CQC Urges Governors to Prioritize Consumer Care When Considering Waivers

Health care advocates provide a waiver checklist for states to achieve the best outcome for their residents

WASHINGTON – As the nation’s governors descend on Washington, D.C. for the National Governors Association (NGA) Winter Meeting, Consumers for Quality Care (CQC) today issued an open letter urging them to keep consumers top-of-mind when considering state waivers.

In the letter, CQC points out that many states are considering harmful Section 1332 State Innovation and Section 1115 Medicaid waiver requests that, despite CMS claims they “give states additional flexibility to design and improve their programs,” actually pose a serious threat to quality health care by weakening access and decreasing coverage for many Americans.

In an effort to ensure states keep the focus on consumer care when navigating the waiver process, CQC, an organization led by health care advocates and former policy makers, created a checklist for state officials to consider as they craft waiver requests.

Some of the checklist’s consumer-focused considerations include:

Would this waiver preserve quality care by offering adequate provider networks, emergency care and essential health benefits?

Would this waiver put patients at the center by ensuring benefits for special populations, providing adequate exemptions for those with chronic conditions and engaging health care advocates in providing input on the waiver’s provisions?

Would this waiver cut costs to consumers by preventing cost shifts or cost increases and capping Medicaid out-of-pocket costs?

Would this waiver preserve access by ensuring no barriers to coverage, an accessible network of doctors and options for prescription drugs?

Would this waiver ensure transparency so that the public understands its potential implications – both to their health care and their state’s fiscal health?

“The answers to these questions are critical,” the CQC board wrote. “Higher costs, cuts in coverage and reduced access to quality care will harm consumers in every state, across the country.”

The checklist also highlights a number of ways already implemented waivers are harming consumers across the country, including through cuts to transportation benefits, increased out-of-pocket costs, restricted access to medications and unreasonable barriers to coverage.

“We know that every state’s top priority is preserving quality health care for their constituents. As such, we urge you review and consider our waiver checklist when submitting your waiver requests. The risks to consumer health care quality and access are high when waivers are not implemented with consumers at their core,” the letter reads.

CQC is led by a board of directors that includes the Honorable Donna Christensen, physician and former Member of Congress; Jim Manley, former senior advisor to Senators Harry Reid and Edward Kennedy; Scott Mulhauser, visiting fellow at Georgetown University and former Chief of Staff at the U.S. Embassy in Beijing to Ambassador Max Baucus; and Jason Resendez, Executive Director of the LatinosAgainstAlzheimer’s Network and Coalition.

The full checklist can be accessed at www.consumers4qualitycare.org/statewaiverchecklist