Statement of ACAP CEO Margaret A. Murray on CMS Healthy Adult Opportunity Demonstration


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WASHINGTON—ACAP CEO Margaret A. Murray released the following statement today in response to the Healthy Adult Opportunity, new guidance released by the Centers for Medicare and Medicaid Services that would allow states to receive capped funds for Medicaid expansion populations.

“ACAP has long advocated for Medicaid modernization, so long as it adheres to certain key principles—that it covers all Medicaid enrollees equitably and provide state budget writers with certainty. Some Medicaid innovations are faithful to these principles. The Healthy Adult Opportunity initiative is not.

“Despite the initiative’s structural shortcomings, we must acknowledge that CMS has done more here than merely rebrand block-grant proposals of years past; some components of this program represent genuine steps forward for Medicaid, including an option to offer continuous eligibility for enrollees for up to 12 months.

“We applaud the requirement that states taking up this waiver opportunity measure the quality of care delivered through the adult core quality measure set – given the fact that Medicaid represents one sixth of all health care spending, it’s imperative that policymakers and others understand that enrollees are getting the accessible, high-quality care they deserve.

“But nothing about either policy mandates that it be tied to this program’s structural flaw—its spending caps. Since any state that exceeds its capped Federal allotment will have to cover the excess costs from state taxpayer revenues, HAO will inject more uncertainty into state budgets. This uncertainty would leave people vulnerable to significant cuts in the event of a natural disaster, high-cost medical innovations, or an unanticipated event such as the recent outbreak of coronavirus.

“What’s more, this initiative allows states to walk away from actuarial soundness provisions, which assure that states pay health plans enough so they can cover all mandated services. We’ve seen what happens when actuarial soundness is given short shrift, and it’s a story that doesn’t end well for anyone—health plans, enrollees, or states.

“ACAP remains open to innovative approaches to modernize Medicaid and welcomes some of the steps CMS takes with the Healthy Opportunity Program. But incentives to strengthen the safety net need not be paired with mechanisms to cut holes in it.”

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About ACAP
ACAP represents 67 Safety Net Health Plans, which provide health coverage to more than 20 million people in 28 states. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly-sponsored health programs. For more information, visit