to encourage the efficient dissemination of common sense reforms and best practices.
  • CMS should design waiver templates that address time-sensitive and pertinent Medicaid challenges, supporting state efforts to quickly and effectively respond to changes in the marketplace attributable to provisions in the Affordable Care Act. CMS should standardize certain components of the waiver application process to provide states direction and reduce uncertainty as they look for creative and innovative ways to manage forthcoming changes in the Medicaid program. This will enable states to focus efforts on common challenges, such as addressing health care reform and dual eligibles, and promoting new payment methods and innovative care delivery models.
  • HHS should make guidance and assistance provided to state leaders by the Medicaid State Technical Assistance Teams transparent and public on Medicaid.gov. Many states are dealing with similar issues, and state leaders would benefit from timely access to information that supports planning and decision making at the state level.

“The federal government and the states both have an interest in identifying reforms that will improve health care quality, reduce costs, and promote innovation,” said Governor Phil Bredesen. “Our recommendations for improving the current waiver process will not only allow states to innovate but also foster a more effective state-federal partnership.” In the coming months, BPC’s Governors’ Council will continue to look at other policy areas for opportunities to improve the state-federal relationship. For more information on BPC’s Governors’ Council, please visit www.bipartisanpolicy.org.


Ashley Clark
(202) 637-1456


2012-03-01 00:00:00