The Cystic Fibrosis Foundation opposes any policy that prevents access to a critical source of health care coverage, such as Medicaid. Proposals that create barriers to Medicaid eligibility could lead to interruptions and delays in treatments and care for people with cystic fibrosis.
What Is the New Policy?
In 2017, the Trump administration issued a memo encouraging states to submit waiver proposals to pursue new Medicaid policies. The proposals -- including work requirements, lockout periods, lifetime limits on coverage, and premium payments -- could create barriers to Medicaid eligibility and access to critical coverage for people with CF.
Generally, the work requirements make Medicaid recipients verify their participation in community engagement or employment activities. Although many people who rely on Medicaid work, some people with CF may be unable to work because of the amount of time they need to spend on treatments and other activities to maintain or improve their health.
Many of the proposed work requirements include potential exemptions; however, the exemption requirements and application process are often unclear. People who qualify for an exemption may not understand how to apply or have the expertise to submit an exemption application, putting them at risk of being denied Medicaid coverage.
Some of the waiver proposals require Medicaid members to make a monthly premium payment. In some cases, people who do not pay the mandatory premiums within a certain grace period or do not renew Medicaid eligibility on time are subjected to coverage lockout periods. Some of the proposals limit the length of time an individual can receive Medicaid coverage by implementing lifetime limits.
Why Does the Foundation Oppose the Policy?
In addition to the administrative burden on individuals with CF, these proposals would create additional administrative complexity and costs for states as they will have to devote more of their staff and resources to verify and document compliance and exemptions with these policies. For instance, Kentucky, Tennessee, and Virginia have estimated that adding a work mandate will cost tens of millions of dollars. These types of administrative costs will divert resources from the intent of the Medicaid program -- providing access to care to the state's most vulnerable citizens.
Medicaid is a vital resource for approximately one-third of adults with CF in the U.S. Without comprehensive health insurance, people with CF are more likely to have interruptions and delays in treatment and care, which can have serious short-term and long-term impacts on overall health. Any loss or gap in coverage may put people with CF at risk of declining health.
Implementing a coverage limit or lockout period for people with a life-threatening condition, like CF, because they were unable to satisfy work requirements, obtain an exemption, or meet premium payments, is excessively punitive. It also prioritizes spending cuts to Medicaid over people's health and well-being. Although we applaud state efforts to expand Medicaid, we oppose tying expansion policies to work requirements.
The Foundation is closely monitoring the implementation of these waivers and engaging with state policymakers to help ensure that people with CF who rely on Medicaid have access to the care and treatments they need. To stay informed about our advocacy work and to get involved, text “FIGHTCF” to 52886, or sign up online for the Foundation's Advocacy Alerts.