Oklahoma has filed two applications to be relieved of many of its Medicaid obligations under federal law. Oklahoma has applied -- two times -- for authority to provide its own version of ensuring health coverage to low-income people using federal taxpayer money in large part and as it sees fit. It is fair to say that the Oklahoma applications are Dickensian at best. On the other hand, Oklahoma's applications would not bring back either poorhouses or debtor's prisons. Certainly not yet.
The deadline for leaving Comments is the close of business tomorrow, Saturday, June 27, 2020. Bizarrely, Comments are not being accepted on regulations.gov like I had a reason to expect, but on the website for Medicaid.gov. To get to the button for "Submit" Comments, I had to Google the name of the particular "demonstration" (i.e., application for a waiver of Medicaid laws) which I identify in my Comment, reproduced below. Before I could "Submit," no less, I had to prove that "I am not a robot" about 6 times before I could "Validate" my Submission. It takes a lot of determination to be heard sometimes and in some places depending on who is in charge, it seems. Persevere. I did.
Here is my Comment on Oklahoma's first application for authority not to comply with Medicaid as it is presently written. Feel free to use it or any part of it, or to paraphrase it in any way, but please leave your Comments. Stand your ground against abuses of the poor.
If you do not help in this effort, who will?
COMMENTS TO OKLAHOMA SOONER CARE MEDICAID WAIVER APPLICATION.06.26.20.
Re: Oklahoma Sooner Care - PCMH and ITU Amendment Demonstration.
Submitted on Medicaid.gov portal on website Friday, 06.26.20.
Before an "experimental, pilot, or demonstration" project can be approved for a Medicaid Act waiver, the agency must first identify the objectives of the Medicaid program. Many of the program's significant objectives are identified, for example, in § 18D:2, The purpose of Medicaid, by Dennis J. Wall in Catastrophe Claims (Thomson Reuters West 2020).
The Medicaid program is authorized by Title XIX of the Social Security Act for the purpose of ensuring health coverage to low-income people. That is still its purpose today. See 42 U.S.C.A. § 1396-1, “Appropriations” (purpose of appropriations for Medicare program is to enable each State “to furnish [1] medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services, and [2] rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care”) (emphasis added).
It was enacted into law in 1965 at the same time as Medicare.
Like many other social programs —Medicare, SSI, and the Children's Health Insurance Program—Medicaid was tacked on to the Social Security Act. The reason is fairly clear. All these programs were and continue to be viewed as social insurance programs and not privately offered insurance policies.
Within parameters established by the federal government, the States administer Medicaid. This explains why there is a variation in Medicaid disbursements from state to state.
However, the Oklahoma SoonerCare "demonstration" is not a demonstration or a waiver of the Medicaid Act. It is a request for approval to disobey the Medicaid Act. The Act was established by Congress to provide funding to assist States to implement the purposes of Medicaid. The Oklahoma SoonerCare application would substitute Congressionally required federal funding, as necessary, to meet medical needs with a block grant to Oklahoma and, once the block grant of federal funds ran out, then there would be no more funding of medical needs of Medicaid patients in Oklahoma.
To say again, this is not an authorized demonstration or waiver of the Medicaid Act requirements. The Oklahoma SoonerCare request is instead a request to disregard those requirements completely by putting a cap on federal funding instead of meeting the purpose of the Medicaid Act to support State funding of medical services.
Further, consideration must be given to whether and to what extent the SoonerCare "demonstration" would help provide health coverage for Medicaid beneficiaries. Consideration must also be given to describing how it would promote coverage. Failure to do any of this voids any approval of the application as arbitrary and capricious.
Federal law and regulations are a kind of wrapper around the Medicaid program, holding it together in essential respects, while State laws and regulations are authorized to change some of the insides of the program, as it were, by changing various coverages of services, requirements for eligibility, and for reimbursement of Medicare vendors-providers. See 42 U.S.C.A. §§ 1396, 1396a. However, State laws and regulations are not authorized to change the program entirely, as the SoonerCare application would do if approved.
Thank you for your consideration.
Dennis Wall
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