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    Trump nominates new leader for CMS

    President-elect Trump has announced he will nominate Seema Verma, MPH, a consultant with extensive work in Medicaid in several states, to lead the Centers for Medicare and Medicaid Services (CMS).

    The head of the consulting firm SVC Incorporated, Indianapolis, Indiana, Verma was called by the Trump team the architect of Indiana’s Medicaid expansion, Healthy Indiana Plan (HIP), under the governors Mitch Daniels (R) and Mike Pence (R).

    The SVC website says Verma has worked on Medicaid, insurance, and public health with governors’ offices, state Medicaid agencies, health departments, and departments of insurance. She and her firm, says the site, among other things developed Medicaid reform programs including waivers for Iowa, Ohio, and Kentucky, and helped in Tennessee’s coverage expansion proposal and Michigan’s Section 1115 Medicaid waiver.

    Verma is best known for the Healthy Indiana Plan, approved by the CMS in 2015, and its requirement that participants must contribute a small amount. If participants above the poverty line begin paying the fee but then stop, they can be disqualified for 6 months. In a July 2016 report, the Lewin Group, Falls Church, Virginia, found that of the Indiana residents who could be disqualified, 16% always worried about affording their payment and 29% worried usually or sometimes. 

    After meeting with Verma, Senate Finance Committee Chairman Orrin Hatch (R-Utah) stated middle-class families have struggled to find affordable care under Obamacare, making its repeal and replacement a top priority, and Verma will play a significant role.

    It’s unusual for a CMS head to have Medicaid but not Medicare experience, says Joan Alker, director of the Georgetown University Center for Children and Families, Washington, DC.

    Alker says she is concerned about the vision within Verma’s Medicaid work in several states. Proposals involved more barriers to coverage, such as work requirements, requirements to pay, or disenrollment for missing a deadline for renewal. The Obama administration stopped some of those plans, says Alker.

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    In Indiana the provisions impacted adults, but, says Alker, “We do know that as parents are covered, children are more likely to be covered.” The bigger issue, she says, are potential threats to children’s coverage, including the proposed repeal of the Affordable Care Act; the fact that the Children’s Health Insurance Program (CHIP) needs to be re-funded by Congress next year; and potential significant cuts to Medicaid.

    In the meantime, on December 15 the Medicaid and CHIP Payment and Access Commission (MACPAC), a congressional advisory panel, called for 5 more years of CHIP funding as soon as possible, both to continue the coverage of children under it and to mitigate states’ budget uncertainty.


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