The Senate’s two top Republican proponents for individual market exchange stabilization measures are in talks with CMS Administrator Seema Verma about making 1332 state innovation waivers easier to obtain.

Early insurance rate filings from Maryland and Virginia have shown huge premiums spikes, leading Republicans and Democrats on Capitol Hill to question which party is to blame for the hikes months before midterm elections. Sen. Lamar Alexander (R-Tenn.) said he and Verma are discussing speeding up the waiver application process, although he conceded that most of the measures he and Sen. Susan Collins (R-Maine) proposed to keep rates in check for next year would need to be enacted by Congress.

. . .

The CMS on Monday gave New Hampshire the green light to impose work rules for some adult Medicaid recipients. It’s the fourth state to win approval for that requirement.

The state’s Medicaid 1115 waiver will require adult beneficiaries between the ages of 19 and 64 to participate in 100 hours of “community engagement activities” a month to maintain eligibility for coverage. Community engagement is defined as having a job, being enrolled in school, participating in job skills training, or performing some sort of community service.

. . .

The Trump administration announced Monday that it is rejecting Kansas’s request to impose lifetime limits on Medicaid benefits, drawing a line against a new level of conservative changes to the program.

The administration has already approved work requirements in Medicaid, a controversial move in itself, but Monday’s decision indicates that time limits on Medicaid coverage go too far for the Trump administration.

. . .

President Trump is sending a plan to Congress that calls for stripping more than $15 billion in previously approved spending, with the hope that it will temper conservative angst over ballooning budget deficits.

Almost half of the proposed cuts would come from two accounts within the Children’s Health Insurance Program (CHIP) that White House officials said expired last year or are not expected to be drawn upon. An additional $800 million in cuts would come from money created by the Affordable Care Act in 2010 to test innovative payment and service delivery models.

. . .

This fall’s midterm election ballot just got a little longer in Utah. In mid-April, progressive activists announced that they’d gathered enough signatures to force a November referendum on Medicaid expansion.

Utah isn’t the only red state flirting with extending free government health insurance to able-bodied, childless adults. Within weeks, activists in Idaho will surpass the number of signatures required for their own ballot referendum. Groups in Nebraska just launched a signature-gathering campaign, too.

If voters choose to expand Medicaid, they’ll surely regret it.

. . .

House lawmakers quickly voted to continue New Hampshire’s expanded Medicaid program Thursday, spending almost no time debating one of the session’s biggest policy issues.

The current program uses Medicaid funds to purchase private health plans for about 50,000 low-income residents, but it will expire this year if lawmakers don’t reauthorize it. The bill approved Thursday would continue the program for five years but change its structure to a more cost-effective managed care model. The plan also would impose new work requirements on enrollees and use 5 percent of liquor revenues to cover the state’s cost as federal funding decreases.

. . .

Supporters of Medicaid expansion sued Maine on Monday to force state officials to implement the voter-approved law that has been held up by Gov. Paul LePage, who has stalled it for months while imploring the Legislature to first fund it on his terms.

In doing so, they put Attorney General Janet Mills on the hot seat, with a lawyer saying the suit will end quickly if the Democratic gubernatorial candidate and frequent foe of the Republican governor agrees with them because she controls the state’s legal representation.

. . .

Idaho is poised to allow a vote on Medicaid expansion after an activist group said it has collected enough signatures to put it on the November ballot.

Reclaim Idaho said it has collected the required 56,192 signatures needed to place the measure on the ballot. The deadline to turn in the signatures is Monday.

. . .

This year could mark a significant shift for Medicaid programs across the country, as some states look to expand the government insurance program to more poor Americans while others seek to add more requirements for people who benefit.

Initiatives to get Medicaid expansion put on the November ballot are underway in Utah, Nebraska, Idaho and Montana. And Virginia lawmakers appear on the verge of securing an expansion deal, after years of rejecting the idea.

. . .

Arizona has asked the CMS to allow it to end retroactive coverage for Medicaid beneficiaries.

If granted, the waiver request now under review at the CMS, would nix providers’ ability to bill for services provided in the three months before a beneficiary applies for Medicaid coverage, assuming the patient was eligible during that time.

Providers in the state had urged the state not to submit the waiver to the CMS because it could put hospitals in a difficult financial situation and limit access to care.

. . .